This memoir focuses on the various ways in which his being an African American affected Tweedy’s medical education and early practice as a medical resident and later in psychiatry. Raised in the relative safety and privilege of an intact family, he found himself underprepared for some of the blatant forms of personal prejudice and institutional racism he encountered in his first years of medical education at Duke Medical School.  One shocking moment he recounts in some detail occurred when a professor, seeing him seated in the lecture hall, assumed he’d come to fix the lights.  Other distressing learning moments occur in his work at a clinic serving the rural poor, mostly black patients, where he comes to a new, heightened awareness of the socioeconomic forces that entrap them and how their lives and health are circumscribed and often shortened by those forces.  Well into his early years of practice he notices, with more and more awareness of social contexts and political forces, how the color line continues to make a difference in professional life, though in subtler ways.  The narrative recounts clearly and judiciously the moments of recognition and decision that have shaped his subsequent medical career.    


One of the ways in which this particular story of institutional racism, a problem familiar to many readers by now, is conspicuously effective is in the intelligent reflectiveness Tweedy brings to the subject.  He gives full weight to his own sharp experiences of anger and frustration in white-dominated educational and professional environments, and also to moments of satisfaction, connection, and obstacles overcome or dissolved.  He offers a way for readers to recognize racism in medicine and medical education—even in the ways susceptibilities linked to particular racial groups are reported, for instance—while also recognizing the social ambiguities, the shifts in policies and procedures, and in professional discourse that have made inroads through the thicket of bias and culpable ignorance that still stands as a barrier to integration with integrity.  In its way it is a “coming of age” story, though it begins with the first year of medical school.  It offers a very contemporary, astute, edgy and compassionate look at a dimension of professional life in medicine that remains, for all the increased public attention devoted to racism in other spheres, underreported and insufficiently addressed.  An important read for anyone involved in health care.



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