Black Man in a White Coat (40 page)

Other medical writers, while supportive of the core feature of expanding health insurance coverage, have voiced skepticism about certain aspects of the Affordable Care Act. See for example, Darshak Sanghavi, “Bringing Down the House,”
Slate,
June 23, 2009, and Darshak Sanghavi, “Grand Illusion,”
Slate,
January 20, 2010. In both articles, Sanghavi articulates his doubts that an individual insurance mandate will be effective in extending affordable health care coverage to the uninsured. See also Jerome Groopman, “Health Care: Who Knows ‘Best'?”
New York Review of Books
, February 11, 2010, and Jerome Groopman and Pamela Hartzband, “Sorting Fact from Fiction on Health Care,”
Wall Street Journal,
August 31, 2009. Groopman raises concerns about whether the health care law's early emphasis on expert-based guidelines and “best practices” might interfere with doctor-patient health care decision making.

One side has taken a race-focused approach:
For articles on cultural competency, see Joseph Betancourt, Cultural Competence—Marginal or Mainstream Movement,
New England Journal of Medicine
2004; 351:953–955, and Sunil Kripalani et al., A Prescription for Cultural Competence in Medical Education,
Journal of General Internal Medicine
2006; 21:1116–1120. For a related paper that focuses on physician workforce aspects, see Fitzhugh Mullan et al., The Social Mission of Medical Education: Ranking the Schools,
Annals of Internal Medicine
2010; 152:804–811. This article ranks the quality of schools based on the percentages of graduates who practice primary care, work in underserved health areas, and who are underrepresented minorities.

The other method is more race-neutral:
For writings that take a more race-neutral approach to improving the health of black patients, see Jonathan Glick and Sally Satel,
The Health Disparities Myth: Diagnosing the Treatment Gap
(Washington, D.C.: American Enterprise Institute for Public Policy Research, 2006), and David Mechanic, Policy Changes in Addressing Racial Disparities and Improving Population Health,
Health Affairs
2005; 24:335–338. Mechanic asserts: “it is important to think carefully about interventions and not assume that initiatives directed at reducing such disparities bring the largest gains in advancing the health of black citizens. Increasingly, much of the policy discussion is focused on whether disparities are increasing or decreasing and less so on which interventions can bring the largest health gains for all.” Finally, see Darshak Sanghavi, “Color Bind: How to Fix Racial Disparities in Medical Care,”
Slate
, August 14, 2009. Sanghavi offers evidence to assert that “universal quality-improvement plans coupled with publicly reported measures are the best way to cut health disparities,” and that “these kinds of race- and class-blind interventions are arguably the
only
ones proven to reduce disparities on a meaningful scale.”

On the individual level:
For an interesting take on the patient's perspective, see Sherrie Kaplan and Sheldon Greenfield, The Patient's Role in Reducing Disparities,
Annals of Internal Medicine
2004; 141:222–223. The authors argue against doctor-patient race matching and cultural competence training as panaceas to remedy disparities, asserting that “focusing solely on physicians and the clinical setting is meeting only half the challenge.” They propose formal “patient training programs” that teach minority patients to “make the most of those brief office visits” with physicians.

Ongoing public and private efforts to encourage healthier lifestyles:
The most well-known recent campaign in this realm has been Michelle Obama's Let's Move! initiative. It launched in 2010 with the ambitious goal of solving the problem of childhood obesity within a generation. The program organizes its work around five pillars: giving kids a healthy start in life; empowering parents and caregivers to make healthy choices for kids; improving school food; ensuring access to healthy food; and promoting physical activity. It is not surprising that this campaign has been criticized by the political right, which has raised concerns about excessive government interference. But it also has critics on the left, who argue that it doesn't go far enough to address the role of income inequality in obesity and other health-related disparities.

there are clear signs of progress:
For data on reductions in teen pregnancy, see National Vital Statistics Report,
Births: Final Data for 2010
61, no. 1 (August 2012). For data highlighting a lower infant mortality rate among blacks and an increased life expectancy, see National Vital Statistics Report.
Deaths: Final Data for 2010
61, no. 4 (May 2013). For information on the reduction in violent crime among black people since the mid-1990s, see Erika Harrell, “Black Victims of Violent Crime,” Bureau of Justice Statistics, August 2007.

 

Selected Bibliography

B
OOKS
ON
M
EDICAL
P
RACTICE
AND
T
RAINING

Ansell, David.
County
. Chicago: Academy Chicago Publishers, 2011.

Austin, Paul.
Something for the Pain
. New York: W.W. Norton, 2008.

Black, Keith.
Brain Surgeon.
New York: Wellness Central, 2009.

Brawley, Otis.
How We Do Harm
. New York: St. Martin's Press, 2011.

Carson, Ben.
Gifted Hands
. Grand Rapids: Zondervan, 1990.

______
.
The Big Picture
. Grand Rapids: Zondervan, 1999.

Chen, Pauline.
Final Exam
. New York: Knopf, 2007.

Cook, Robin.
The Year of the Intern
. New York: Harcourt, 1972.

Davis, Sampson.
Living and Dying in Brick City
. New York: Spiegel & Grau, 2013.

Emanuel, Ezekiel.
Reinventing American Health Care
. New York: Public Affairs, 2014.

Gawande, Atul.
Complications
. New York: Henry Holt and Company, 2002.

______
.
Better.
New York: Henry Holt and Company, 2007.

______
.
Being Mortal.
New York: Henry Holt and Company, 2014.

Groopman, Jerome.
The Measure of our Days.
New York: Viking Penguin, 1997.

Jauhar, Sandeep.
Intern
. New York: Farrar, Strauss, and Giroux, 2008.

______
.
Doctored.
New York: Farrar, Strauss, and Giroux, 2014.

Klass, Perri.
A Not Entirely Benign Procedure
. New York: Putnam, 1987.

Konner, Melvin.
Becoming a Doctor
. New York: Viking Adult, 1987.

Lerner, Barron.
The Good Doctor
. Boston: Beacon Press, 2014.

Marion, Robert.
Intern Blues
. New York: William Morrow and Company, 1989.

______
.
Learning to Play God
. New York: Addison-Wesley, 1991.

Mukherjee, Siddhartha.
The Emperor of All Maladies
. New York: Scribner, 2010.

Mullan, Fitzhugh.
White Coat, Clenched Fist
. New York, Macmillan, 1976.

Nuland, Sherwin.
How We Die
. New York: Knopf, 1994.

Ofri, Danielle.
Singular Intimacies
. Boston: Beacon Press, 2003.

______
.
Incidental Findings
. Boston: Beacon Press, 2005.

______
.
What Doctors Feel
. Boston: Beacon Press, 2013.

Reilly, Brendan.
One Doctor
. New York: Atria Books, 2013.

Rothman, Ellen.
White Coat
. New York: William Morrow and Company, 1999.

Shem, Samuel.
House of God
. New York: Richard Marek Publishers, 1978.

Shilts, Randy
. And the Band Played On
. New York: St. Martin's Press, 1987.

Sweet, Victoria.
God's Hotel
. New York: Riverhead, 2012.

Verghese, Abraham.
My Own Country
. New York: Simon & Schuster, 1994.

Vertosick, Frank.
When the Air Hits Your Brain
. New York: W. W. Norton, 1996.

White, Augustus.
Seeing Patients
. Cambridge: Harvard University Press, 2011.

B
OOKS
ON
R
ACIAL
AND
C
LASS
T
HEMES

Carter, Stephen L.
Reflections of an Affirmative Action Baby
. New York: Basic Books, 1991.

Cashin, Sheryll.
The Failures of Integration
. New York: Public Affairs, 2004.

______
.
Place, Not Race
. Boston: Beacon Press, 2014.

Cosby, Bill, and Alvin Poussaint.
Come On People
. Nashville, Thomas Nelson, 2007.

Cose, Ellis.
The Rage of a Privileged Class
. New York: Harper Collins, 1993.

Gasman, Marybeth.
The Morehouse Mystique
. Baltimore: Johns Hopkins University Press, 2012.

Gates, Henry Louis, Jr.
Colored People
. New York: Knopf, 1994.

Golden, Daniel.
The Price of Admissions
. New York: Crown, 2006.

Graham, Lawrence Otis.
Member of the Club
. New York: Harper Collins, 1995.

Hoberman, John.
Black and Blue
. Berkley: University of California Press, 2012.

Hrabowski, Freeman, et al.
Beating the Odds.
New York: Oxford University Press, 1998.

Jones, James H.
Bad Blood.
New York: Free Press, 1981.

Kahlenberg, Richard.
The Remedy
. New York: Basic Books, 1996.

______
, ed.
Affirmative Action for the Rich.
New York: The Century Foundation, 2010.

Kennedy, Randall.
Sellout
. New York: Pantheon, 2008.

______
.
The Persistence of the Color Line
. New York: Pantheon, 2011.

McWhorter, John.
Losing the Race
. New York: Free Press, 2000.

______
.
Winning the Race
. New York: Gotham Books, 2005.

Moore, Wes.
The Other Wes Moore
. New York: Spiegel & Grau, 2010.

Robinson, Eugene.
Disintegration
. New York: Doubleday, 2010.

Sander, Richard, and Stuart Taylor Jr.
Mismatch
. New York: Basic Books, 2012.

Satel, Sally.
PC, MD: How Political Correctness is Corrupting Medicine
. New York: Basic Books, 2000.

______
.
The Health Disparities Myth
. Washington, D.C.: American Enterprise Institute, 2006.

Skloot, Rebecca.
The Immortal Life of Henrietta Lacks
. New York: Crown, 2010.

Steele, Shelby.
The Content of our Character
. New York: St. Martin's Press, 1990.

______
.
A Dream Deferred
. New York: Harper Collins, 1998.

Suskind, Ron.
A Hope in the Unseen
. New York: Broadway Books, 1998.

Washington, Harriet.
Medical Apartheid
. New York: Anchor Books, 2007.

West, Cornel.
Race Matters
. Boston: Beacon Press, 1993.

Wideman, John Edgar.
Brothers and Keepers
. New York: Holt, Rinehart and Winston, 1984.

Williams, Juan.
Enough
. New York: Crown, 2006.

 

Acknowledgments

It's hard for me to believe that I've actually written a book, and I'd feel like a cheat if I left taking all of the credit. The first round of thanks goes to all of the patients and patient family members who have allowed me into their lives. I am a better person for having gotten to know each of you, however briefly, and I can only hope that I've returned some small part of this goodwill back into your lives.

On the writing front, Rebecca Gradinger has been all one can ask for in a literary agent. When she offered to represent me, I knew that I was in good hands. The same is true for my editor, Anna deVries, whose diligent efforts shaped this book into something much grander than I initially envisioned.

Several people were immensely helpful at the early stages of the writing process, including Tom Linden, Doris Iarovici, Peder Zane, Peggy Payne, and Paul Austin. Jane Harrigan deserves special mention in this regard; without her, I seriously doubt I would have ever gotten an agent or book contract. Longtime friends Christine Wilder, Kevin Woodson, and Jattu Senesie all provided valuable insights and edits.

My supervisors and colleagues at Duke University Medical Center and the Durham VA Medical Center have been wonderful in supporting my professional life as a psychiatrist. There are too many of you to name individually, but you know who you are. Special mention must go out to H. Keith Brodie, Dan Blazer II, Jean Spaulding, and Brenda Armstrong—all Duke mainstays—for their advice, encouragement, and support throughout my work on this book.

I'd be remiss without thanking the authors whose books on medicine and race I've cited in the bibliography. Each of you, in your own way, has been an inspiration for my efforts.

Finally, I have to end by giving thanks to my family. I'm a loner by nature and don't make friends easily, so you all have really been my foundation. Mom and Dad, I'll never be able to express how grateful I feel to have been born into your home. To my brother, Bryan, the example you've set as student, husband, and father is one that all young black men should have. And to Kerrie, my wife, you and our two boys are what make every day worth living.