EP. 145: A DOCTOR’S REFLECTIONS ON RACE AND MEDICINE

WITH DAMON TWEEDY

Feb 25

WITH DAMON TWEEDY, MD

A psychiatrist and noted author shares his personal experiences as a black doctor in America and explores the search for authenticity in a system that often demands conformity.

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Episode Summary

Medicine is often framed as a meritocracy, where intelligence, hard work, and dedication dictate success. Yet, institutions of medicine are shaped by histories of exclusion, bias, and systemic inequities. And for clinicians coming from marginalized backgrounds, the journey is not just about learning the science. It's also about learning an entirely different set of rules — rules that are unspoken and unwritten, but deeply felt.

For Damon Tweedy, MD, this struggle was deeply personal. Raised in a working class, all-black neighborhood, medicine once felt worlds away. Earning a spot at Duke Medical School was a milestone, but it came with new challenges. The paradox of being both visible and invisible; of constantly proving — sometimes subtly, sometimes forcefully — that he belonged. Dr. Tweedy talks about the paradox of striving to be “twice as good,” while still being mistaken for the janitor, turning down an invitation to play golf with faculty because he simply did not know the game, and realizing that for some of his classmates, medicine was not a leap into the unknown, but simply an inheritance.

Beyond race, this episode is also about identity, resilience, and what happens when personal history collides with professional expectation. It's about how trust in medicine is built or broken not just for doctors, but for patients. Dr. Tweedy shares how his own experiences have shaped the way he interacts with patients, why he approaches conversations with more humility, and why sometimes the most important thing a doctor can do is simply acknowledge the weight that a patient carries into the exam room. Ultimately, this episode is about the search for authenticity in a system that often demands conformity.

Damon Tweedy, MD s a professor of psychiatry at Duke University School of Medicine, where he teaches and mentors medical students. He is also a staff psychiatrist within the Durham Veteran Affairs Health System, where he co-leads an integrated primary care-mental health team. He graduated from Duke School of Medicine, and then attended Yale Law School where he focused on health policy and medical ethics, before returning to Duke to complete his medical internship and psychiatric residency.
Dr. Tweedy is the author of several essays and articles that explore the intersections of race, medicine, and mental health. His first book, Black Man in a White Coat: A Doctor's Reflections on Race and Medicine, made the New York Times bestseller list and was selected by TIME Magazine as a top non-fiction book that year. It was described as “a smart, thought-provoking, frontline look at race and medicine” and “essential reading in our time of racial unrest.” His writing has been featured in publications including the New York Times, Washington Post, Chicago Tribune, and Discover Magazine. He also served as non-fiction editor of the Bellevue Literary Review. His second book, Facing the Unseen: The Struggle to Center Mental Health in Medicine was an Amazon Best Nonfiction Book of April 2024 and was selected by Nature as one of the five best science books of 2024.
In this episode, you will hear about:
• 3:24 - Dr. Tweedy’s path to medicine and his experience as a black first-generation college student
• 14:08 - How Dr. Tweedy navigates experiences of being discriminated against as a black physician
• 24:58 - Dr. Tweedy’s approach to navigating discriminatory experiences between patients and trainees
• 29:56 - Dr. Tweedy’s path to becoming a public voice regarding race and medicine
• 32:07 - The current approach to teaching race and medicine in medical school, and Dr. Tweedy’s thoughts on how it can be improved.
• 43:42 - Effectively serving patients of different racial backgrounds without falling into profiling or prejudice
• 48:49 - Dr. Tweedy’s advice for new medical students
Henry Bair: [00:00:01] Hi. I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and healthcare executives. Those who have collected a career's worth of hard earned wisdom, probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging, and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] Medicine is often framed as a meritocracy, where intelligence, hard work, and dedication dictate success. But we also know that institutions of medicine are shaped by histories of exclusion, bias, and systemic inequities. And for clinicians coming from marginalized backgrounds, the journey is not just about learning the science. It's also about learning an entirely different set of rules rules that are unspoken and unwritten, but deeply felt. For Doctor Damon Tweedy, this struggle was deeply personal. Raised in a working class, all black neighborhood. Medicine once felt worlds away. Earning a spot at Duke Medical School was a milestone, but it came with new challenges. The paradox of being both visible and invisible, of constantly proving, sometimes subtly, sometimes forcefully, that he belonged. We discussed the quiet ways the exclusion Manifests not in overt hostility but in the raised eyebrows. The off hand comments the moments of misrecognition that tell you in ways large and small, that you are an outsider. Doctor Tweedie talks about the paradox of striving to be twice as good, while still being mistaken for the janitor, about turning down an invitation to play golf with faculty because he simply did not know the game. And about realizing that for some of his classmates, medicine was not a leap into the unknown, but simply an inheritance beyond race. This episode is also about identity, resilience, and what happens when personal history collides with professional expectation. It's about how trust in medicine is built or broken not just for doctors, but for patients. Doctor Tweedie shares how his own experiences have shaped the way he interacts with patients, why he listens differently. Why he Why he approaches conversations with more humility, and why sometimes the most important thing a doctor can do is simply acknowledge the weight that a patient carries into the exam room. And ultimately, this episode is about the search for authenticity in a system that often demands conformity. Damon, it's an honor to have you here. And thank you so much for joining us.
Dr. Damon Tweedy: [00:03:21] Yeah. Thanks, man. This is a pleasure. Looking forward to the conversation.
Henry Bair: [00:03:24] To start us off, we always like to ask what drew you to medicine in the first place? And of course, we would love for you to share more about the environment in which you grew up and how that has subsequently informed your path.
Dr. Damon Tweedy: [00:03:38] Oh gosh, great question. I would say certainly wasn't like that. Had family members in medicine or any sort of particular like mentor or anyone who early on that sort of set me on that path, kind of looking back, pretty unlikely to become a doctor if you think about sort of my origin story. I grew up in the suburban kind of outside of the DC metropolitan area, Washington, DC, working class, blue collar community, all black. Uh, literally 100% neighborhood black. First generation college. My older brother was kind of the trendsetter in my family in that way. And he kind of normalized the idea that going to college was a goal. That's something that you could obtain in a in a really direct way. And so that was really important to have that in my own sort of family. And my parents certainly wanted us to sort of achieve that. My parents grew up in the in the South in segregation, you know, and so there's a lot of history that kind of goes with that, you know. But they wanted sort of that, you know, one generation builds on the next kind of thing. And so, uh. I would say the first time it began to be even the remote possibility. But in middle school, I got tested into a magnet program, and the program was mostly students who were pretty much all white and Asian, pretty much. And being being in that environment was totally different than what I was accustomed to. And of course, there were challenges at first. But as I began to thrive in that world, it began to be something so realistic that I could go to college, be a Stem major. And then as I got into college, I actually got a first year after my first year of college, went to University of Maryland, and I was in the lab research lab in NIH, and I met with a black physician mentor who was a cardiologist.
Dr. Damon Tweedy: [00:05:16] He trained at Johns Hopkins, and he allowed me to sort of meet current medical students. And it was like, was this interesting? And it kind of just began to normalize, because if you had asked me as a 12 or 13 or 14 year old, could I become a doctor? It would've been inconceivable. Like, you know, no one I'd seen or known was kind of, you know, other than the doctor I'd go to. But that was a person who was in a very fancy world, and I couldn't have imagined myself being someone in that space. And so it was only kind of through these sort of series of events started in high school, but then really into college that I began to think about. This is something that I could do and that it would be important to do because, you know, there are a lot of people in my family, particularly, who had all sorts of health problems. You learn about the health disparities, you know, in med school, but, you know, I lived it. My family, you know, people with diabetes and cancer and high blood pressure and premature. And it was something that, you know, I was like, maybe I can combine this interest and aptitude in science and to something that would be more practical and kind of help those around me. So that was sort of how it all kind of came together. So, so nothing out of the ordinary from the average sort of medical school applicant. Yeah.
Tyler Johnson: [00:06:16] Yeah. Right. Let me actually ask you. So I am not a first generation college student. I think that my my family was relatively recent to this kind of thing. My grandparents did not go to college and had no plans for their kids to go to college. But even so, even just with a mother and father who had both gone to college, it wasn't until well after I was in college and doing quite a bit of reading and sort of thinking that I recognized that for people who have no background and no sort of, you know, it's not just kind of in the water in their families. I have heard it described as being like, there is a code, right? Like you show up on campus and you realize that there are certain assumptions and certain ways of doing things that other people seem to just understand by rote that are not as obvious. If you haven't come from that background as if you have. Did you get any of that feeling when you went to college, and then later when you went to medical school? And can you talk a little bit about what that was like?
Dr. Damon Tweedy: [00:07:19] So I got a lot of that in medical school. College. So when I was in high school, I was in this magnet program, and this is early 1990s, and there was a local school called University of Maryland, Baltimore County, and they were actually early in their existence, establishing a program that was geared towards getting underrepresented minorities, particularly African American people, into science, science careers, particularly like engineering and and research and medicine. So it was geared towards that. And that was my college experience. And so because I had that experience, I was in this kind of unusual environment where I was being really nurtured to have these sorts of experiences. Right. And so, like, this is what you need to do to go to medical school or to go to get a PhD and whatever, you know, to go to an engineering program. And so it was really we had this wonderful program of high achieving African American students to sort of help you sort of deal with some of the challenges that you might face. So the things you just described really have to be in medical school. So I got to medical school, I went to Duke for medical school. And I remember that first week of medical school, you know, meeting all these my colleagues again, I have a very blue collar family. Many of my friends in college also came from blue collar families, kind of first generation college students. And you get to Duke and it was like, whoa, these these people are like, they're driving fancy cars and they're and their dad is the head of this department at the hospital or head of this department at the undergraduate campus, or is, you know, an attorney at this particular law, you know, all this sort of fancy upper middle class kind of stuff.
Dr. Damon Tweedy: [00:08:49] And they had gone to like Europe and, you know, all these sort of places. I'd never been anywhere outside of the little region I grew up in. And so it was a very different experience. Right. And so that's where people were having these sort of conversations about things that I didn't really grasp, you know. And so some people get that experience in college. So I got that really more in medical school. My college experience was much more insulated people. So very similar backgrounds to myself who were sort of working towards this kind of goal. But yeah, and just to give you an example of a story, I never played golf, golf or tennis, by the way, and I just remember, you know, those are country club sports. At least that's the perception. And I just remember two things. So one time the tennis story is kind of a little bit funny. The golf story maybe not as funny, but the tennis story. I was with my classmates one day. We were on the court and I and I'm standing on the line like, you know, those who know tennis, there's like a service line and there's like a baseline, you know, and the ball you got to serve within that box. And so I'm standing right there and my classmate is like, no, if you stand right there, the ball is going to hit you really hard and you're going to get hurt. I was stubborn and didn't listen to him.
Dr. Damon Tweedy: [00:09:48] And he hit the ball and he hit me really hard. And so like, okay, this is what this is the things I didn't learn. And then as far as golf, faculty members, um, basically invite students to go play golf, you know, for some sort of this is like the informal curriculum in medical school, right? And I'd never played golf, and I thought I'd make a fool of myself. I turned down that request. What was interesting was how that then, sort of like I was then perceived as being aloof or, you know, not with the program because I didn't know that that world like, how do you navigate going to a golf course and, you know, and all that. And I just didn't know anything about it. And so that was really interesting. Like welcome to the fancy world moment, as the third thing was a classmate who had a family member who was on faculty invited me one day to the the faculty Club and the faculty club there. You know, it's a fancy place, right? And I went there and I was the. And this is something that you kind of I've gotten used to over the years, but everyone there was white except for me. And except for the people who were like the sort of service staff. And that was a really kind of eye opening experience of like, okay, you know, there's this world and there's these two different worlds, and I'm being part of these two different worlds, and I'm trying to straddle these two different spaces. So those are the three things that really kind of stuck out as unique.
Tyler Johnson: [00:10:57] And you know, we talk a lot with people on the podcast about, for lack of a better word, sort of their interior life. Like really what is going on inside of you as the things outside of you are also happening. Right? And I know that you have spoken and talked and and written and whatever a lot about this. So anybody who has been any amount of the way through the medical training journey knows that it is just consuming, right? I mean, it is just everything that you can do, even if, you know, your life has kind of been teed up in such a way that it, you know, you've been sort of prepped to do this your whole life. It feels like, I think, for some people. But even then it is enormously difficult just to learn all of the stuff that you need to learn. Right, just to just to get all of the things that you need to memorize and then the skills that you need to acquire and all the rest. And so I guess all of that is to say, can you walk us through what is it like when at the same time that you're trying to do all of the normal, really hard stuff that's involved in doing your medical training, when you're also trying to grapple with the fact that you are existing, as you put it, as sort of a bridge to these two different worlds, or at least are perceived to be a bridge between these two very different worlds and also trying to sort of grapple with, as we were talking about before, sort of learning the code that is required to become, you know, sort of fluent in moving through the kind of the politics and the social circles and the kind of you mentioned the unwritten curriculum, like, what is it like to try to grapple with all of that stuff at the same time that you're just also trying to, you know, learn the cranial nerves and whatever else?
Dr. Damon Tweedy: [00:12:36] Exactly. Yeah. So med school is its own language, right? It's so, you know, learning the language of medicine is hard for everyone. The challenges that you face, the challenges of being an intern, all that stuff is unique. Some of the things are sort of very, you know, across the board. They're hard, they're challenging. So I would never sort of make it out to be that. I'm sort of like, you know, someone should feel sorry for me. I know it's hard for all of us, but what's interesting, though, of course, as you say, is that my experience has been that in addition to that, there's always this idea that I'm different in some way. So what you're getting at is that there's sort of this kind of experience that all of us sort of experience, right? This kind of collective struggle, if you will, to go on this medical journey which we all face. And it's a times when there's a solidarity in that. Like, you know, you're just like, we're all in this together, right?
Tyler Johnson: [00:13:20] Comrades in arms. Almost.
Dr. Damon Tweedy: [00:13:21] Yeah, exactly. So it's all it's there. So there's something to that, right? But my own experience has been that in addition to that, there's there's always this idea that even if I wanted to just be like everyone else, which often I did, people would tell me or circumstances would tell me that I was different. And then I had to find ways to navigate that difference. So we all have had gone through Go to internship, the 3 a.m. call to go down to the ER. Right? We've all had that experience, but of course, for me the added dilemma was I go down to that 3 a.m. call and I'm told that this person doesn't want to see an inward doctor. And so it's like, well, how do you navigate the idea? Okay, I'm up 3 a.m. there's that. But then there's this extra thing to add on to it. That's the kind of thing that's always been this sort of challenge, right? It's like, as much as I want to be like everyone else, there are people telling me that I'm different and I have to figure out a way to sort of navigate that space.
Tyler Johnson: [00:14:08] And if I can ask, what has navigating that space looked like for you? Like how how do you figure that out?
Dr. Damon Tweedy: [00:14:17] It varies. You know, there's a range of things that go through your interior life when the experiences happen. So you might feel shame, embarrassment, shock, anger. You could just imagine all sorts of emotions depending upon the situation. A lot of those things all sound kind of negative, right? Of course. And there's been a lot of challenges that I've had to sort of figure out. So I just gave the experience of the 3 a.m. call to the hospital where the patient doesn't want to see an inward doctor. Right. And that's the patient that I have to admit to my team. Yeah. And what do you do with that? Go in there and it's like, man. Then the patient's family had sort of a Confederate flag shirt. And, you know, it's like, what in the world have I walked myself into? And how the hell am I going to get myself out of it? Right. That was experience that was really, really powerful. So, like, how do you how do you deal with that? Right. I'm going to give you an example of kind of what sort of thing would give me the strength to get through that. Two things actually. Because as a first year medical student, I had a similar kind of experience of like, you know, again, first year med school, you know, it's tough.
Dr. Damon Tweedy: [00:15:11] It's hard. Everyone's sort of learning all these new terminology. Um, at least most of us are. And one day, this professor, he comes up to me at the entrance and confronts me. And he's like, you know, why are you here? Are you here to fix these lights in the classroom? And it was just like, no, but there's like, all these emotions kind of come through in a moment because, like, well, why did he single me out among all the people in the classroom? Why me? You don't want it want it to be that just because your skin is darker, you're black. That can't be the reason, right? Why is he doing this? Uh, and then he sort of escalated and got really sort of frustrated. You know, I called someone last week. Why didn't you? Why haven't you fixed this already? He's really agitated. I said no, that's not why I'm here. And then he's like, well, why are you here? I'm a student in your class. And there was just this, like, really awkward silence. And so in that moment, again, I'm a med student. First year, I want to be like everyone else. But I've been told pretty clearly that maybe I'm not. So what do you do with that situation? All sorts of emotions run through.
Dr. Damon Tweedy: [00:16:12] You're upset. I'm angry. But I know that I'm a big, tall black guy, and maybe showing anger in that setting is not going to turn out the right way. So I have to figure out a way not to show that. That's one of the mental gymnastics you have to kind of deal with. And at least I had to deal with at the time. But I have to prove to myself and this guy that I belong here, right? He can't just tell me I don't belong here. So that's the thing. When we talk about, like, imposter syndrome, like, do you really belong here? Well, I really feel like I like I had to show myself first and then everyone else. I did belong here, and so I really just kind of just buckled down in the way that I never buckled down before. Ended up getting one of the highest grades in the class. And then the way it worked back then was that you would meet with the professor after the class. And I just remember that encounter with him where he was really awkward and he never acknowledged what happened, but it feels like he clearly knew what had taken place. And so he's really just sort of like, you know, awkward.
Dr. Damon Tweedy: [00:17:01] And, um, at first he was kind of in disbelief that he saw, like, the score I had on the exam was actually me. He did this weird sort of thing where he looked at my ID badge and the name on the paper. It was really bizarre. So at the end of day, I kind of showed him like, I, I sort of stuck it to him. I proved that I belonged right and in his own way. And so his gratification in that way. But there's also this sense of like, man, is this how it has to be? And is it always going to be this way? Because I am different, because people think I'm different and I have to figure out how to work with that. And so one way to work with that is to sort of push through and be twice as good and that sort of thing that people say another way is to find support from people who've had similar experiences. And also thirdly, to find support from people who can kind of say, even if they don't look the same as you, they understand that there's a struggle and they want to help you along the way. So I think those are all the things that I sort of drew upon to sort of move forward.
Tyler Johnson: [00:17:48] You know, I just have to say, in passing, as we're addressing this, that I still remember, because that anecdote you just told is in your book, I believe.
Dr. Damon Tweedy: [00:17:57] It's in the first chapter.
Tyler Johnson: [00:17:58] Yeah. And I still remember the first time that I read that anecdote. I just remember the first year of medical school being so scared to death, honestly, that I was going to fail out, right? And that everybody was going to figure out that, you know, everyone was actually a lot smarter than I was, and that I never should have been let in in the first place and whatever. But I still remember the first time I read that story, you know, you have, I think some of those moments in life where you kind of recognize for the first time, or at least, you know, reminded in a way that you never have been before just how different it is to live behind somebody else's eyeballs than it is to live behind yours. Right. And that sort of a experience of having, in effect, your sort of identity and credentials questioned on a just sort of a snap judgment, kind of immediately and viscerally that they maybe weren't, you know, you were sort of mentioning that it's like they weren't aware of it until they became aware that it was so embarrassing that then they couldn't even talk about it. Like, I just had never had something like that happen to me. Right. I just remember that being a really sort of galvanizing moment for me to try to recognize as a relatively tall white guy, how different it is to move through the world for people who don't look like me.
Dr. Damon Tweedy: [00:19:21] Yeah. So there's certainly, again, I guess, you know, I appreciate you saying that, but I also want to say that there's two things I just want to kind of clear up. One is that, you know, I'm not demeaning people who do blue collar work, because that's my family. My dad worked as a blue collar person. He worked in a grocery store. Honorable. Great work. The problem in our society is this idea that people can only do one thing or another, and we're slotting people. We're in some ways just trying to boxing people in. And this is all you can do. And this is the only reason you should be here. And you don't belong in our other world. And so that was sort of the message that I, that I got from that. And then that was the sort of the struggle that I faced at that moment. And again, there's other examples as well. And I think the lesson you just said about walking in other people's shoes is also just so important for us as doctors, right? When we think about the patients that we see and the challenge that they face, I think it's I think those lessons that I've experienced personally help me in my own sort of clinical experience, as well as I approach patients.
Henry Bair: [00:20:17] Can you elaborate? You know, you said that your personal experience is, even as a trainee, have now shaped how you how you approach patient care. Are there any examples that really illustrate the concrete ways that you interact with people, whether it's colleagues or patients, are actually materially different as a result of the experiences with differential treatment that you've experienced.
Dr. Damon Tweedy: [00:20:40] I'll say a couple things, you know. So again, coming from a very blue collar, working class African-American background, one of the, you know, obviously realities of a lot of academic medicine is a lot of places. Those are the kind of settings where people receive care. Like a lot of these, a lot of these, you know, well-known, highly regarded academic medical centers are in these places of, you know, a lot of black people, often lower socioeconomic status. There's this tension between the often between the sort of more well-off elite institution and the sort of surrounding community that's a sort of a tried and true kind of narrative. So a lot of times, a lot of these patients, I would see it would begin to be these two different worlds. And so in some ways, it's a challenge to feel like, well, I have a foot in each of these worlds because I know a lot of what these patients are experiencing from my own background and my family's background, but I'm also part of this other medical world. So there's been challenges with that, but it's also been an asset. Oftentimes I'll see patients and I can really kind of have that sort of instant kind of kind of connection like, oh, this guy reminds my uncle.
Dr. Damon Tweedy: [00:21:30] He's just like my uncle. He's just like my cousin in a very real, concrete, tangible way. You know, a lot of the things that we talk about, we might call things that disproportionately impact the black community, are things that often were things that happened in my own family. And I can really kind of relate to it in that sort of personal kind of way. I also think that being on the receiving end of a lot of sort of snap judgments among people, often not flattering, often negative, really makes me attuned to how we as doctors can do that to patients, because I've been on the receiving end that so many times as a citizen, as a person, so I can know what it's like to go into a room and to be judged in a way that's often less than flattering, right? It can range from being physically like, perceived as a threat, being perceived as being incompetent or not capable of whatever it is I'm supposed to do. And so I know those spaces really well. So I know what it's like for patients to sort of enter into those boxes and be perceived that way, because I've experienced it myself as a person.
Henry Bair: [00:22:22] So what do you do, though? I mean, you bring up that must be a challenging situations where you are misconstrued as being less capable because of whatever preconceived notions people have. How do you deal with that? How do you navigate that? How do you overcome that or prevent that from happening?
Dr. Damon Tweedy: [00:22:39] So you mean for me as an individual, there's two ways of looking at it, right? Because you can perceive that as a burden. It may be internalize it. When we talk about this imposter syndrome thing, this idea that maybe I'm not as good because people are telling me this or they've told me this. You can internalize that way, or you can be sort of angry and internalize it and be sort of, you know, that sort of thing and be angry at the person who's sort of at the other end of it. And that's not that I haven't done those things. I certainly have. But it's also, I think the higher level thing that I've sort of worked towards is how do you use that as an opportunity to help inform someone else, to help them see a different way to help them be better? It's easy to just sort of say, well, these people are bad, this person's this, that ignorant or whatever racist. But it's also, I think, more helpful if you can sort of kind of go to that next level. Some people are those things, but everyone's not. Some people just don't know what they don't know. And you have to sort of think about trying to put yourself in their shoes and what has been their perspective, what has been their experience? Racism doesn't harm, certainly harms black people and other minorities, but it also harms. It harms everyone in its own way. You know, so that's how I've sort of come to look at it. And it's helped me think about as an opportunity to sort of help people see things differently. And it's also practically allowed me to feel like I have more control over situations, because if I can just allow an interaction to sort of like discombobulate me emotionally, in some ways that person has kind of won.
Dr. Damon Tweedy: [00:23:58] And so I feel like it's incumbent upon me to to be able to sort of have control over my own sort of narrative in a way, and to not allow someone to sort of take that from me, because then I've empowered them in a way in which I don't think that they necessarily should be empowered. And I use it as an opportunity. And so if I have a, you know, if I have a trainee who's like and even with trainees and faculty, I try to impart some of that, I don't want to call it wisdom impart that some of that experience to to the trainees, you know, um, This person you're seeing in this space. They may be very different than the than than what you're familiar with, with your with your experiences, life experience is familiar with. But you're also seeing that person in a time where they're really, you know, there's distress. Medical illness is incredibly stressful and distressing, and people respond to it in different ways. And maybe you've seen that illness a hundred times, but this may be the only time this person is experiencing that. And how do you sort of honor that? So I know, I know, I'm seeing a lot of things, but I think all those things kind of come to play when I engage with people who may perceive me in a negative way, but also how I want people to engage with patients.
Tyler Johnson: [00:24:58] So can I ask two sort of related questions, a sort of internal facing one and then an external facing one. The internal facing one is that I'm really struck when I listen to you. You know, as a medical educator, I've had multiple experiences where I'm on the wards with a medical student, resident, fellow, whatever. And usually this doesn't come to me because as I already said, I'm a white guy and pretty tall. And, you know, it's just this is not the particular problem that I usually deal with. But I have had trainees who have been confronted with racism or sexism or whatever, and even just sort of being in the room and hearing, as this happens to somebody else, I have this kind of almost a visceral response to like jump in and intervene and do something and, you know, whatever. And so I guess the thing that really strikes me when I am listening to you is that you seem to have I don't know if it was always this way or if it has only come to be this way over time. But you seem to have developed a way of cultivating a little bit of distance through what I have to imagine is still some kind of visceral response and the way that you actually react. Right. Like you seem to have created a sense of grace and space within yourself that allows you to then even help trainees to think about instead of responding to racism or what have you, with a sort of a visceral, reactionary response. You are trying to think empathetically about what the person in the, you know, the patient in the bed, even though they're treating you that way, what they might be going through and what might be going on for them. How have you cultivated that kind of grace and space?
Dr. Damon Tweedy: [00:26:37] Yeah, it's it's not easy. I don't want to pretend like it is. And I also understand the challenges because I don't anyone to think that I don't understand how much more difficult it can be for a medical student or an intern who's definitely much less, you know, there's much less movement in terms of what they can do. I totally get that. So this is where I think it's really important, because people always ask me these questions like, what should that medical student do? And what should you do if you're the person who's like the faculty person? I think those are really important questions. Do you think you were kind of asking me that without asking me that I don't know.
Tyler Johnson: [00:27:04] Yeah, that is definitely a because I have had I have had medical students, on the one hand, explain to me that if I respond to proactively, it can feel kind of condescending and demeaning, like, you don't think I'm capable of of responding on my own, but I have had other people say that if I don't respond actively enough, it can feel unsupportive or isolating, like I'm just kind of leaving them hanging in the wind to deal with their own thing when they're in a position where they have very little power.
Dr. Damon Tweedy: [00:27:31] Yeah. So like one example, like I gave you this, you know, I don't know if I did it, handled it right or anything, but I was with a female medical student and it was a patient who was sort of doing this kind of like, well, nurse assistant, kind of, you know, stuff where he was really trying to limit or kind of constrain the fact that she was, you know, about to be a doctor. She might have even been a resident. So instead of saying, doctor, he was saying Mrs.. And all that sort of stuff. And I remember telling a patient in a particular case, you know, well this, this is doctor so-and-so right. So I sort of sort of clarified that and that, you know, she's not only a doctor, but she's going to be she's a great doctor and she's probably going to end up being my supervisor one day. And I just sort of just I kind of laid it out there for the person to sort of sort of. And he's like, oh, okay. And then he just sort of backed away and kind of moved on. But I did it in a way in which I was like, I wasn't like angry about it, but I just sort of said it like that. And I thought that that sort of got the message conveyed. We kind of just moved on. And so that's I think it can be helpful to speak up in a situation where you're in a position where you can do that. It doesn't always mean you have to do it in the moment, always, because there's another setting where I remember a couple of medical students and you tell me what you guys think about it, but I guess one student was was, I don't know the specific country, but he was Asian descent.
Dr. Damon Tweedy: [00:28:35] The student was of Hispanic descent. And he walked into this room. And this patient sort of kind of does say some negative things about both ethnic groups, if you will, kind of in one fell swoop. And the attending was a white physician, and they kind of left the room and the attending was like, well, I'll just see the patient, don't worry about it. And so I think the downside of that was that what they wanted was not necessarily that the student that the attending, like, castigate the patient, but at least acknowledge that, give them some space to say what was happening and how it affected them, because some people wouldn't necessarily want you to do anything, but they'd want you to at least be able to give them the choice to say, okay, I don't want you to do anything, or I'd like you to do something. If you just ignore it, then it really feels like you just kind of pretend it didn't happen. Because some people will want you to be to be more proactive, and some people will want you to kind of leave alone, but at least they have that. At least you're giving them that space to say how they'd like to sort of address that issue. I think that's really important.
Tyler Johnson: [00:29:25] Yeah, I will say that in my. I mean, obviously you have world's more expertise in this than I do, but I guess the one from my relatively small amount of experience just in helping students who confront these things. I think that you're right. That acknowledgment is pretty much universally important. Right. Like, I have never met a student who doesn't want it to be surfaced and doesn't want it to be sort of named as what it was.
Dr. Damon Tweedy: [00:29:49] And from there, how do you want to do from there? It's going to vary depending on the person. But yes, I think that's the first sort of foundational piece.
Tyler Johnson: [00:29:56] Yeah. So the second part of my two piece question was to then say, can you also talk though then a little bit about your journey? So, you know, it's one thing to face this personally in a room as a medical student or an intern or whatever. It's another thing to sort of then have a moment or a series of moments over years where you kind of kind of reconcile how you're going to deal with this as a person, you individually or as a doctor, but then you have gone multiple steps further to where you have made this. You know, this has become a large part of your life's work in terms of your writing and your speaking and your, you know, this is a thing that you have become a public voice and a public face about. How did that come about?
Dr. Damon Tweedy: [00:30:38] Yeah. You know, I really like narratives. You know, as I got in medical school, I really discovered that I enjoyed this sort of idea. How do you tell a story and encapsulate a bigger theme or issue, whether it's a policy issue, whether it's an ethical issue? But how do you tell that through the lens of a story, this doctor patient encounter? I thought that was a fascinating thing to sort of read as I was a medical student. There's several authors, of course, who've done that really well, but what struck me was how little about at least at the time, that I was experiencing it and beginning to think about writing, about race and about how how much race intruded on this in clinical encounter. You know, again, we talked about how the how the idea that so many medical hospital settings are in places where, like half the population or more is black. But there was like no discussion about what is that? What was that that tension, that dynamic, that that issue was like. And so a lot of my own early writing was like almost like a letter to one's younger self. It was like a way to sort of process or cope with what I was experiencing, to make sense of it. And then as I began to sort of write more for an audience, it was like, well, maybe this is the way in which I could help other people, because these are things that I wish that I could have read as I was encountering the field that, gee, you might experience these sorts of things, and this is one way that you might be able to handle it or deal with it. You know, and learn from it and learn from others. And so that was sort of how I began to really get into the space of writing about my experiences, particularly as a black man in medical school and in medical training. It felt like there was a sort of gap vacuum, if you will. And I was trying to sort of speak to that in some sort of way.
Henry Bair: [00:32:07] In what ways do you feel like modern medical? Because I do think that training regarding cultural competency and health disparities. Societal determinants of health are, at least on the surface, they are being taught in most medical schools as required components of the curriculum. Certainly at, you know, where I went to medical school, where Tyler works at Stanford. It's a very big part of preclinical curriculum. What do you think about current efforts implementing those ideas into the curriculum? Is it going well? Are there things you would change? Any other thoughts about that?
Dr. Damon Tweedy: [00:32:44] Well, let's just put a little bit of historical perspective on it. So like I was, you know, a medical student 25 plus years ago and those things weren't in place then. And so I just always, as I sort of joke in some ways, um, so basically in my med school curriculum, we had about one afternoon, like a two hour session devoted to any discussion about this topic. The four year curriculum. So the joke is, of course, that if you were sick that day, you just missed out. You got you just nothing. So so that's where we started. So that's like that's the kind of the, the framing of it, you know like no discussion about, you know, even now, like everyone hears about like the Tuskegee syphilis experiment and that kind of stuff. Nothing. So there's been a lot of changes, right, the last couple of decades. And as you just alluded, there's a lot of people that are sort of a lot of schools. Most schools actually have some sort of component to it. I think there's a couple ways of looking at it. You know, one way is if you have a separate course where you talk about it, there's advantages to that. But there's also disadvantages because it makes us feel as if, well, this is a separate thing to still talk about. You only talk about it in that setting. The truth is, I mean, you know, if you had an ideal world you could learn about. I know I'm not devising the curriculum, but, you know, you could talk about diabetes and heart disease. You could talk about it from the standpoint of like, the pathophysiological implications and how do we treat it and all that stuff. We also talk about, you know, some of the social and societal aspects of it and who's impacted more and why.
Dr. Damon Tweedy: [00:34:00] And you sort of more seamlessly integrated versus having like, well, there's a course where you just learn only about these things. I remember a student telling me that during one of their classes. They were wanting to talk about this issue, and they were kind of pushed aside by the professor saying, oh no, you can only talk about that in that, in that one course or that one or that one class. And I think so I think there's pros and cons to it. So I think that even having the class is still better than what I had, which is nothing. But I think if we can more seamlessly integrate these kinds of conversations into a broader discussion, I think that would be better. Because the truth of the matter is, no matter what field you go into, whatever clinical specialty you go into, these issues come up right. It's not just like, I mean, some people will say, well, you know, this is an amazing thing to me. I've heard certain Afro-American students in particular who are interested, like in kind of, you know, social justice, for lack of a better phrase, being sort of told to go into certain specialties like emergency medicine or ob gyn or, you know, family medicine, things that you may associate with the health disparities. Right. The truth is that no matter what field you go into, whether it's neurosurgery or whether it's oncology or whatever, doesn't matter when you go into these things are going to pop up. And it's really important for us to be able to seamlessly kind of integrate these into all areas of medical education.
Tyler Johnson: [00:35:06] Can I ask a question? And I recognize that this is a very hard. Maybe it's an impossible thing to answer, but I it seems like you might be the person to be able to speak to it if anybody can. So I'm going to ask you anyway. I'm just I'm struck by the way that you have been able to take what I think pretty much everybody would agree are some really, really difficult aspects of your life and particularly of going into medicine and have been able to metabolize them in this very kind of grace filled. I don't mean that as a like a theological word, but just in a way that is, you're looking to make things better, right? You're looking to look with empathy, even to the person who is saying racist things. As a patient, you're looking for ways to empower the medical students who are coming after you. You're looking for ways to educate the people who maybe haven't experienced this first hand about what this is like. And and, you know, to try to help them spend a minute walking in somebody else's shoes or whatever. Do you think that there is a way? Away. I don't even know the word to use for the ability to do that that you have done. But do you think there is a way to teach that in medical school? Like, do you think there is a way to educate people how to take the really, really difficult things of medical education and of life and to be able to metabolize them in ways similar to what you have done?
Dr. Damon Tweedy: [00:36:27] Yeah, I have all the same human emotions that everyone else has, right? I struggle when I judge people. And so I think the first step is recognizing that we all have this sort of flaws or limitations within us. All of us do. Right? So I think that's sort of how I come at it from that standpoint. Right. And that gives me a more human way of judging approaching others. But I'll say this selfishly, when I was a medical student and I wrote about this in my first book, I was dogged by health problems. So I was dogged by this high blood pressure. I went to a student health clinic and they did some blood and urine tests. There was a question about early kidney disease. So I was like this walking health disparity pitcher, picture. You know, I was that person that I was learning about in the classroom. It's like, well, what do I do with this? How am I going to make sense of this? Am I going to live this life? And I even I even looked at some studies and I found that black doctors, on average, they actually don't. You guys know there was a study that was done like a cohort study done for like a 30 year period. It compared black physicians trained at Meharry Medical College in Tennessee, all black at the time, to white physicians, white males at the time at Johns Hopkins, because that's what the Johns Hopkins was at the time. And they followed him for 30 years, and they did his cohort study, and they found that the black physicians had much worse health outcomes over time, despite the fact that sort of on a cross-sectional basis, they may both be ophthalmologists.
Dr. Damon Tweedy: [00:37:43] Right. But what was the baggage that led up to that, to becoming that? And what was the baggage you face once you were still in that field? And so I thought it was a fascinating thing. It's like, well, how can I not be one of these statistics? What can I do for myself? What kind of mental self-care can I take to sort of address this? So for a while I did the I did traditional treatments for blood pressure for years, but I also recognized I had to figure out a way a way mentally to not always let again. I mentioned earlier, if someone does something that's kind of not cool, if we might say or or seems prejudiced or whatever. And if you get so discombobulated that you're so flustered and you're angry and you know all this stuff that has a physiological toll, and there's so many times I would go into these situations in a room and I would be defensive. I'd be like, well, what? This person doesn't think I belong here. And I think that impacted me from a health standpoint because what I later as I, as I was thinking about learning some mind body techniques and things of that sort, I started to see like tangible benefit to my own physical health and my blood pressure for the last, you know, I don't know, 15, 20 years has been completely normal. Those early lab results that I have, they're abnormal.
Dr. Damon Tweedy: [00:38:46] They've been normalized for well over a decade, almost two decades now. And I think that mind body thing is powerful. And so I recognize that there is something to be said for this idea of like, sense of control. Like the worst thing you can have is you feel like you have no control over anything. Right? And that's like the most stressful kind of thing that people can experience. And the more that you can sort of feel like you have can have control even within a world that's not you can't have control of everything. But even if you can find some sense of control within that larger world, it can really do wonders for you. So there's a selfish reason why I do it. I just want to make sure I play that out there, and it really helped. I think people can think about that, you know, like, can you allow someone to discombobulate you or can you exert the control over your own mental well-being? And because now I can look at that person who maybe is racist and I can think, well, that sucks for them because, you know, that's you got a screwed up life. If you can see someone and have such negativity and hostility towards someone by the way they look, that's something that's on you. That's a you problem. And it's not necessarily my problem. And so and the more that I've sort of embraced that mentality, the more it's helped me deal with things, if that makes sense. That's really helped me a lot personally.
Tyler Johnson: [00:39:47] Yeah. And I want to be clear, I'm not trying to, you know, make you out to be a saint. That's not my.
Dr. Damon Tweedy: [00:39:53] Hell. No.
Tyler Johnson: [00:39:54] But but I do think that there is. You know, sometimes I think we have this idea that, like, I don't know, quote unquote good people are just kind of vaguely, in some undefinable way, they're just quote unquote good. But I think that there are concrete skills here. Right? So what I'm hoping to be able to have you articulate is I think that, to be clear, I have no idea what it is like to be on the receiving end of racism. And I understand that. And there are many people who don't. And I don't understand what it's like to be on the receiving end of sexism or many other isms. But two things are true. One is that many people do have a visceral, firsthand understanding of that, and there are skills to be used there. And also, as you mentioned earlier, everybody does face difficult things for any of a number of reasons. And I think that some of the skills that you're articulating are skills that are important in life generally. Right. How to take the difficult stuff that life dishes out to you, whatever it is, and be able to metabolize it into something that then redounds to the good of yourself, as you said, and of other people. I think that's a really powerful idea.
Dr. Damon Tweedy: [00:41:00] Yeah. And sometimes, you know, you can't just do it all in the moment. So this is where you need to have outlets, right? There's all sorts of constructive outlets that people can take. So writing is one for me, right? Writing has been one thing. Physical activity exercise. Of course. We also know that there's things that people do that are maybe less healthy for them, that maybe help them sort of in the moment, or whether it's substances and these sorts of things. And so I think it's also learning about those things, like, what are the things that can help me sort of address something in a moment and get through it and then reflect on it and then kind of move forward. I think those are the things that have really helped me. The other thing I'll say is, speaking particularly as a black person, I think understanding history has really been a valuable thing for me. Understanding. So like when I experienced these things at Duke that I described in my book, I was able to talk with people who had come through Duke earlier, a generation earlier or more and really hear their experiences. So it's like being open. I think stories are really powerful. I think hearing their stories helped me frame my own experiences in a better way better way.
Dr. Damon Tweedy: [00:41:57] Because yes, there were things that I was experiencing that were tough. No, no doubt, but it was also there were other people who had experienced worse. And in some ways my experience was sort of part of that larger, you know, struggle journey. And so just as they had worked hard to help open doors, for me, it was I felt like it was sort of my obligation, if you will, to sort of then sort of, you know, try and make things better for the next. Who would come after me? Let's just think about history and like, think about Duke. So I enter Duke in 96. It integrated in 1963, which again seems like a long time ago. But my parents were are still living. That means that when they were my age, when I entered Duke, they could not have gone to Duke. They could not have been anywhere on campus unless they were in a service capacity. That would have been my parents story. I mean, my grandmother was my grandmother was that sort of person. She worked as a, you know, as a housekeeper. So I know that history and I know that, you know, I was building upon that history.
Dr. Damon Tweedy: [00:42:52] So here I am in this space. Yes, it's hard, but I know that my parents had it worse. And I think it's also important not just for me as a black person, but I think the history is also important. I'm also part of a project. Understanding the history of what segregation was like for black patients is also really important for all doctors to know, because it helps you understand when a patient comes into that emergency room and they have this perspective that you don't, it doesn't. It seems alien to your own experience. It's like being open. So I think the big lesson is, and how I've helped myself get through a lot of the challenges, is curiosity, right? There's a certain humility like, I'm not the judge jury, executioner for anything. But it's also humility to understand, to be willing to ask questions, to be able to understand that there's other perspectives, to understand that I have baggage and that that baggage impacts me. And so if I have baggage, other people have baggage too. And how do we then sort of find the best way to help people. And so that's sort of my guiding principles.
Henry Bair: [00:43:42] So I want to turn a lot of these ideas that we're talking about in, in concrete terms. So I'm a medical trainee. I see lots of patients and I'm an ophthalmology. And to your point about how these ideas about racial disparities and prejudice crop up in every specialty. I do deal with it. I come across it. I don't always have to engage with it, but I have the opportunity to engage with it on a daily basis. Just to take examples, glaucoma, at least statistically, there is a difference in the risk factor for glaucoma. Same thing with diabetes.
Dr. Damon Tweedy: [00:44:15] Yeah. My my dad has glaucoma. My mom has diabetes. So yes, this all feels very real to.
Henry Bair: [00:44:19] Me, right to the point where it's actually baked into some of our recommendations. We recommend that if you are of African descent over the age of 40, you should get screened for everyone else. It's a little older than that, and I understand, like statistically that makes sense. But also it can be a little bit tricky to convey that to patients, right? Because I don't want to make patients feel uncomfortable, that they have higher risk because of certain backgrounds that they have no control over. Similarly, you know, there's that issue that you brought up earlier about trust in institutions. And because of the history I. I recognize that there are very valid reasons why minorities might not have as much trust in the institutions. You know, one of the things when I think about, again, a disease like glaucoma or diabetic retinopathy is these diseases can cause a lot of damage to the eyes. And the patient will would not have known about it. It's us telling them that they have these diseases, and they just have to trust us that we see something. And they based on that trust, they have to agree to a whole host of procedures or medications we might be putting on them for life. That's a lot to ask of someone, anyone, but particularly of groups that you know, have, again, like I said, historical reasons for having less trust. So as I navigate those things, you know, differential risk factors based on race or having to think about different histories of different patient groups, I acknowledge that. But at the same time, if I treat anyone differently because of that, isn't that a form of profiling as well? I don't want to bring those sorts of, I guess, yeah, profiling or Profiling or prejudices into any sort of patient encounter, if it might not apply to the patient. How would you recommend that? I balance those things? On one hand, acknowledging that there may be things that apply to these patients, minority patients that don't apply to anyone else, but on the other hand, not, you know, sort of falling into the trap of profiling and prejudice.
Dr. Damon Tweedy: [00:46:12] Yeah. So I think part of that is like, how do you get that patient in front of you to believe that you kind of get them or understand them, right? And so in some sort of way. And so sometimes if you in a situation where it seems like you're counting distrust or hesitancy or whatever you want to call it, I often ask the person, like, my sense is that there's something they hear that maybe is making you feel a little bit uncomfortable in some sort of way. Asking that question opens them up to say all sorts of things. They might say something about me particularly. You're sort of taking a risk in a way, but it's also an opportunity to be able to sort of understand. So like a lot of times you hear this story about like a patient with diabetes and wanting the person to start insulin and it's like, well, well then what is it about that that maybe he's making you feel a little bit uncomfortable, right? Or making you feel like this is not the right way to go. And then the person can tell all sorts of stories. And so I've had a couple different times where a person has told me that, well, every time someone in their family starts insulin, they end up having kidney disease and they die.
Dr. Damon Tweedy: [00:47:04] That's their narrative, right? That's their story. It doesn't mean that that's the actual medical, but that's their story. It's important for us to understand that so we can know how to approach what might help them get back to the point where we, you know, where they might be willing to take this insulin that they need, or maybe that they feel like, well, this thing happened to my mom. My mom came to this place and got mistreated in some way. Give the person that little bit of space to say that and then acknowledging that is really valuable because like you just said that, you know, you know, that we have this history of mistrust or this history of bad things that have happened in the medical community. The patient may not know that. You know that the patient may see you and see something totally different. They may see you as a representative of that history. Just allowing yourself that space, that patient, that space to say that thing often can just go so far. Is this idea. Like, you can know what the patient basically needs from a medical standpoint, often pretty quickly once you have a lot of experience. But the biggest task is not knowing that. It's like, how do I get the patient on board in a way that's that we can sort of collaborate together.
Dr. Damon Tweedy: [00:48:01] And that's the challenge. So sometimes it might be in that first five minute visit or whatever it is, you may not get the intervention that you want. Let's say an outpatient setting where it's not like a life and death sort of thing. You may not get the intervention that you think is medically indicated. Your main task may be to get that person to come back for that second visit, where you can actually do that. And so that's a different way of thinking about, you know, the medical agenda versus the agenda of how do you connect with this person as a human and give them a space to sort of share whatever that thing is? I'm not saying you can you can't always do that because the life or death, you can't always do that. But there's a lot of times in medicine where we can do that sort of thing. But if we have to sort of get out of our mindset that we have to get our medical agenda at the cost of all else, because if we have a medical agenda and the patient doesn't buy it or doesn't go along with it, then it's not going to really accomplish very much. If the patient doesn't go along with the with the treatment that you're recommending.
Tyler Johnson: [00:48:49] So I think in wrapping up, I want to ask you a version of the question that we we usually ask people to finish up. You kind of mentioned earlier that you have now with many years of experience as a doctor and as a faculty member and as a person who teaches those who are coming up through the ranks. You have thought a lot and written a lot about what your experience was as you were coming up through the ranks, but also thought a lot about sort of given what you know now, how you might have approached things then as you were coming up. And so I guess if there are people listening who are especially those who are still relatively young in their medical training, so to speak, or haven't even yet begun their medical training, and you were to give some thoughts on what you think is especially important for them to remember, or especially important for them to do as they come up through through the ranks. What would you say?
Dr. Damon Tweedy: [00:49:38] Gosh, it's a lot. I'd say, you know, one is, you know, medical training is really dehumanizing. It can be it can be really, really, really tough. You know, in all sorts of sorts of ways. I think community is really important. So I have a second year group of second year medical students cohort every year. And it's like Intro to Medicine. That's the clinical year at Duke. And I always tell them, well, what are you doing between now and when we meet again? That's outside of this medical sphere that we that we inhabit that's going to help sustain you or enhance your life. Because a lot of times what happens is people sort of get in this goal driven path, which we all do. You know, once I get to this point, I get to residency, I get the fellowship, and I get to this point, and then I'm going to be happy if I get to this place. But your life, you're living that life at every step along the way, and you have to be able to engage in activities that will fulfill you in some sort of way at every step of the way. So I think that's something that I always want trainees to understand. The other thing I want them to understand is that whatever experience, whatever rotation they're experiencing in the moment is just one slice of what that rotation, what that specialty actually is in reality.
Dr. Damon Tweedy: [00:50:40] And so, like, for instance, I'm a psychiatrist. I absolutely hated my psychiatry rotation in medical school. And so one of my missions has been to expose students to a different way of seeing psychiatry from the one I had. And so these are the things that I try to impart upon students. You know, how do you sustain yourself outside of the medical sphere? And also, how do you try and see the specialty that you're in in a broader way? And so some of that is incumbent upon us as medical educators to help them do that. The other thing I would the other thing I think is really important as a doctor, but this as a person, but also particularly as a doctor, is this idea of like, you know, medical training is so cross-sectional. It's so like in the moment, you see this person in the emergency department and they're in this particular place. And I think there's a sense of like how you condition yourself to see people only in that kind of stage of crisis or distress, and versus recognizing that this person is potentially on a journey with their illness, with their life.
Dr. Damon Tweedy: [00:51:36] And what you're seeing is one snippet of that. It may be the worst. It may be the most stressful, the most worst moment of that. And so I actually actively, every time I go I go into a room with a patient, took a minute to cover air shifts. I always tell myself that, you know, this is I may have seen this suicidal ideation case a thousand times. This may be the only time this person is experiencing this. And so I have to honor that as I go into them, actually mentally go through the exercise of actually doing that. And I tell the student that before we go in, because you can look at a chart and get all this sort of like, oh, here we go again, this again. But actually we actually go through the exercise of doing that each time. And the actual exercise of doing it actually then primes you as you go into the room. So it gives you a little bit of cooling off before you go into that space and go into that potential chaos. It's really helped me as a practical strategy. I always try to do that every time I go into a room.
Tyler Johnson: [00:52:23] Well, Damon Tweedy, we are so grateful that you would join us on the program. We're grateful for your, you know, now sort of your lifetime of reflecting on your own life and your experiences. And as we said earlier, while we're not here to paint anybody as saints, we really are grateful for the way that you've metabolized some of the difficult things from your own life and training, and tried to use those to make both the medical sphere specifically and the world generally a better place. So thank you for your good work, and thank you for joining us on the show.
Henry Bair: [00:52:55] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at the Doctor's Art.com. If you enjoyed the episode, please subscribe, rate, and review. Our show is available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:53:14] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in healthcare who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments. I'm Henry Bair and I'm Tyler Johnson. We hope you can join us next time. Until then, be well.