When Damon Tweedy began medical school at Duke University, a professor in a lecture hall mistook him for a janitor, asking, "Are you here to fix the lights?" Two decades later that question still rankles, although Tweedy's long-game answer was the best revenge: graduating with distinction, earning another marquee degree from Yale Law School and joining the ranks of Duke faculty as a professor of psychiatry.

How much has changed? Just last month, the Association of American Medical Colleges reported that applications from African-American men have declined: from 1,410 in 1978 to 1,337 in 2014.

While many doctors write books -- the Greek physician Ctesias in antiquity, Atul Gawande today -- few have concerned themselves with race. "Black Man in a White Coat: A Doctor's Reflections on Race and Medicine" (Picador, $26) is Tweedy's thoughtful answer to that gap -- and that Duke professor. The writer, 41, took questions from his home in suburban Raleigh, North Carolina.

 

What are the perspectives from which you view the world?

Well, "Black Man in a White Coat," that's two different identities right there. These sometimes blend seamlessly and sometimes clash. I'm a husband, a father -- family is a very important to me. And I have a certain athletic identity that might be more imaginative than anything else. I'm a tall black guy -- six-foot-six -- and I played basketball in college . I was a much better student, though.

Memoir and biography are often riddled with the great-man-rising narrative -- but not yours.

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When you read biography, the subjects often seem like they were destined for greatness. That wasn't my experience. My father was a meat cutter who didn't graduate from high school. My mother's family didn't have enough to send her to college. I was dealing with doubt and fighting failure. I wouldn't want to write a book that went another way.

Your memoir is certainly no tell-all. Did being a psychiatrist influence what you left out?

In my field, you hold other people's secrets, in medicine in general and in psychiatry particularly. Part of me is a very private person, and I wanted this book to be about more than just me. So many leading medical schools are in cities with large black populations, and this creates a tension between hospital and community that interests me.

Can we think of your book as making the medical case that Black Lives Matter?

I think Black Lives Matter is more focused on police issues. I didn't write about this, but when I was a first-year medical student, I was driving back to Maryland, in the daytime, and an officer pulled me over in a rural North Carolina county and said I was speeding. I'm pretty sure I wasn't -- my slow driving is a joke in my family . . . He said, "You don't have a gun in there, boy?". . . I've never held a gun in my entire life. I felt angry, ashamed, all those sorts of things. The tension is: are you going to go along or exercise your rights? I decided it is better to live and fight another day as the lesser of the two costs.

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What do you think of the AAMC findings?

It is easiest for me to think in terms of causes and solutions. Causes: inadequate K-12 educational opportunity, residential segregation, lack of access to positive role models, limited societal perceptions of ways that black men can succeed. I tested into a magnet high school and that really benefited me. Still, people would say to me in medical school, "Why aren't you playing basketball?" Lots of young people still hear the same message: this is the lane you have to occupy. . . . For black men, it's athlete, entertainer or criminal -- stay in your lane.

Solutions: No magic bullet. Each of the causes has to be addressed. It requires simultaneous efforts of academic institutions, nonprofits, private sector, media and government.

Whenever I think of my parents (and their parents) and the conditions under which they lived, I know that this country has come a long way, despite how far we still have to go. Part of me wrote "Black Man in a White Coat" as family history in a way, with the hope that future generations of Tweedy kids will read my account and think, "Granddad and his family had it pretty tough for a while; things are so much better now."