Book Review

Against the Odds: Blacks in the profession of medicine in the United States

N Engl J Med 1999; 341:1480November 4, 1999

Article

Against the Odds: Blacks in the profession of medicine in the United States
By Wilbur H. Watson. 198 pp. New Brunswick, N.J., Transaction, 1999. $34.95. ISBN: 1-56000-3767-6

One hundred years ago, W.E.B. Du Bois predicted that the 20th century would be “the century of the color line.” Made at a time when a rash of Jim Crow legislation established the legal foundation of segregation throughout the United States, Du Bois's prediction of the effect of that legislation was more understatement than overstatement. At the dawn of the 21st century, we are still struggling to demolish the color lines that have limited opportunity for blacks and other people of color in the United States.

Among the many ongoing battles in the struggle against segregation has been that waged by blacks to enter the medical profession and to bring high-quality health care to black communities. The evidence that the battle is not over can be found in nearly any measure of health: life expectancy, infant mortality, and rates of infection with the human immunodeficiency virus, hospitalization for asthma, lead poisoning, rat bites, and death from homicide. Given the grim reminders that we have not yet finished, Watson's book provides a helpful note of encouragement: he reminds us that it used to be worse.

Imagine, for example, a black mother who has waited all day to see a doctor. As evening approaches, she begins to worry she will miss the last bus home if the doctor does not see her soon. She becomes hopeful when it seems that her turn has finally come. But just then, a white woman arrives, and the black mother is put off again. Furious and desperate, she calls a nearby black doctor. Imagine the black doctor's feelings: glad to be of assistance but more than a little chagrined to be consulted only after the white doctor has been so insulting.

In a riveting series of stories, Watson brings to our attention the details of a bygone era of segregation, when an entire culture had evolved to prevent the possibility of mixing. “Colored” patients were assigned to wait in the basements of doctors' offices, or their visits were scheduled on “colored days.” They entered and exited by the back door. When they could find no doctors who would care for them, they gave birth and died at home. Watson takes us beyond the well-known indignities experienced by blacks entering medicine, including the heartbreaking process of searching for openings in medical schools and the difficulties of obtaining postgraduate training. He shows us the day-to-day problems of referrals and payment. If, for example, a black doctor and a white doctor both provided care for a patient, the patient would pay only the white doctor. That the culture of segregation had evolved to a point where it encompassed such minute details would be lost in time, had Watson not worked so diligently to record the stories of the black men and women who practiced under these adverse conditions.

This splendid book is marred by an unfortunate number of typographic errors and at least one incomprehensible table. These problems detract from the reader's pleasure but do not diminish the book's fundamental contribution to a fuller understanding of segregation and its effect on health care and medicine. It is probably true that we can understand the present set of struggles only by understanding the discontinuity in discrimination. Put another way, only by acknowledging what has been eliminated will we have a clear picture of the work that remains. Readers interested in the history of medicine, human rights, civil rights, and black history will find Watson's book an essential reference.

Mindy Fullilove, M.D.
Columbia University College of Physicians and Surgeons, New York, NY 10032