Harvard Doc Decries Health Disparities Based on Race, Sexual Orientation

Growing up in segregated Memphis, Tenn., during the Jim Crow era, Augustus White III knew about those certain places off-limits to him as a black man - restrooms, diners and schools.

He just didn't pay racial barriers much mind.

The son of a doctor and teacher became the first African-American to graduate from Stanford Medical School, the first African-American resident and surgery professor at Yale and later the first black department head at Harvard's teaching hospitals.

Now 74 and one of the nation's leading orthopedic surgeons, White is releasing a memoir on his life. The book, "Seeing Patients: Unconscious Bias in Health Care" (Harvard University Press, $27.95), is also a call for more diversity in the medical field and the end to health care disparities, something the Harvard professor calls "the last frontier of racial prejudice."

White said the book, scheduled for release next month, has been a lifelong project that began when he served in the Army as a surgeon during the Vietnam War. "I kept a journal and saw a lot of horrible things. Over time, that changed me," said White, who considered calling the book "A Black Surgeon in Vietnam."

Among horrors he remembers was treating servicemen - black, white and Latino - who had body parts blown off. "Pain is an equalizer, and, of course, the greatest equalizer of all is death, of which I saw plenty," White writes. "Death is the equal opportunity employer."

He left the Army a strong opponent of the war.

Returning to civilian life, White said he soon became passionate about increasing ethnic diversity in the medical profession and fighting disparities in health care. It's something he reminds colleagues whenever he speaks and attends medical conferences.

"He's built the infrastructure in his profession that when he speaks, we listen," said John Feagin, a retired orthopedic surgeon who lives in Vail, Colo., and was White's roommate in Vietnam. "I'm just delighted with his book. There's a lot in there about his life that I didn't know."

White, born in Memphis to a middle-class family, said he noticed at a young age how few times blacks and whites interacted "except maybe at the nightclubs and brothels on Beale Street." When White was 8, his father, Augustus White Jr., died suddenly, probably of a heart attack. That left White to be raised by an extended network of family and friends who often pushed and supported him during his unique educational path.

At 13, White was accepted to the largely white prep school Mount Hermon School for Boys in Gill, Mass., becoming one of four blacks in his class - his first introduction to New England. White writes that the experience prepared him to enter Brown University, where he became the first African-American president of his fraternity.

"Each time I became the first black to do this or that, I knew people back in Memphis knew about it," White said during a recent interview in his office. "Sometimes, when I went home to visit, they didn't even have to say anything. I knew they knew, and I had their support. That's all that mattered."

But during his journey through medical school in other parts of the country, the Civil Rights Movement began to spread and a young White started to feel like he was missing out.

"It wasn't until a mentor of mine at the University of Michigan told me, 'You don't worry about that right now. That's not your role. You will be in position to make real changes one day. Just keep doing what you are doing,'" White said. "I never forgot that because he was right."

Soon after his residency in Michigan, White decided to study orthopedics at Yale. Why orthopedics? "I noticed very quickly that the orthopedic surgeons were the happiest," he said.

By becoming orthopedic chief at Harvard, White admitted, he could have lost touch with his past while walking in circles of the wealthy and Harvard-connected. But White, who now lives in Weston, Mass., said he couldn't forget those in Memphis and mentors who helped him, even at a time when helping an African-American was dangerous.

That has pushed him to his new mission: fighting health care disparities that exist among blacks, Latinos and gays four decades after the Civil Rights Movement. For example, White said evidence shows that blacks receive less pain medication for the same injuries as whites and Latinos received less angioplasty and bypass surgery for heart disease than whites.

His solution is stressing "culturally competent care" - a commitment by medical professionals to be responsive to different values, language barriers and attitudes of patients that could influence how health care is received.

It's not a new idea, White said, but it's rarely elevated in debates over health care reforms.

"He's dead-on in terms of the bias we have and don't even acknowledge," Feagin said. "That includes not just bias in terms of race but also those who are obese."

White said teaching the public about culturally competent care will remain a mission for the rest of his life. "If I can do anything in my power to make people aware of this bias that affects all of us," said White, "then I think I've completed my mission."