tavis: good evening. from los angeles, i am tavis smiley. biased in our society based on age, race, and other factors is nothing new. when this enters into the health care system, the consequences can be deadly. a conversation with renowned surgeon dr. augustus white on his new book "seeing patients." he was the first african- american to graduate from stanford medical school and the first african-american to lead one of harvard's teachers schools. we are glad you have joined us for a provocative surgeon with renowned doctor and surgeon dr. augustus white. >> all i know is his name is james, and he needs extra help with his reading.

>> yes. >> to everyone making a difference -- >> thank you. >> you help us all live better. >> nationwide insurance supports tavis smiley. with every question and answer, nationwide insurance is happy to help tavis improve financial literacy and remove obstacles to economic empowerment one conversation at a time. nationwide is on your side. >> and by contributions to your pbs station from viewers like you. thank you. [captioning made possible by kcet public television] tavis: the doctor augustus white is the first african american ever to lead one of the schools' teaching hospitals. he was born in segregated

memphis. he became the first african- american to graduate from stanford and he was awarded the bronze star for his service in vietnam. his new text is called "seeing patients." it is and honor to have you. >> it is an honor for me. i watched your program. i am really happy to be here. tavis: there is so much to talk about. i want to get to your life. there is a lot to cover in this conversation. you have distinguished yourself in so many ways. i want to start with the book. what got me aside from the arresting photo was the subtitle. "on conscience -- unconscious bias in health care." >> much of it is unconscious.

some of it is conscious and even mean-spirited. for the most part, i think it is unconscious. i think the people that go into medicine are compassionate people and they want to do a good job. they are still the product of a culture that has all kinds of different biases. that is the reason that explains much of the health-care disparity. not all of it. some of it is money and access. putting it aside, people who go to doctors end up having disparate care without a doctor's realizing that they're doing it. i was working to produce the book to address the health care disparities. our unconscious minds play tricks on us. a lot of times that we are thinking objectively or reasonably, we are not. our subconscious mind is very alive and well and it can

influence the doctor patient relationship. it can interfere with communications event. if the doctor is communicating with the patient, the doctor might unconsciously filter certain information that is not come in or compute so that is not available as the decisions are made. many of these things are subtle and interactive but i think they are quite real. tavis: in this health care debate that we had a year ago and quite frankly are having with congress wanted to overturn what we did, but the debate, one of the things that troubled me so much, the conversation about health disparities never caught on the table. there were many issues discussed in the riding of the law but the very notion that there are health care disparities in this country which lead to thousands of deaths a year, just the disparities themselves.

that conversation was never raised the topic of debate and it never got to the table. that was my read, what was your read in this issue? >> it was 2005 hundred pages. i did not read it all. i am aware on the positive side of this equation, what i am aware of is that there is an institute at the national institutes of health, which is the institute for health care disparities? originally it was called the center for comparative studies of health disparities in our nation. that was elevated to an institute at the nih which means that it has more clout, more resources, more personnel. prior to that, it did not have enough of those things. this is there to do research responsibility to try to look at these disparities, try to analyze them, try to do research to help us improve them. i wish there had been a lot

more. there is no question about that. we need in our medical schools to spend more time and make stronger institutionalize commitments to educate doctors to get some of these issues of health care disparities. so, yes, i wish it had been more visible, more there. this one item i did focus on because it is valuable in terms of elevating the national institute of health's clout and ability to make a difference in this area. tavis: if the lack of culturally competent care is a problem for people of culture -- people of color in this country, obviously it is. the number of doctors of color still pale in comparison to caucasian, white majority doctors. if those persons who are doing the teaching our unconscious to your argument in their bias for their patience, you put that

together, how will we get over the hurdle of these disparities in the health care delivery system? >> i think it is a real challenge. there are many things in the literature, many ways to approach this. there are two basic areas. one is to have the doctor's first realize that in fact that this is an issue that is alive and well. as you said, race is one of the main elements but there are other elements, disabled people, elderly people, obese people, many other of our biases and culture. if you can have doctors aware of it, if you have a major culture and your practice has lots of patience senate, then it makes sense to learn something about that culture. -- if your practice has a lot of latino patients in it, then it makes sense to learn a lot

about that culture. also to realize and explore your own biases. this is a recommendation of the association of american medical colleges. they described various recommendations for educating medical students to help them improve cultural competence. one of that is to explore one's own biases and learn if you are biased against asian people were gay people or obese people, you should be aware of that. when you see a patient, who is obese, you should see a yellow light and say, i am aware of this and i realize i don't have a great propensity and i don't warm-up to people that are overweight. i will mind my manners and give this fellow human being, this patient the care they deserve. that can work. if you use that mechanism, that is a way to improve. tavis: how legitimate is the

concern in 2011, african- americans, people of color, these persons in various areas that you mentioned -- how legitimate are the concerns with regards to suspicions about the health care delivery system? i find that there are people who are very suspicious of the health-care system. is that legitimate? >> yes and unfortunate. there is no question, you mentioned tuskegee. particularly among african- american patients. there is an element of distrust. it makes it harder for them to follow doctors' recommendations and things of that nature but people are intelligent and intuitive. particularly a lot of people in minority groups that have been

discriminated against and they realize when things are not right. i encourage them. part of the whole program is that the patients should be trained and educated about these issues. in the book, i suggest that if you have a doctor and you feel like the doctor is disrespecting you or is biased against you, just say, i came here because i was told you were a good doctor and you have a good reputation and i came here. i am worried, i am not sure we are communicating well. have you had african-american patients before? i don't think that you are listening to me and i'm not understanding what you are saying. if the doctor is offended, blows it off, or is hostile, then you need a new doctor. if he says, i am sorry. what is it that i did that you don't understand, let's talk about it. i would stay with that doctor. you have to be aware that these things can happen. i remember seeing an african-

american patients who had serious cervical spine problems. i was a spine surgeons. i could not understand why it had not been diagnosed and he had been to several doctors. he was a bit perplexed, too. it was very clear what he needed. you're going to move forward. this is a situation where this guy had hit upon two or three doctors that it not pay the kind of attention that they should have to him and he did not get the care he needed and he deserved. patients should be aware and not to say that every doctor is biased, not everyone will give you lousy care, but it is possible that you can get involved with a doctor who was prejudice for every reason. i would say to confront it. if you don't like the response, move on. if it does, then there is a good chance that that doctor will try to help you. >>.

tavis: how open is the profession to this kind of critique? how open are that -- how open are they to receiving that? >> i have had prominent respectable physicians that have pushed back. i'm not the only person trying to teach this. in our medical school, some doctors will say, well, i don't know what you are talking about. i take good care of my patients. these statistics are coming from somewhere. the institute of medicine was commissioned by congress to look at this and they reviewed 600 peer-reviewed journals about these issues that show all kinds of different health disparities in 13 different groups of people. so, we have to face this. it might not be pleasant to some doctors but i think part of the competency as doctors is compromise if they are not

paying attention. in the state of new jersey, in order to get your license renewed as a doctor or to get your initial license, you must demonstrate some training in cultural care. that is the only state that does that. other states that try to address this. california has a requirement for continuing medical education. these are courses that doctors take after they finished medical school. you sign up for two or three days. all of those courses must include some recognition of culturally competent care education. these are things that will help us to move forward. tavis: how much do you think politics impacts this conversation? i recall discussing this in the national media when the story came out. the bush administration was accused some years ago of

tinkering with the data. the data suggested that they were not making the kind of progress they should have been making on the issue of cultural competence where people of color are concerned. so they started tweaking the data so that when the report came out, it would not appear as bad as it was. i raised that example and it comes to my mind to ask whether or not there are politics being played around what we really know about bias in our health- care system. >> i will assume that definitely there still is. i don't think there's any question about that. there are differences of opinion, differences of in this is. people don't like to acknowledge that we have 13 groups of people who are experiencing characters because of bias. it started with women, all women, not just minority women. our granddaughters, daughters,

sisters, wives, grandmothers, mothers, it said rep. this is nice. this is not something to be proud of. -- this is not nice. our attempts to cover it up might occur and happen. there is a paradox between the institute of medicine report in 2003 which documented all of these things. the fact that the organization that certifies all medical schools in the united states, they have a key educational directors to try to address this. this is not a hit in thing. -- they have two educational directors to try to address this. if you ask people on the street, they don't know about health care disparities. that is one reason why i wanted to get this known to the public. some doctors don't really known. -- don't really know. some of them are defensive.

some don't realize this is sequenom. there is a paradox i cannot explain. i wish i could. -- some don't realize this is going on. >tavis: what have you seen in your career that has sensitized you to this issue that you dedicated your life to this? what have you seen or experienced that made you have to do this? >> i have had my career and orthopedic medicine. that has been my primary role in life. since i was a youngster growing up in memphis, i cared about issues of race, discrimination. i wanted to make whatever contribution i could to change that, to eliminate that. i have been concerned about diversity in medical schools and diversity in the profession of orthopedic surgery, etc. i was on an airplane traveling back and forth. i try to use that time to study

or read. i do not engage in conversations much at all. there was this young woman, probably 25 years old, very pleasant, relaxed. somehow, i ended up in a conversation with her. we were just chatting a bit. somehow, it came out through the conversation that i was a physician. she paused and she got this look in her eye and she kind of staring into space and she said, you know, i hate to go to doctors. for i could tell, that is something that i should follow on. i said, tell me, why do you say that? she said, well, you cannot see it because except for my face and neck and hands but i have total body tattoos. when i go in to see the doctors and i get examined, they treat me so badly. i could just envision that. i could see that happening.

i got into it and obviously all of these other racial and other groups that suffer these disparities come to the surface and that is why i kept going with it. tavis: i ask questions every day and i don't know what the questions -- what the answers will be. i did not know that a tad too story would be part of it. i am not making light. -- i did not know that a tatoo story would be part of it. you referenced memphis a little while ago. you were born and raised there. you were raised there in the segregated south. how did being raised in the segregated south impact your life choices, your decisions, particularly where education is concerned? you don't get to where you are without being educating. -- educated. connect those stocks for me.

>> in the black community in the segregated south, the vehicle for progress, the vehicle for survival, the feel cool for pushed back was education, education, education. -- the vehicle for pushback was education, education, education. the teachers in the south, they viewed their ability to improve issues of race in our country was to make sure that they got every ounce of potential out of every kid that they took care of in the segregated public schools. so, whatever those schools might have lacked in resources, books, ph.d. teachers, master's degree teachers, whatever it might be, they more than made up for by teachers who wanted to motivate them and encourage them and guide them to do their best.

it was never part of a unique strategy, it was just the environment that i was in. another was a teacher, my aunt was a teacher. that is what i grew up again. i ended up going away to school in the ninth grade. my education in the ninth grade on was not in the segregated south but was in new england and in california. tavis: did it scare you in new england coming out of memphis? [laughter] >> you are right. tavis: especially back then. >> no, i did not. i did what i had to do. i did what i was supposed to do. i had almost no contact with white people. tavis: i can imagine. >> i had a little bit. my uncle had a drug store. he rented from a jewish family

right next door. i had a little bit of the conversation in that store with the kids. i knew about issues of race. in fact, i used to sell newspapers. i would gather up the papers and i would have a route in the neighborhood and i would pick up the papers on the corner once a week. i was selling the pittsburgh courier. i realized that i was getting nervous and anxious when i went to pick up the papers to sell and i would take a run to my different clients. if i had a few leftover, i would go around the neighborhood and sell them. i was afraid subconsciously and i sta because i thought there would be a lynching on the front page. -- i stopped doing it because i thought there would be a lynching. that was my dramatic exposure to race. -- traumatic exposure to race.

tavis: you have been distinguished as an african- american so many ways, including at harvard. we live in a time where there are still african-americans doing things for the first time including being president of this united states. how have you processed the to the first african-american in so many things? >> a lot of it was the process of history. i wanted to do the best i could with what i was doing and do my best, whether it was sports or trying to be the best doctor i could be. in that process, as there were opportunities to get through the door, i went through it. due to some of my mentors, one in particular, and dr. cobb, a

distinguished african-american physician, a doctor at harvard. i had the good fortune of meeting him when i was young. he said, you get through the door but you have to open the door and bring others in. that is what i wanted to do. when i had an opportunity to get to yale. my career mentor gave me a job there. when i got there, i worked with him and talked to him and we encouraged others to come to yale. he won the american academy of orthopedic surgeons at diversity award for educating the first african-american female through yale. carlton west came through. dr. todd said when you get in the door, open it up. that is what i did. -- dr. cobb said that when you get in the door, open that up. tavis: you were in vietnam.

there are all of the biases in the health-care system. i want to ask you about how we treat the veterans when they come home. one could argue that we're not as good as we should be. >> i would not disagree with you. we are doing a lot better than what we did with our vietnam veterans as a society. it was unfortunate the way the vietnam veterans were treated. we are working harder on that. as you know, the first lady has an interest in that. the problems are formidable. the psychological problems, the tremendous medical problems, the amputees. i know that medical technology and the trading for and duties is much better than it was. -- the training for amputees is much better. tavis: the health-care debate is

not over yet. we will see what comes out of congress in the coming weeks and months as far as the health care debate is concerned. never a more important conversation in my mind than talking about the disparity in the health-care system. the new book is called "seeing the unconscious bias in the health-care system." >> thank you for having me. tavis: that is our show for tonight. thank you for watching and keep the faith. >> for more information, visit tavis smiley on pbs,org. tavis: 20 next time for a conversation with robbie robertson. >> all i know is his name is

james, and he needs extra help with his reading. >> i'm james. >> yes. >> to everyone making a difference -- >> thank you. >> you help us all live better. >> nationwide insurance supports tavis smiley. with every question and answer, nationwide insurance is proud to join tavis in working to improve finaial literacy and remove obstacles to economic empowerment one conversation at a time. nationwide is on your side. >> and by contributions to your pbs station from viewers like you. thank you. [captioning made possible by kcet public television]