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Excerpt from Oral History Interview with Andrew Best, April 19, 1997. Interview R-0011. Southern Oral History Program Collection (#4007) See Entire Interview >>

Black doctors' ability to respond to needs of black patients

Best explains his belief in the continuation of the Old North State, a society created for black medical practioners who were excluded from the state society. The Old North State can provide support for the unique needs of the African-American community, Best believes. The relative poverty of the black community presents challenges to doctors, he believes, a condition that requires a different set of problem-solving tools and a different attitude from doctors. In considering the mindset that Old North State seeks to foster in its members, he remembers experiencing racial discrimination from hospital administrators.

Citing this Excerpt

Oral History Interview with Andrew Best, April 19, 1997. Interview R-0011. Southern Oral History Program Collection (#4007) in the Southern Oral History Program Collection, Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.

Full Text of the Excerpt

KAREN KRUISE THOMAS:
I'd like to go back to the Old North State Medical Society. You said right after you joined the organization in '54, there were a lot of discussions about trying to integrate the then all-white North Carolina Medical Society. Do you know why they started talking about that then, or what brought it up? Was it in response to the Brown vs. Board decision, or other national events?
ANDREW BEST:
There was a movement toward integration. There were some people who were saying there's no use of having two medical societies. Now that we've offered you total full membership, there's no need for the Old North State. Our position was then, and still is, there is a need for the Old North State because in our programs and promotional work, some of the things which concern us are not covered or even considered by the predominantly white state medical society. They don't even recognize, in a lot of cases, some of the concerns that we have.
KAREN KRUISE THOMAS:
Can you give some examples of some of the things the Old North State Medical Society does that the North Carolina Medical Society doesn't? What were some of the differences?
ANDREW BEST:
One of the main things was, our population base has more indigent, and a greater degree of people who cannot pay for the services. Our concern for the indigent of non-paying person, the welfare patient, is just one area. It might seem to be racial, but it's not. We recognize that there are more blacks involved in the poverty areas than whites. But the whites who belong to that same poverty category suffer some of the same things so far as health care and promotion is concerned. Let's contrast a person who doesn't have the financial stability to go to a doctor. They will wait till the last minute. It's hard to get them to even participate in a preventive program. My patient's a whole lot sicker on average by the time I see him than my white counterpart's patient, because they're going at the first little pain or discomfort they feel. Maybe they go to a hospital where they can be treated entirely differently than my patient, who by the time he comes in, his heart's about to kill him, he's got chest pains. By the time I get him over there, he has a major myocardial infarc. That's the difference, that our patient population presents us with different problems than the average white practitioner. We in the Old North State are concerned about that. Philosophically speaking, we had to try to get our doctors to understand there's a certain part of charity that goes with the territory. [END OF TAPE 1, SIDE B] [TAPE 2, SIDE A] [START OF TAPE 2, SIDE A]
ANDREW BEST:
Aside from the scientific part of medicine, we've got to deal with the problems of attitudes and getting to the doctor in time so you're in a preventive mode, and all of those things. Whereas our white counterparts don't. One thing that really proves my thesis is that now, since we are desegregated, we have acceptance of minority kids going to all the various schools, UNC, Duke and everywhere else. When those young doctors finish, they have no concept of the social approach, or the realities of life and practicing. So often, I have observed young doctors in the last ten years being more oriented toward those pictures of Washington, Lincoln, Jefferson, Cleveland, and all them boys. Where they are more concerned about the dollar return than about the relief of pain and suffering. Where I was trained at Meharry, we often got reference to the acceptance of the realities of life and the demands of your profession. I remember Dr. Walker, who was the chief of medicine and a surgeon too, for a long time during my tenure at Meharryߞhe would always say, "There is something in your horizon of medicine that goes beyond the color green"ߞthat's the money. "There are certain things you'll find you've got to do." And the likes of Dr. Walker would point out the fact that be it as it may, there are some things about the attitudes and the realities of our part of the population that you just don't get in school. When those young doctors finish Duke and Chapel Hill and whatnot, it shows. For example, the episode where Charles Drew got in a wreck up here near Burlington and got messed around for a while. I wasn't there, but I heard two accounts. One said that the nature of his injuries was such that he would have died and he couldn't have been saved. The other account was that getting him sent from a white hospital over to another hospital, the time frame contributed to his death. The point that my training and my doctors would always say, you have to remember that the problem of racial tension, the fact that you may not be looked on as you should be, and may not be accorded the privileges that you should be, that's something realistically that you've got to deal with. Life is not going to always be pie in the sky. All I'm saying, Karen, is that our training and background gives us a different perspective than the training over yonder.
KAREN KRUISE THOMAS:
How did the training you received at Meharry prepare you to deal with the kind of obstacles that you would have to face? Can you think of any specific examples?
ANDREW BEST:
In general, our doctors and professors would always mention what they called the realities of life and living. I have seen many instances where here is a person of color with the same academic preparation, but a preference, sometime I think it may even be unconscious, is given to the white guy over the black guy. That's a force of that racial barrier that has never been completely erased, even in these days of desegregation. I wouldn't go back to the segregated pattern, not for anything in the world. I know to start with that I may get some things leveled against me that a white person doing the same thing, they might not even bother. That's the people who are sitting up at the top in administration. We have a rule that you have so many days to complete a chart on a patient that's been discharged. If you have over, say, ten charts that are delinquent, they may suspend your hospital privileges until those charts are in order. That's all right. But on one experience I had [in the mid-'60s], I was summoned by mail to go before the credentials committee, and it hadn't even come to my attention that there were some fine lines down there that say the credentials committee may, if it chose, say to the offending doctor that he has to go back and re-apply. Then they suspend your privileges and make you go back through all that credential and administrative ( ).
KAREN KRUISE THOMAS:
This was the credentials committee of the hospital?
ANDREW BEST:
Yes. In other words, when I got this certified letter from the chief [of staff], I went over and got all the charts straightened up. I was feeling kind of good when I met with the committee, because I could report that all the charts were complete. When I got there, the chief of staff read off to me that fine print. In all the years I had been here, it had never come to my attention that if that credentials committee elected to do it, they could send the offending doctor back through the whole process, suspend you from the staff and make you re-apply all over again. [There were] six members on this committee, and when the chairman of the credentials committee recommended that I be dismissed from the staff and given the option of no longer being on the staff or re-applying, there were four out of the six who stood up and defended me. When he first got the floor, he said, "Let me ask Dr. Best a question. Are your charts complete now, do you have any delinquent charts?" I said no sir, I did not. They went on through the discussion, each person made his comments, and they took a vote. There were five people other than the chief, and just one sided with the chief to censure me with suspension and having to re-apply. When the meeting was over, it was four to two, so that killed the whole thing so far as I was concerned. But the one person who sided with the chief, as I was getting in my car, he came over and said, "Andrew, it was nothing against you as a person, but we have this affiliation prospect with the medical school that's being worked out, and we've got to be careful about our rules and regulations so far as the quality of our care." Which was a smokescreen, which I knew. I said, "You have a right to your opinion." And I'm burning on the inside, but I was able to be calm on the outside.
KAREN KRUISE THOMAS:
So you thought being called before the committee was racially motivated?
ANDREW BEST:
Sure, I have no doubt.
KAREN KRUISE THOMAS:
Did you know other physicians who had had done the same thing, and had not been called before the committee?
ANDREW BEST:
It was just common knowledge, if you were to be notified, whatever I'm doing at that particular time, just stop and get that done. That had been a very effective mechanism for [getting] doctors [to keep] their charts in line. But I had a feeling, and I could be mistaken, that this particular person was subjecting me to the fine print of the regulation.
KAREN KRUISE THOMAS:
Was he one of the six that you felt were unconvinceable?
ANDREW BEST:
Yeah, he was one of them. He just disagreed with my activity in the community. This same person was a cardiologist. There was a patient of mine, a dentist, who had more white patients than black. He had some chest pains, and I felt like he was having a heart attack, and sent him to the emergency room, and indeed his cardiogram showed that he did have a myocardial infarc. I called on the group where this particular man was the head, and called his newest partner, who had seen this dentist when he was doing a fellowship at Chapel Hill. So I called on him to consult with me, and this gentleman said to me in no uncertain terms that this doctor did not accept or reject patients for their firm. So I said, "This man was Dr. So-and-so's patient when he was a fellow at Chapel Hill before he joined your firm." He said, "Makes no difference. I will not see him, and no member from my group will see him." So I called another internal medicine specialist, and he very kindly came to see [the patient]. But I knew this particular person had the history of being one of those rednecks who disagreed with this man's reputation for servicing the white part of the population. It was true that his name had been linked romantically with a couple of white ladies, so that was just burning this man up. That substantiated what he was doing to me on these charts.
KAREN KRUISE THOMAS:
Did the incident with the dentist happen before what you told me about the charts?
ANDREW BEST:
No. That happened way after. But the incident with the dentist verified for me the fact that this man has racial animosities as a part of his heart. One of the things I tried to do in the context of human advancement is try never to show any adverse reaction where I am retaliating. I always have chosen to keep myself calm and on the positive side of it.