Before seeing his patients, Dr. Michael Tutt sits quietly as nurse Anna Barber folds and ties his waist-long black hair into a traditional Navajo knot, or tsiiy-de-del.
Tutt, whose grandfather was a medicine man and whose mother was a nurse, works at the Ft. Defiance Indian Hospital on the Navajo Reservation, and in nearby clinics. He is one of a small but growing number of American Indian physicians.
Indians make up 0.90% of the U.S. population, according to the 2000 census. But they make up only a fraction of a fraction, 0.06%, of U.S. physicians, a 2000 survey by the American Medical Assn. showed. The AMA found only 491 across the country.
Those in the medical profession hope Indian doctors can help bridge the gap between traditional and Western practices for their people, bringing an understanding of their culture into the examining room and an acceptance of the role of traditional healers.
Tutt literally speaks their language.
"It's a dream come true," said Julia Rae Ashley, 48, a weaver on the Navajo Reservation who has been seeing Tutt for years for her rheumatoid arthritis.
"It's easier for me to talk to him than to a white doctor," she said. "We understand one another. He looks through me and knows what I'm going through."
"What's remarkable about Michael is that he always said he was going back to the reservation," said Dr. Michael Grossman, associate dean of graduate medical education at the University of Arizona. Grossman served as Tutt's advisor during his residency at St. Joseph's Hospital and Medical Center in Phoenix.
"He could have had a career at the university but truly felt the call to serve his people," Grossman said.
Grossman said he has learned over the years that "there is a lot of validity to concerns regarding diversity." Language differences also cause problems, he said, with meaning lost among doctor, interpreter and patient.
"It's like whispering down the lane," Grossman said. "You think you're getting the answer to the question you asked, but you're not."
Tutt, 42, was born in Shiprock, N.M., the oldest of five brothers, and grew up in Kayenta. He became interested in medicine while hanging out in the lab at the Indian Health Service hospital where his father was a health educator and chief executive officer.
One of the doctors told him to consider going to medical school. So after he finished his bachelor's degree at the University of Arizona in 1983, he applied.
"Even though they had a place for me at Arizona, my professor told me to go somewhere else, that the students would all be from Arizona and would all be Republicans, that I should see more of the world," Tutt said.
Tutt chose Tufts University School of Medicine in Boston because it sounded like his last name, he admitted, laughing.
"It was an old school, all third- and fourth-generation students, a different environment with different thinking," he said.
When he got there, people asked him if Arizona was all desert, if he lived in a tepee.
School was easy for Tutt and his studies went well, leaving him time to party.
Although some Navajo medical students have a difficult time in anatomy classes because of the taboo against handling cadavers, Tutt said his grandmother prepared him.
"She was very traditional, but she recognized it was a new, modern world," he said. "She taught me not to be afraid, to ask questions."
Tutt ran into difficulty while finishing his residency at St. Joseph's, when his partying caught up with him.
"I was drinking a lot. It was beginning to affect my work, so I went to my supervisor," he said. "He told me it was nothing to be ashamed of."
Grossman said the idea is not to weed out people in trouble but to identify them before they harm themselves or others and get them help so they can return to their career.
Tutt checked into a 30-day alcohol-treatment program and, when he applied for his Arizona license, was ordered to undergo random drug testing for three years. He hasn't had a drink since 1990.
"Seeing the problems alcohol causes up here on the reservation keeps me sober," Tutt said.
Tutt eventually finished a two-year fellowship in rheumatology at the University of Arizona. It was during his fellowship that Tutt's grandmother questioned him about his practice.
He recalled her saying, " 'What kind of doctor are you going to be? Are you just going to throw out handfuls of medicine?' "
"She thought that was the lazy way," he said.
Tutt said traditional medicine men must learn prayers, or sings, that last for several days. They must perform them perfectly, he said, or they can injure the patient or themselves.
"Sometimes I think I took the easy way out," he said.