"Your individual choices are significantly influenced by your environment, both physical and social, because that's where culture comes into play. And we know how much marketing, you can actually sneak way more than I could on that." - Dr. Marsha-Gail Davis, MD
Shireen: Marsha Gail Davis, MD is a primary care internist and preventionists. Originally from the island of Jamaica, she received her MD from the University of California San Diego and completed her residency in the Yale primary care residency program. She is currently completing additional training in the UCSD preventive medicine residency program while serving in the role of chief resident Hi, Dr. Davis. How are you?
Dr. Davis: Good morning, Shireen, and feel good to speak with you today. I'm very excited.
Shireen: A pleasure to have you on ,I am looking forward to our discussion. So diving right in Dr. Davis, I would love to know what led you to health and medicine.
Dr. Davis: Really, when I decided that I wanted to go into medicine, I actually thought about wanting to help my patients get healthy. That was my desire. That was my, my interest because I said as a physician, this is the way that I have impact. This is how I help people, I actually help them to stay healthy. And if they're sick, I help to bring them. I have to bring them back to health. So that was my honest answer. You know, my interest in becoming a physician, I'm, I always loved biology. I'm a biology major for a reason. Like I could talk about biology all day, I find biology so interesting, just the way things work naturally. And I think the human body is like pretty much the best, like the most amazing machine on the planet. And I could learn about it all day, which is what I do. So I'm just in the perfect situation. But um, that's really my, my thought that this is what I'm able to do. I want to be well people need to be well, how do I heal them? You know, get back to help? How do I heal? What do I hope? That was really my interest.
Shireen: You know, you call yourself a preventionists. Now, I'm very curious about that term. What does it mean to be a preventionist?
Dr. Davis: I like the term I think when people think about it, like what is that, you know, versus like primary like preventive medicine physician or primary care doctor, you know. Prevention is like it has like a little bit of a ring to it. And I like that because overall, what a preventionist is, is someone who advocates for prevention, someone who believes in the power of prevention, someone beavers, you know, policy of prevention, and that's me, I just believe we do not value prevention enough. And we just kind of treat prevention, like an optional thing, or we kind of treat it like Oh, that's nice. That would be nice if we could prevent some stuff, you know, and it's like, wow, we treat it as an optional thing, when it's actually something that we can please synergy and we can put resources in. And when we do that it has so much impact. So it does baffle me a lot that there isn't this type of value that's placed on prevention, that it has this inherent value that people don't, please me, that's what I believe in. And that's what I am. And one of the things about that actually, you know, am I getting our training and public health. And one of the books we have to read is by a well known epidemiologist who wrote, essentially the introduction to epidemiology. And he has a little section that talks about prevention and treatment. And what he says is that all too often prevention and treatment have been seen as mutually exclusive. And that's exactly what we see in our current healthcare system. Like either we're doing treatment. And if we do prevention, that's all in the public. That's all. It doesn't come together in the clinical setting as much. And yes, we have from the standpoint of prevention or vaccines, you have screening you have from intimidation. That's what we consider prevention in our world, our current kind of health care challenges. That's not enough to really combat that, you know, screaming, they're not actually dealing with what we call primary prevention. That's dealing with secondary prevention primarily, preventing disease from developing the first place, which I know a lot of people would like. Yes, I'd love some chronic diseases. You know, in 10 years, no one, no one has that kind of attitude, you know, and so we treated it almost as if it's okay for people to get disease, we just kind of were very nonchalant and included in my opinion about that. It's almost as if we have people walking on the side of a cliff and we tell them that they need to walk them backwards. And so if they fall off because they're walking backwards, they don't see what's happening. They, they're walking, walking, we're like, oh, you're fine. They walk backwards, they fall off the plane, and we don't put any fences there. We don't give them any signs. We don't say hey, they're off to the side. Stay in one line. Put the fence there. So if they do happen to bump into it, they bump into it and don't fall over, you know, that's kind of the environment that we live in. And we're just incredibly reactive and not proactive about healthcare.
Shireen: That's a very interesting approach, you know, when a cover a, from from different lenses. So first, let's talk about the physical, right. So in terms of physical environment, how can an individual create a more health conscious environment for themselves?
Dr. Davis: I think because that comes down to kind of the individual choices in a sense and that is just one piece of the whole puzzle. That's one, one block, you know, and this wall we're trying to create helps us to really protect ourselves from disease, because it is twofold. Your individual choices are significantly influenced by your environment, both physical and social, because that's where culture comes into play. And we know how much marketing, you can actually sneak way more than I could on that. And the power of marketing to actually change beliefs as a marketing team is what people think what they believe about dropping, you know, that's what we believe, and that's influenced so much of what we do. And then when you think about your individual choices, it's based off of those beliefs. So we can't be to individual choices outside of that context. And I think so much of what we do is to do that with the Oh, um, food industries, that usually the conversation is you should have enough willpower to stave off not eating my food, if it's not healthy for you. But there's also social responsibility, because the impact that you have is just so grand, especially when marketing dollars are being allocated, like there's actual investment going into marketing. So there's that conversation of you have to be strong enough to withstand the influences does it doesn't make any sense. I would I think the first thing I am talking about is just having kind of inventory on yourself, where do you feel you are in terms of your health, and also people can determine that accurately for themselves? And when you do that, then you say to yourself, okay, like, what do I want for my health? And those questions sound like very trite, like, okay, is that going to really do anything, but what it is it develop awareness and awareness is very powerful. And we know that from just meditation, that's what meditation does. And when you have awareness, and you can actually start to behave differently, because you have enough time to think about what's happening. So you can make a different decision. So once that happens, then you have to think about your physical environment. And one of the things that we are often recommended when people are trying to, you know, change their eating habits is when you're in the store met, let that be the decision of I'm going to determine what comes in my home, because it's better to develop what we call skill, power versus relying on willpower. And that's a wonderful concept. That's one that Dr. Katz, David Katz, he speaks a lot about, and most people like the prevention community, talk about creating the environment in yourself. Make it hard for you to meet the decisions that are not the best help, but you don't really want to meet and you get frustrated when you meet them. And you get mad at yourself, like why they don't want to do that, like, you know what I mean? So there's a way that you can build kind of the system around yourself where Oh, I didn't even bring the Hot Cheetos in my house today. No, but there's one groceries and you don't have access to it because it's not physically they're what happens is when you're at home, things happen, you may get stressed, you come home from a long day of work, your willpower is variable, and it's not going to be strong at that point. So you want to put yourself in a situation to be at home after night, you can fight outside, but let it be that at home, it's more of an easy kind of transition, you know, around your different choices that can push you, you know, towards health very easily.
Shireen: So that was the physical environment I wanted, then hop over to sort of the social environment that the community that you're surrounded by. So what do you feel is the power of community, and how does that impact countering health disparities or even impact analysis?
Dr. Davis: I do believe in the power of community, I just have this belief because I've benefited from the power of community, you know, especially, you know, in this country, and what we know to be the case, you know, the reality that we all live in. And especially with all the recent conversation that was fueled by a very unfortunate event, when it was a bit of joy, virtual aid is that we do live in a society that operate differently than we would like you live in a society that has reshawna inequality, that's very, very clear. And so that's an environment that we're marinating in a regular basis. So it's not going to be easy to jump out of that, you know, if you're marinate chicken, you can really get that stuff out of the chicken very easily in there. It's all in there. And so when I think about community, I think about the ability to create kind of a micro environment that can protect you from what the alter environment may be trying to do. And I feel that that's what I would see something I've benefited from in my own rearing, you know, my upbringing. I was raised by a wonderful, you know, single mother, who was intelligent, brilliant, just an ocean window guiding, you know, my sisters and I, you know, toward where we are today, and we owe everything to her very clear, but it's just the idea that, you know, she put things in place her own way that she valued education, that was something she created in our environment. So when we thought the word vacations is something you need to do, this is something that really embarks on on the people that she's her own it, as if my mom was not about, you know. Don't be jumping all over the place and going to Indian, any person tell us to have like, I need to know this person, I need to know who they are, I need to know their values. If I'm not there, I'm not going anywhere. And it's funny cuz like, as a child, I was like, man, hey, you know, I can't even do this. But as I got older, I was like, that makes so much sense. Because you can see how not having that type of vigilance is actually dangerous. You know, you can just be comfortable without having your child to school over a man and reverse themselves. That's just how we are raised. I think that that's just understanding that you have to be very specific about what you're putting in someone's environment, especially my mom. Well, she just had this knowledge of everything and she put that into place. And as a result, they're my sisters and I all were able to become successful beings in society. So I think you can do that with culture and community where you can create a new environment and we see that happen with HBCU. You know, that's, that's a new environment that's created and you see the type of success that comes from an HBCU. Kamala Harris is the VP of the United States. He went to Howard, you know, that is beating a community that they'd be able to offset from what the impact of the larger community could return to do a little bit of a couple examples on personnel and then one.
Shireen: We talked about the physical environment, the social environment. Next I'd like to discuss cultural competency. How does cultural competency really translate into the work that you're doing?
Dr. Davis: I think that's so, so important because that is the underpinning, I would see or related to home bias works itself into healthcare. Um, because I think that's where lack of cultural understanding stems to misunderstanding and misunderstanding stems, I don't know how to provide care to this person in a way that will be in their best interest. And that's something that is happening on unconscious level as we discussed implicit bias. And that become a real topic of conversation over the years actually, just my own experience. And resident the other intern we, we had some conversations are owned that in a very kind of generic way. But towards the end of residency, there was specific effort in putting that in the curriculum where one of our chiefs she was chief when I was an intern, she ended up becoming faculty in our program. And she started doing a diversity series diversity curriculum implementing their diversity curriculum in our, in our residency. And so that was exposing a lot of people to what is bias? What does implicit bias look like? Have you ever heard of that, like, what does that look like? And that's important, because if it's done with intention to be truly engaged, if it's more of the checkbox thing, then there's no point in doing it, because you're not actually doing but if you're engaging and thinking about it, you're going to have a different understanding when you're like, I did not think about that, because a lot of we're still we're still in this kind of culture where there's distraction: I don't want to be seen as racist, I don't want to be seen as someone who doesn't engage with a culture like that there's more of a fear of being seen that way versus actually operating in that leaves room during that kind of a phenomenon easy. But when you become aware that everyone has a bias, and that's something that is have to add, it can't get away from it. And then you're less defensive about someone saying, Hmm, what you did there, what you did there kind of uncertain me, because I felt like there was some bias in that, then you're saying, Oh, you know what, Thanks for pointing that out to me, let me see how I can work on this. Because the only thing that you have to work on cultural competency, some people have said they don't like that term, because it's like, you have to get good at culture. It's really, and that kind of meat can work into it versus more of a step back and drop down, where it's going to be humble about what I'm learning about somebody. I can't get good at it, and then be able to tell you more about your culture, because it could have on that side, you know, it could kind of err on that side of I know, I have all this knowledge, and I'm gonna still be in a place of being the x No, I'm not, I'm not that good in your life. I'm not the expert in your experiences, I need to step back, I need to sit down, I need to listen, and I appreciate you on time point of view. And then I got to build my knowledge from teaching. I love it.
Shireen: So with that, Dr. Davis, we're toward the end of the episode. At this point, I'd love for our listeners to know how they can connect with you and learn more about your work.
Dr. Davis: Um, so I am, you know, dabbling into the idea. I joke with my friend that I'm a geriatric millennial. And I probably shouldn't say that, all right, hey, it is what it is I am, I'm learning how to be a little bit more tech savvy with all of these things. So I'm on ID. And I really am working to let that be a community that really valued that, really promotes prevention. My goal is to make orange on the priority to bring to bring that up into the topic of conversation, the way that we have so many things now that weren't on the topic of the conversation that are one one particular issue and always on racial inequality and hold that literally about the conversation and the fact that we'll be able to get into the conversation around the election. And that was something that every question had to include that that's the power of community again, that they feel that that was a conversation that was brought to the forefront. So I want that to be the sort of engine and I want to Amin prevention popular because that's also cultural as well. golfing prevention is important, it will be important. So that'd be the main goal. And that's what I love for people to engage with me on and have conversations and the boards and share and become informed about.
Shireen: We'll also make sure that your tags are in the show notes. So people can find you there. And you know, follow that to people who follow us on Instagram.
Dr. Davis: You have a pleasure. Thank you, Shireen.
Shireen: So with that, Dr. Davis, thank you so very, very much for your time here with us today. I do want to say this is a great note to end 2020 on this is going to be our last 2019. God, where am I made last year, this is a great note to end. This is a great note to end my money on. Thank you so much for your time again here with us today. So listeners, I want to talk to you for a second. Thank you so much for supporting us through 2020, through this crazy, crazy year. We'd love to interact with you and though we're done for 2020 we want to keep the conversation going. So my question to you is what are some of the actions you take to build a more health conscious environment in your home, especially around the holidays, let us know with a post on social media and use the hashtag hashtag chronic conquering chronic illness. I'm gonna say that again, hashtag conquering chronic illness and don't forget to tag us and to know our tags again, go to the show notes. So with that, thank you so very much for your time and for listening to us.