The family physician and public health leader breaks down diabetes, HIV prevention, and why the doctor’s office is the last place you should be afraid to be honest
Dr. Kisha Davis carries two worlds in one career. As a family physician and the Chief Health Officer for Montgomery County, Maryland, she treats patients and shapes the conditions that determine whether those patients ever get sick in the first place. Her work with the American Academy of Family Physicians centers on supporting doctors so they can better serve their communities, with a particular focus on Black and African American patients who have long faced gaps in care.
What is the value health associations bring to the community?
When we think about health associations like the American Academy of Family Physicians, our motivation is really about how we support physicians to take better care of patients. Our advocacy is around healthier patients and supporting the doctors who take care of them.
We are in National Minority Health Month, and a lot of building healthier communities starts with making sure that our minority populations, especially our Black and African American folks, have what they need in terms of healthcare. Part of that is having doctors that look like them, having doctors that care about them, having doctors that recognize the unique needs and challenges of our communities.
Why are public health and medicine so connected for you?
When I was working at a community health center coming out of residency, we saw a lot of patients with diabetes. We did all the things. We had the podiatrist, group visits, new medications, a nutritionist. Not one of those things helped me have one fewer patient with diabetes because I was getting to them too late.
There is a lot we can do in the doctor’s office to help patients with diabetes have optimal health. But if I want a community with fewer diabetes cases, I need to start before they even come into the office. That is where public health comes in.
Public health is about how we shape communities so they are healthy. If public health is not working in the community to improve housing, education, transportation, and employment, then doctors on the other end are just getting to things too late.
What are the main drivers of diabetes risk people should know about?
The amazing thing about diabetes is that we now also know about prediabetes. And if you’ve got prediabetes, that’s actually reversible. You want to be thinking about things like your weight. We know that there’s a link between obesity and diabetes. If you’re a woman who’s had kids, you want to be thinking about gestational diabetes. If you had diabetes during pregnancy, that puts you at risk later on.
You want to be thinking about family history. We also want to be thinking about activity level. Folks who are more active are less likely to have metabolic syndrome. Getting up and getting moving and walking, all of those things play a role, and certainly diet. Half your plate should be fruits and vegetables, then a quarter protein, quarter grain. Those are good lessons to live by. Something that we don’t talk enough about is really that social connection piece. That really does have a big role to play in our health and in our communities.
How can accountability partners support our health goals?
Accountability partners make a difference. You can have that partner who helps encourage you. You tell them that you want to lose weight, and then when you go for that second piece of cake or the extra chicken wing, they say, didn’t you say you were trying to lose weight? But then you have that other accountability partner who says, well, you should get it anyway. So make sure you are putting the right folks around you who are encouraging you on your journey.
I need to walk every day, so I found somebody in my neighborhood and she said, “I need to walk every day too.” So at 5:30 every day, we meet up and hold each other accountable. My accountability partner said, just text me an emoji to let me know that you did it. When I haven’t texted her for a while, she sends me a, where are your muscle emojis? There are little things we can do that help create that accountability with a personal connection.
There are also accountability things you can do for yourself. Just like with my kids, when they do well, they get special privileges. Do that for yourself. When you have maintained your diet or gotten your walk in, how are you rewarding yourself? What concert are you saving up for? What’s the thing you’re going to do that feeds your soul, but also helps keep you accountable for those health goals you’re trying to meet?
Why is it helpful to bring someone with you to important doctor visits?
Having that extra set of ears when you’re receiving important news is such an important thing. Sometimes we can get stuck at hearing the thing, whatever it is, and we need somebody else to be there to hear the additional things that are said after the news is delivered. Having somebody who can say, but did you hear what the doctor said after they said X, Y, or Z?
I certainly have had the experience being the doctor where a couple will come in, and one of them, typically the husband, will share part of the story, and I will go down a certain path, and then the other person, typically the wife, will say, well, you didn’t tell all the story. Give the doctor the rest of the information. Which can oftentimes change how you think about a situation.
Someone can help you hear the news and the follow-up plan, but also help make sure that all of the information is getting shared, so that when we are developing that plan of action, there’s another set of ears that’s hearing and agreeing and understanding what those next steps are.
Why is trust so important between patients and doctors, especially in the Black community?
At the core of any patient-physician relationship is trust. I need to trust you, and you need to trust me that I’m working in your best interest. You are the person that’s in control of your body. I can give you recommendations all day long, I can prescribe medications, I can send you referrals, but it’s the patient, it’s you who is in control of whether you do those things or not.
I’m an advisor to help you live your best life. I recognize, and I think I would be a fool not to, that there has not always been trust, especially in the Black community, with healthcare professionals. Only 5% of the physician workforce are Black or African American, and so the training and the cultural humility has to happen for all doctors.
Great if they look like you, but even if they don’t, we need to get to a place where we have that ability to have those open, honest conversations between doctors and patients.
What should people know about getting tested regularly?
I hear this a lot. People say they’re not gonna go to the doctor, because if they go, they’ll find something. The things that most commonly kill people are preventable. If you wait long enough, you’re probably going to find something, and you’re probably not going to like the news. But if I can get you in sooner, I can often prevent it. If I can find that prediabetes, we can actually work together to prevent it and reverse it. With high blood pressure, if I can get that early, we can get that treated, sometimes even control it with diet and exercise. Even cancer, if I can find it early, there’s a lot we can do.
We want to know your numbers. Blood pressure, cholesterol, blood sugar. For men, we want to be looking at prostate cancer. For women, breast and cervical cancer. And for both, especially in the Black community, colon cancer. Those numbers are going up, and we’re seeing them in folks even younger. Chadwick Boseman is a perfect example.
I also hear a sense of inevitability.” My mother had high blood pressure and had a stroke, my grandmother did too, so it’s just my fate.” I want to remind people that it is not your fate. That warning sign is a warning that you need to take it seriously, but it doesn’t mean that is your health fate. There is a lot we can do with diet, exercise, and medication so that the outcome your parents or grandparents had is not the same outcome that you have.
What do women need to prioritize to protect their physical and emotional health?
It’s something that I struggle with, that I know a lot of Black professional women and men struggle with. The family responsibilities, the work responsibilities, the community responsibilities, and feeling like you have to do it all. I am learning on my own journey how to start to say no to things. What really helps to guide me is asking what’s my true north. What are the things that are important to me? And what is just extra?
A great thing that was given to me was, you gotta learn to juggle. Some of those balls are glass balls, and some are rubber balls. You gotta figure out what are the glass balls. My kids are the glass balls. You can’t drop your kids. My spouse is a glass ball. But some of those rubber balls, sometimes they gotta drop, and that’s okay.
I often talk about the pillars of wellness, eat well, move more, stress less, and connect deeply. We talk a lot about the eating well and moving more, but we don’t talk enough about the stressing less and connecting deeply. Getting the right amount of sleep, taking the time for you, connecting deeply with family and friends and loved ones. Those are just as important parts of the stool as doing the eating and the movement.
What should the community know about HIV prevention today?
Sexual health and wellness is such an important topic that we don’t talk about enough. Coming up in the 90s, seeing people die when HIV was a death sentence. Now, HIV is easier to treat than hypertension and diabetes. We are in a time now where ending HIV is within our sight. There are three things we need to do as a community to end HIV.
One, you need to know who has it. That means you have to get tested. That should be part of your regular routine with your doctor. If you get diagnosed, we want those folks treated as soon as possible. At the health department where I work, we’re implementing protocols where if somebody tests positive for HIV, we start them on medication the same day. We want to get that viral load to zero within a month. That’s unheard of when I started my career working with HIV.
If you don’t have it, we want you to take a medication to keep you from getting it. PrEP is pre-exposure prophylaxis. Before a potential exposure to HIV, you take a medication to prevent it. There are daily meds, and now there is a six-month injectable shot. Twice a year, you can get this medicine and it protects you from HIV. There is also post-exposure prophylaxis called PEP. It’s kind of like the morning-after pill, but for HIV. That can be obtained at most health departments and your doctor can prescribe it.
We can’t be silent about it. We have the tools in our toolkit to stop it in its tracks, and we can see the end of HIV in a generation. That is just amazing, recognizing where we were 30, 40 years ago.