Hello everyone. I'm Dr. Pracha Eamranond, Chief Medical Officer at Doctorpedia.
And today it's my honor to present my friend and colleague, Dr. Luke Davis,
Associate Professor of Epidemiology at the Yale School of Public Health.
Welcome Luke.
Great to see you, Pracha.
So Luke and I go a long way back. We went to medical school together,
studied for the boards together,
and we've had the amazing opportunity to travel in so many different continents,
but also to work in healthcare in places like Thailand and
Kenya. And while I focus a lot on digital health globally,
I'm still very much a local, to the Northeast.
And Luke has been spending a lot of time working and implementing his
best practices in research that we're going to go over today,
in places like Uganda. So before we start with that,
just why don't you let our audience know, Luke,
a little bit about yourself and about your career?
Right, well Pete, you remember when we were in medical school,
both of us were very interested in international health and after a few years of
practicing medicine and getting my training,
I finally got an opportunity in 2004 to go and spend some time in Sub-Saharan
Africa, initially in Kenya working as a doctor. And then later on,
I moved to Uganda where I started a research project to better understand
diagnosis of TB.
It was a terrible time in those days and it really directed my
passion over the subsequent years.
Yeah.
So over the decades that Dr. Davis and I have been really studying
and learning and teaching,
and I've seen this enormous development in your career and to
be able to actually practice that,
particularly through the pandemic and now post pandemic,
I think we have a lot to learn from you.
So can you tell us specifically about what you do in your research
and how it applies to medicine here in the United States,
and in Africa?
my work really started in my identity as a physician and wanting to try to
diagnose these pulmonary infections and help people get better.
And initially I focused for a number of years on proving diagnostics,
but over time I recognized that a lot of what we need to know to cure
tuberculosis and HIV.
And I think I now see many other diseases we already know how to do.
It's just a matter of putting that into practice.
We like to call that the "no do" gap in medicine,
and it's been incredibly fun for me in my everyday work to work with lots of
different types of people from different backgrounds.
They might be designers of new technologies for diagnosis of TB,
might be mobile application developers who are trying to reach consumers who are
out in the community.
It might be social scientists who really try to understand what are the
behaviors that keep us from healthy practice or healthy conditions.
So it's a lot of fun.
Right. And we were just talking before this, in my teaching,
yesterday we were, I was working with the medical students.
And just what you mentioned makes it so hard sometimes to practice because we
learn so much about basic science and about
treatments,
but we don't necessarily spend so much time on the social sciences and how that
intersects with healthcare delivery.
So it's interesting because I started off as you know Luke,
initially researching infectious diseases,
and one of my first publications was around tuberculosis.
But really how to actually manage these conditions in the context of
all that's going on,
particularly when there's not so many resources for a lot of these patients,
how has this been impacted with the pandemic?
And what's the biggest lesson you've learned during this whole process?
I think it's really just reinforcing what I've been coming to understand over
the last few years. I mean, Pete, you remember when we were in medical school,
it was all about trying to look at the science and deliver the best
evidence-based practice.
Even though the humanism of medicine was really emphasized,
when we went into the exam room,
we were focused on what do the guidelines tell us to do. And over the years,
and I know you're the same way,
we really enjoy the people we meet and their backgrounds,
we learn so much from our patients. And over time,
as you hear about the struggles that people have with their diagnosis,
with their treatments, even their family members who might be ill,
it becomes obvious that these social determinants are really what drives those
outcomes. And I think that I've been realizing that in my research,
and that's kind of taken me into this field where I'm not just working with
biostatisticians and clinicians and epidemiologists,
but I'm working a lot more with other people who understand the other side of
life.
And I think the pandemic has shown us that our health really does impact
every aspect of our life and our life does impact our health.
And so we need to kind of look at those in a more integrated fashion.
Right. So I'm just going to take it to my own world.
I've practiced a lot in inner city Boston,
in Lawrence, which is per capita the poorest town in Massachusetts,
Hartford. And you see so
many challenges related to accessing the healthcare system,
problems with drug abuse and mental health
problems that have been exacerbated by the pandemic.
And then you bring in all these other issues
like domestic violence and food shortages and not having access to
food, where there's a lot of food deserts in these particular areas.
It really requires a systematic process of getting
to help these patients. We hope at Doctorpedia, for example,
that we can actually break down those barriers and democratize access to health,
because we know there's so many gaps and the care that we need is not
always within the confines of a clinic office, like where we're at right now,
actually. But instead, many times it takes being at home,
being in the community to actually understand how to best deliver healthcare.
So, yeah.
I haven't actually been to see what goes on in Uganda,
for example, but I'm curious,
how are you really tackling the
challenges as it relates to tuberculosis?
Well,
I think the most exciting work that we're doing now is using a process called
human centered design or user centered design.
This is a situation where we try to really lean into the empathy that we have
for patients. As clinicians, we have that,
but really put ourselves in their shoes by bringing in people
who can talk about the experiences that people are having. Sometimes going
to their homes, seeing the conditions that they are living in,
sharing a meal and start to kind of understand that when someone gets a
diagnosis of tuberculosis, that's the worst day of their life.
And at that same time that we're diagnosing them and putting them on treatment,
we're asking them to do so many other things.
And to try to have empathy for that and try to think about how can we reframe
what we're doing so it doesn't feel like a medical procedure,
but maybe it feels more like the type of experience that you might get from a
great consumer experience.
And we're testing that now and hoping that that really can help people
feel less alone and have better clinical outcomes.
Right. Thank you, Luke for that. I mean,
I think really putting back the empathy into healthcare is something that
we struggle with as physicians, as health systems,
because many times the drivers of health and the care that we
provide is not necessarily driven by the empathy.
And I think it really requires, no matter where you are in the world,
this understanding that we need to get back to looking at all the
factors, particularly social determinants of health,
in order to really be able to tackle these big,
big problems like you've been doing. So we're running out of time now,
but I'd like to ask you one final question, which is,
do you have any lesson or a pearl that you would like
to tell our audience before we adjourn?
Well, I mean, I think that,
I just want to reiterate some of the messages that we mentioned,
which is that health is a holistic matter.
It's not only about what your physician tells you,
it's about the lifestyle that you're leading.
And so looking for opportunities to change your lifestyle so that
you can get the most out of your health experiences, would be ideal.
All right. Thank you, Luke,
Dr. Luke Davis associate professor of epidemiology at the Yale
school of public health. Thank you very much. And please stay safe out there.