Dear Doctor: Jennifer Davis
The pediatrician and adolescent medicine specialist on her experience working in a school-based health center in the South Bronx and how she hopes recent events will inspire systemic change in our healthcare system.
A pediatrician and adolescent medicine specialist, Jennifer Davis, MD, has been working with young patients for the past 10 years. Through her South Bronx high school clinic, Dr. Davis cultivates strong relationships with her patients and invests deeply in community care. Read on to learn about how COVID-19 has affected her access to patients and how she hopes that this time will inspire practitioners and their greater community to take actionable steps toward building a more equitable healthcare system.
How did you get started in medicine and what inspired you to choose your specialty?
Though I’m the first doctor in my family, I had a strong interest in medicine from a very early age. In school, I loved learning about biology and found the stages of prenatal development fascinating. Throughout college, I became invested in women’s health and women’s health issues. When I began medical school, I was headed toward a career in obstetrics and gynecology.
But my intention began to shift when I attended my first pediatric panel. During the event, an adolescent specialist — who is now a colleague of mine — described what she did every day, and I realized that it was exactly what I wanted out of my career, too. I loved the idea of getting to work closely with teenagers while still keeping a focus on gynecology and reproductive health.
What’s more, after I completed my rotations, I realized that OB-GYN involved a lot of surgery and I didn’t see myself as a surgeon. I wanted an office practice that would encompass women’s health, but also enable me to work with a younger population. It soon became clear that adolescent medicine was the right path for me.
In your chapter of the recently released book, The Chronicles of Women in White Coats 2, you talk about speaking up and finding community. Can you tell us more about that experience?
In the book, I talk about the challenges I faced with my pre-med college classes (especially organic chemistry) and the difficulties I had speaking up about those challenges with peers. I didn’t reach out to my professors or classmates, and instead tried to handle it on my own. When I did meet with my pre-med advisor, she questioned my desire to become a physician, making me feel even more isolated.
Years later, I attended my 20 year college reunion and learned that so many of my classmates were going through the same thing at the time.
I realized that regardless of what we might see on the surface, we all face some form of challenge and adversity in life. Finding a way to share your experiences with others, like what I’ve found in the larger Women in White Coats community, isn’t a demonstration of weakness, but power in solidarity.
How is your approach to pediatrics and adolescent medicine rooted in the South Bronx community that you serve?
The kids I treat face so many obstacles in their day-to-day lives — from poverty and
immigration to divided family structures — so it’s really important for me to keep an open mind, listen to their concerns, and meet them where they’re coming from.
For example, a kid may come to me for something like frequent headaches or stomach aches, but the real issue lies beneath the surface. In these cases, I have to listen to my gut and dig deeper with the patient. One of the first questions I ask is if they’ve eaten that day or if they’re getting regular meals at home, since I’ve seen many cases of chronic headaches and stomach aches that result from food insecurity.
Other times, I’ll ask my patients if they’re stressed out or if there’s been a recent change at home. That’s usually when the conversations get going, and I learn about whether a patient has been fighting with a significant other or misses a parent who lives in a different country. All of these factors have a big impact on their physical or mental health. The best thing I can do is to listen and keep an open mind. They won’t always be ready to tackle the bigger issues, but I do what I can to let my patients know that I’m always there for them.
Can you tell us more about the unique environment in which you work?
I work in a school-based health center, which is basically a full pediatric clinic located inside a high school in the Bronx.
One of our main functions is to be a safety net for our patients. There are a lot of immigrants who go to my school — mostly from the Dominican Republic, but also from South America, West Africa, and Bangladesh. These kids often don’t have health insurance or a regular provider, so we fill that gap for them.
We treat kids who feel unwell, need reproductive healthcare, have experienced a sports injury, and have asthma attacks. But we also treat those who have bigger issues affecting their lives. For this reason, I’m fortunate to work with a Spanish-speaking mental health provider whose office is just across the hall.
What are some of the biggest obstacles of working in a school-based health center and how have you overcome them?
Unfortunately there’s still a prevalent stigma in the school (and in most communities) with mental health, so I have to be careful in how I approach these conversations. To help patients overcome this stigma, I never use the word “social worker” because a lot of them equate the term with something negative. Instead, I use a benign term like “counselor” and tell the kids — many of whom are Spanish speaking — that the in-clinic counselor is very down-to-earth and can speak Spanish much better than I can.
Another challenge is access to the patients’ parents. While it’s a blessing to work in a school where we have direct access to the kids and can cultivate strong relationships with them, tracking down their parents when necessary can be difficult. In many cases, the kids either don’t know a parent’s phone number or their parent or guardian doesn’t have a working number.
Also, working in a school-based health center means that I work for a bureaucracy inside of another bureaucracy. While the clinic is part of a major hospital system, the school it’s located in is run by the Department of Education. Navigating these sometimes conflicting agendas can be very tricky.
How did COVID-19 impact you and your practice?
Drastically. Our kids experience a lot of trauma in general, but this has been a particularly difficult time. The population that I work with is experiencing high unemployment and high rates of COVID-19.
Because I also have a masters in public health, I was relieved when the city first decided to close the schools because I knew this would help reduce the spread of the disease. But understanding how this would restrict my access to patients was another piece of the puzzle.
The center where I work is one of thirty school-based health sites in the Bronx, and collectively this network employs over 200 medical workers. Shutting down schools affected all of these people in addition to the kids they care for.
How have you continued to care for the community?
Recently, I’ve been working at different enrichment centers across the city. These are centers dedicated to caring for the children of essential workers. These locations were set-up with socially distant computers and other resources that the kids would need, but a lot of them have since closed due to low enrollment.
I’ve been in the same enrichment center now for over a month, but I haven’t been able to physically see patients. Instead, I’ve incorporated telehealth into my practice, but this has been pretty limited.
We do hope to assist with administering vaccines, which is a paramount concern in the pediatric medical community during this time — we don’t want to see the effects of a measles outbreak during a pandemic.
What was the transition to telehealth like?
We have an internal tracking system of which kids are prescribed ongoing medication — for asthma, birth control, or other reasons. Initially, we reached out to the girls who were on birth control to ask if they needed a refill. We were even able to have some of them come in to some sites for a Depo-Provera shot.
Then, we started focusing on the kids with asthma to make sure that they had their medication and pumps at home.
Mostly, I’ve been doing a lot of monitoring to make sure the kids have the medication they need. We’re not doing any sick visits over the phone at this time, so our telehealth approach has been pretty limited.
Is there anything that has been particularly difficult about using telehealth with your adolescent patient group?
Overall, it has worked well for medication monitoring, and the patients seem to be receptive. But working with teenagers means that a lot of them don’t like to pick up the phone, and most of them never listen to voicemails. Some of our patients have also had their phones disconnected during this time, which has made access even harder.
Our patients are used to having us within walking distance, but now they need to find the clinic number and call or leave a message if they need to reach out to us about something.
How do you see healthcare in general changing post-COVID-19?
I think telehealth is going to become a more regular part of medical practices, especially in outpatient medicine.
I also believe that this virus has underlined the racial disparities in healthcare. The confluence of the COVID-19 pandemic and the murder of George Floyd has sparked a lot of introspection among people who are not just looking at the systemic racism inherent in the police system, but at what’s happening within our healthcare system, too.
I truly hope that practitioners will take this opportunity to change the way they relate to their patients. People in the medical field need to think about how their own implicit bias can affect how they see and treat patients. They also need to realize that the environment that a patient lives in — including access to adequate food, shelter, etc. — can affect their overall health.
Black Lives Matters has opened up so many conversations about race and healthcare. What are some steps you think we can take as a society to help make healthcare more equitable?
There have been countless studies demonstrating the implicit racial disparities and biases among health professionals and their influence on healthcare outcomes. For example, Black women, regardless of socioeconomic status, are more likely to die in childbirth. These disparities have been around for some time, but seeing how COVID-19 is disproportionately affecting poor communities of color has really shed light on the inequities of our healthcare system.
I hope that this moment in history encourages people to accept and acknowledge these disparities and feel inspired to do something about it. The more people who are interested in these issues, the more likely we are to affect systemic change. This cannot be a Black issue — people of all backgrounds need to become invested.
How else can we improve these inequities?
Access, access, access. Not enough people have access to health insurance. Obviously, this has been a big topic of debate for some years, but I think COVID-19 has underlined the danger of tying health coverage with employment. We need to find a better way to ensure coverage so that if you do experience job loss, your health is not at risk as a result.
Vital Signs
What does your perfect Sunday morning look like? I actually got to experience this for the first time in ages this past Sunday. It starts with a homemade breakfast, a walk or run in Central Park, and grabbing a latte on the way home.
What’s the best meal you’ve cooked at home recently? One of my favorite Indian dishes, Chicken Saag.
Do you have a go-to TV show/movie/book/podcast at the moment?There’s almost always HGTV on in the background at home, which helps me to relax and de-stress from the news cycle. I’ve also been reading more female authors of color. I love contemporary romance and just finished a book by Alisha Rai. My college classmate Jasmine Guillory has a new book coming out this week, so I’m looking forward to reading that one, too.
What’s one healthful habit you’d love to see patients adopt? Eat regularly and get adequate sleep.
Know a great female doctor in NYC? We’d love to meet her, introduce us here!
