On this week’s episode, Dr. Alex McDonald interviews Dr. Frank Domino about how medical communication has changed over time and how this can present challenges for patients and clinicians.

Dr. McDonald: Welcome everyone to today’s podcast for Physicians Weekly. I am here with my good friend—and I have to admit, I’m fanboying a little bit here—Dr. Frank Domino, who has a podcast of his own and is an editor. He has done so much amazing work, and I’m so excited. Frank, thank you so much for joining us on the podcast today.

Dr. Domino: Alex, thanks for inviting me. It’s an absolute pleasure to be the person answering questions instead of asking, so I’m thrilled to be here.

Dr. McDonald: It’s kind of like we’re going to have a podcast and talk about a podcast, so it’s like a podcast inception. This could get really, really trippy, so hold onto your hats here. Let’s start off, just tell us who you are and what you do for your day job, as well as all your extracurriculars, as I like to call them.

Dr. Domino: Sure thing. I’m a family doc. I did medical school in Houston, did residency in New Jersey, and worked for a number of years at a very urban community health center in the early ‘90s. It was the early days of HIV, and at that time I did full spectrum family as well as obstetrics.

A few years after that, I started my own practice in Poughkeepsie, New York, and was there for a few years. Then, in 1996, my family and I moved to Central Massachusetts near Worcester to work at the University of Massachusetts Medical School.

I moved here to be a clinician and by happenstance, someone asked me if I’d be interested in doing a little teaching. I reminded them that I graduated near the bottom of my class in med school and that I never saw myself teaching in a medical school setting. Then things just moved along in that I was relatively well received by my students, and then I was asked to do a grand rounds, and I know I did a horrible job. Then someone asked me to give another lecture and I said, sure.

Then I started lecturing because I was pretty good at math. A colleague of mine said, “Hey, we know you know about evidence-based medicine, and you can do math. There’s this startup company that is looking to hire family physicians as editors.” That startup was called UpToDate. I worked for them for five years. When that ended, the people at Lippincott Williams & Wilkins said, “Hey, we need someone to edit the five-minute clinical consult.” In short, that’s how I got to where I am.

The lesson of that story, Alex, for all of us, is that if someone presents an opportunity, don’t be afraid to say yes because you never know what’s going to work out. What’s the worst that happens? If it doesn’t work out, you step away. But so much of life is what happens due to chance interaction that leads to new career choices and opportunities. I am the luckiest person I know. I’ve had the most fun career. I can thank a lot of mentors for that, but I also thank the fates for opening a few doors and taking a chance on me.

Dr. McDonald: I think that’s one of the coolest things about being a physician and, particularly, being a family physician. There are so many skills and opportunities which we can apply to so many different settings. In your case, education and medical communication is amazing, the work you’ve done. Like I said, I’m a little bit of a fanboy here talking to you today, so I appreciate your insights. You also have a podcast with Pri-Med, is that correct?

Dr. Domino: That’s correct. That’s another story of how happenstance took me along. I had started helping with the American Academy of Family Physicians when they planned their yearly meeting. They needed someone who had a sense of tech. At the time, I was working with an application for my POM pilot and trying to help develop that, and the academy wanted someone to speak and develop some curriculum around tech, so I started doing some volunteer work with them.

Through that work, people in our department started recognizing me as someone who might be used to giving lectures on a national stage. Then, one of my colleagues retired, and he was the only family physician on Harvard Medical School’s continuing medical education committee because Harvard does not have a Department of Family Medicine. Through that work, I started collaborating with them and with Pri-Med.

A number of years ago, Pri-Med approached me and said, “Hey, we’d like to have a bit more of your time.” They bought some of my time through my department, and that’s how I started working with them back in 2017, 2018. They came to me and said, “We’re trying to figure out how to be in the tech world more than we are now. Sure, we have a website and we have online content, but we want to start a podcast.” And I thought, oh, family doctors are too busy to listen to podcasts. I said, alright, I can host it, and we tried a variety of formats the first few times and it was kind of mediocre.

Then I realized that the thing that people like hearing from me is: there’s a new publication, what does it say and how does it make any clinical sense? We started focusing on 10-minute podcasts that review one, maybe two articles on a given subject, and try to put it in a clinical context. We have close to 5 million downloads.

Dr. McDonald: That’s amazing.

Dr. Domino: It is. It’s out of control. I’m sure you are not far behind; you just started a little bit later. But it’s incredible how many people will come up to me and say, “Are you the guy on the podcast? I recognize your voice.”

Dr. McDonald: That’s amazing. I think that thirst for information and knowledge, but have it be short, to the point, and clinically relevant, is so needed. I get these journal magazines in my mail every month and I don’t have time to read through the whole thing. It’s fascinating. I’d love to do that. I just don’t have the time. So listening in the car has been a great way to stay up to date on these things—no pun intended.

Dr. Domino: No pun intended. In my private practice days, there is no way I could keep current. And that was in the ‘90s before technology was bringing us so much information. And the number of medical journals has almost doubled in the last 30 years.

There’s just so much information. If it wasn’t for having some time bought out by the five-minute people plus Pri-Med—they actually give me almost two days a week that I can spend getting caught up on what happened and, when I don’t understand it, reaching out to my specialty colleagues.

The New American Diabetes Association guidelines came out this past year and some things made perfect sense, and a few other things seemed way out of left field. I was able to reach out to two different, nationally known colleagues in the world of diabetes, endocrinologists, and they were terribly helpful in me interpreting that data and then being able to share it with my peers.

But in private practice, there would’ve been zero time to have the opportunity to A) read the darn thing, it’s so long; and then B) track down somebody who is knowledgeable and say, “Hey, does this make sense?”

Dr. McDonald: Yeah, I love the fact that you can do that, you have the time, and then you can share it with all of us. I don’t know how many of the public listen to your podcast versus just physicians, but I think getting evidence-based, accurate information out to people is critical, especially in this day and age, when you have Google and social media and who knows what. Your focus is mostly on physicians and the physician audience, is that correct?

Dr. Domino: Well, it’s physicians and nurse practitioners and physician assistants. We do have some audience in the registered nurse world and in the PharmD world, but I’d say the vast majority are the physicians and the APPs.

That’s why, on my podcast, I have some physicians that I collaborate with, but I also have three nurse practitioners and one physician assistant and will hopefully have another one soon. They’re terrific. They bring a slightly different perspective to what I do and what I think about. They really appreciate being included, and they’ve expanded the audience. It’s been win-win-win.

Dr. McDonald: I think that’s phenomenal. I appreciate the breadth of healthcare perspectives in the whole team being involved there. What keeps you going? Why do you do this? Why is it important to make sure we get evidence-based, accurate information out there on a regular, ongoing basis?

Dr. Domino: We’ll talk about the diabetes guidelines again. The influences that led to some of their recommendations—some of them were based upon really strong evidence, and some were based on expert opinion driven by what’s happening in the world of pharma. The latter has been the case. When that happens, I like the opportunity to say, “Wait a minute, I have to at least look into that more.” I think my colleagues who listen to my podcast or hear me lecture appreciate someone culling through things and helping them either debunk misinformation or put new information in clinical perspective.

Probably now more than ever, there are so many ways people can get influenced and have their opinions swayed. I’ll tell you a quick story. A patient of mine came in; she and her husband are both my patients. They somehow were told that they needed to take vitamin D every day. Well, I’ve lectured on vitamin D, I write a chapter on vitamin D, and I’m like, “Oh, that’s great. How much do you take?” She showed me the bottle, and she was taking 50,000 international units every day.

Dr. McDonald: Daily? Wow, interesting.

Dr. Domino: The American Association of Clinical Endocrinology says 4,000 per day is the maximum studied. She was taking 50,000, more than 10 times the highest dose that was safe.

There’s very little literature on what to do with someone who has self-induced toxicity of vitamin D. We got her settled out, but here’s someone who’s potentially going to have years of stored up, fat-soluble vitamin, with who knows what sort of adverse outcomes, because they heard from a friend who saw an Instagram post that you should do this.

I feel like that happens to us and our colleagues as well, whether it’s at a conference or one of the 400 emails we get every day from a variety of sources that say, “Hey, do this.” The fact that I have the time and a little bit of training to figure out what’s good, and then share that information, is extremely rewarding. I get a great deal of gratification by saying, “I read that the guidelines say do this, but I wouldn’t do that.”

Dr. McDonald: Right. I think that’s extremely helpful because there’s data and then lies, right? And it just depends on how you slice it. I think knowing who’s presenting this information, where the funding is coming from, and where there are potential conflicts of interest are certainly something that we should all be aware of.

We all have biases, whether implicit or not. We try to accommodate for those biases when we do research studies and publications, but at the end of the day, I think we need to be more aware of where information’s coming from and who’s behind that information, not only as physicians, but as the public.

Dr. Domino: You bring up a great point, and you do this on your podcast in general, but before I went to med school, I worked for two years in a research lab at a very well-known medical school. Our lab did rat experiments on malnutrition, and we collected all this data. My researchers and the whole department would run all this data, and if they didn’t get good results, they’d run it a different way. Their goal was to get a couple of publications out of these experiments all the time.

I thought, whoa, wait a minute, that seems odd. It certainly made me a bit skeptical. The advent of looking at systematic review and meta-analysis level data—you can still get fooled by it. It’s not impossible. But it’s so much better than it was 30 years ago. But if you don’t have some opportunity and dedicated time, it’s very hard to keep up with that.

And your point about facts and non-facts, or facts and less-than facts, that quite honestly scares me. Right now, the United States has a whooping cough/pertussis outbreak like we’ve never seen. I would bet you’ve never seen whooping cough until just recently, if you have, and certainly the only time I saw it was in immigrant populations years ago.

We now have measles in the United States. I finished medical school in 1988. I’ve never seen measles, and we have measles in Worcester County now because people have decided vaccines are dangerous or bad for you. I’m really sad that people who are in leadership positions have felt comfortable endorsing misinformation and sometimes outright lies. I hope your audience, my audience, has the wherewithal to stand strong and keep focused on true medical data and support that in our patient care.

Thanks for listening. Stay tuned for next week’s episode. To hear more, follow PeerPOV: The Pulse on Medicine on Apple Podcasts, Spotify, or Amazon Music.

This transcript has been edited for readability.