In part two of their discussion, Dr. Alex McDonald and Dr. Frank Domino discuss how clinicians can leverage their roles as trusted professionals to ensure patients receive evidence-based medical information.

Dr. McDonald: As physicians, we’ve been trained to educate our patients one at a time. We need to think bigger picture. Now we need to think about how we not only educate our patients individually, but educate our health systems, colleagues, communities, or even our nation, especially with this little thing called social media. It’s so easy to get information out there, be it accurate or not.

Part of the reason I do this work and am talking to people like you is we need to make sure that all physicians, nurse practitioners, physician assistants, and nurses are empowered to 1) critically assess the information and know what they’re getting, and 2) speak up and share their voice as trusted professionals.

Nurses are the most trusted professional, I think across the board, followed closely by physicians. I think it’s in the 70% range in terms of overall trust as a nation. Members of Congress are in the single digits. We really need to use that privilege as a trusted profession to make sure we are spreading accurate, good information and raise concerns when we think that there is bad information being disseminated.

Dr. Domino: You bring to mind the need for us as clinicians to share good information, and certainly, you can do that one-on-one in your office. I’m not suggesting you do this, but one of my colleagues puts together a monthly newsletter and emails it to all his patients. I know a number of different physicians who set up a Facebook or Instagram page where, on a regular basis, they post something that’s happened.

I’m not saying everyone needs to do this, but certainly, as the week goes on, if you have three or four topics that you keep hearing about in the office, you could put together a short summary on those things, print them, and leave them in the exam room while people are waiting so that they’re not reading a magazine from 1998.

Recently, I had a person very hesitant to get the zoster vaccine. I asked them why, given they have a history of shingles already. They said, “Well, somebody that I work with had a cousin whose arm fell off.” And I’m like, I understand you heard this. I’ll be honest with you, when I got my vaccine—the first one, no problem; the second one, my arm hurt for days.

On the other hand, I’ve seen plenty of people with shingles. I often ask the patient, “Have you ever seen anybody with shingles? They’re miserable. If you’re one of those unfortunate people where the pain never goes away, there’s not really anything we can do with that.” So I like having that conversation.

I had a handout for the longest time that was myths and benefits of the zoster vaccine. I used to leave them in my exam room right next to the “how to find four minutes a day to exercise” and “best diet hints for weight loss” handouts. I left them out on my desk so that people had something to look at while they were waiting inordinately long because I was running behind.

Dr. McDonald: I think, to your point, there are so many ways to educate our patients. It’s not always one-on-one, and that’s not always the most efficient way to do it either. If you have a physician, colleague, or a younger medical student or resident who’s really interested in helping spread evidence-based medicine and science and accurate information, what recommendations do you have for them? Where do they start and how can they continue to grow and build those skills? I think these are all tools and skills that we really need, especially in this day and age.

Dr. Domino: Whether you’re any kind of physician, joining the ACP Journal Club doesn’t cost very much a year. They take a new publication and debate it a bunch. I don’t go to it as much as I used to in the past, but I found that to be a really good source of information.

If you’re a family physician, the American Family Physician articles are extremely well done. They grade every recommendation they make, and many of the recommendations are C level. They’re not like, “Oh, we know this to be true, or we know this not to be true,” but at least you know and have a framework to start.

The pediatrics publications have a similar construct, so in the primary care world, that helps. And I’d say that covers 80% to 85% of the way most people should keep up.

The New England Journal of Medicine publishes a journal watch where they review a paper, cover the abstract in a few sentences, and then give expert opinion right after it. That’s been a really interesting source for me to get information because you’ll read something, go “that’s interesting,” and then you’ll read the expert opinion and go, “that’s not a known fact.” It’s a great place to look to understand and interpret why that data came out.

If I was a new, young physician looking for where to start, I think those are great places. There are other resources as well, but I think until you have a good handle on information—every organization, including the American Academy of Family Physicians, has a daily email they send out. I’ll be honest with you, I look at it all the time, but sometimes there’s more headline than substance. I think the folks that pay for that email have some degree of a vested interest. So that may or may not be the best information, but it’s another way to keep up.

Dr. McDonald: I always think it’s interesting, too, when it comes to studies and the catchy headlines. Everyone’s after the latest, greatest thing, but the incentives are not aligned to confirm existing research. Everyone wants some new latest, greatest breakthrough that no one ever realized, but there’s no evidence in the value of recreating someone else’s work to prove that it’s actually accurate.

I think as a medical organization, we need to have more emphasis on that. It probably doesn’t sell as many magazines or get as many clicks or views, but confirming existing knowledge is something that I’m really interested in. Even if it’s not new, confirming what we already thought we knew or confirming what we know is something we should think about overall as a medical community.

Dr. Domino: You bring up a great point. Anyone who’s listening to this podcast has had the experience of being told, “This is the way to go,” and then some years later they say, “No, don’t do that.”

When I teach med students, I always present a case of a 68-year-old male who’s pretty healthy. He comes in asking, should he be on a baby aspirin every day? I send my students out there, and some Google search it, some use ChatGPT, some look in other online resources, and they all get different answers. And I’m like, yeah. In 2010 we all said, “Oh, you got to do this,” and then were like, “Oops, killed more people doing that. Sorry.”

It’s an interesting world. Being a skeptic is very easy, but the opportunity for someone to recreate or repeat that data is so important. That’s where systematic reviews come in. Someone says, “Let’s take a treatment and look at all the literature on this, not just what got published, but what wasn’t published.” Our hospital librarians tell us about 40% of the randomized controlled trials that are listed in the public domain never get published—40% of the trials, because there’s no incentive for them to publish. It didn’t work.

Dr. McDonald: It didn’t sell journal articles or online clicks or whatever. Right.

Dr. Domino: You’re even more cynical than me.

Dr. McDonald: Hey, well, again, let’s just be honest about where we’re coming from.

So, what’s next for you? I’m curious. You’ve done so much amazing work, and I love hearing you speak every year at some of the national meetings. Give us a sneak peek behind the curtain. What’s next for the great journey of Frank Domino?

Dr. Domino: For the last 20+ years, I’ve been trying to teach myself watercolors. I have the artistic ability of a second grader. As I get closer to retirement, I’m thinking about trying to get a little more art in my life. I love going to art museums. My wife and I belong to a variety of them. I never looked at art before, and I really have come to appreciate that. No one’s going to see my art hanging in any museum anytime soon, but I feel like our work is so consuming, and so to have another outlet is probably going to be the next big thing for me.

I’m still trying to develop technology for well over 18 years. I’ve enjoyed trying to help people lose weight and exercise, and there are so many cool apps that can help people. I came close to coming up with a whole concept that was completely covered by insurance that I thought was going to be wonderful. It was going to help us as clinicians get reimbursed for our time and energy and help people lose weight. But like most pieces of technology, the funding to support it disappeared, and the process has dwindled. If I could resurrect that piece of it, I would.

My daughter’s an adult and well on her way. She doesn’t need help from her family anymore. My wife and I are approaching retirement. I think I need to do a little bit more community work. I’ve done a fair amount of board work, a little bit of volunteer work, but recently one of the medical directors of the free clinics here in Worcester passed away suddenly. I ran a free clinic for two years here back in the early 2000s. I think I need to try to get more involved with them because I’m personally frightened about what’s going to happen in the next few years in our country with regards to healthcare.

I feel like we’re going to go back to the days where those who are marginalized have less healthcare, and we, as a population, are going to suffer. Life expectancy in the US is still five years less than our neighbors to the north in Canada or our friends down under in Australia. Five years. We’re not talking weeks or months. I’m really fearful that’s going to get worse, and the thing that’s going to bring us down, the thing that’s going to hurt the population the most are inadequate services and care for the underserved.

Dr. McDonald: And we know we can’t just segment, right? If there’s an outbreak of a communicable disease in a population that doesn’t have access, we know that’s going to impact everyone. It’s not just the haves and the have-nots, because we’re one community, locally and nationally and globally. As the COVID-19 pandemic taught us, no one is immune or isolated from community health. We’re all in this boat together.

Dr. Domino: Yeah.

Dr. McDonald: Well, this has been such a phenomenal conversation. I really appreciate all your perspective and everything you’ve done thus far in your career to help others. Last question here. This is always the question I end on. What makes you most proud to be a physician?

Dr. Domino: I tell my med students this when I give them the orientation to the family medicine clerkship. I always say I’ve been the most fortunate person I know. Early in my days here in Massachusetts, a baby was born and developed fever on day 8 of life. I had to put the baby in lumbar puncture, calm the family down, and I’ve taken care of her since.

She’s in her twenties now. I saw this child a great deal in her first few years of life. When she was five, she came in for her physical and invited me to come to her birthday party. I was like, “Oh, thank you. I can’t make it.” I sent a little gift.

But I’ve been invited to a five-year-old’s birthday party. I’ve been a pallbearer twice at my patients’ funerals. I’ve had these relationships with people where I feel like I’ve been a big part of their life and they’ve been a big part of mine. When those opportunities happen, when people express their interest and thanks for my care, it just makes me feel like, wow. All the frustrations with documentation and billing and RVUs and going to meetings about silly stuff—they become insignificant because you’ve touched one life.

There’s a great poem by Emerson. It talks about being successful and what it means to have succeeded: if you can make one person breathe a little bit easier. We get that opportunity, multiple times every day when we interact with our patients, to relieve their anxiety. You can’t cure their cancer or prevent their stroke, but you can help address their concerns. Maybe they’ll live longer, maybe they won’t, but if they live better because of your presence, that’s really amazing.

Dr. McDonald: Amazing. Perfect note to end on. Frank, thank you so much for joining us. We greatly appreciate all you’ve done. I continue to listen to your podcast and enjoy your presentations, and I’m going to sign up for a ACP Journal Club. That’s a great piece of information, a great pearl. Thank you so much for your time. This has been phenomenal.

Dr. Domino: Alex, you’re wonderful. I love following you. I love the fact that you’ve curated this huge audience. You’re doing a great public service, and to everyone listening, thanks for all you do. Take care now.

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.