Pediatrics and Common Sense w/ Dr. Thomas J. McDonagh Jr.

Episode Information

August 12, 2021

Pediatrician Dr. Thomas J. McDonagh Jr. talks about his early interest in pediatrics, the role religion plays in his life, his approaches to treating patients, how sometimes doing nothing is the best medicine, and more.

Topics Include:

• His interest in pediatrics from a young age
• How he incorporates faith into his life
• His own approaches to being a pediatrician
• How he applies pediatrics to parenting
• Advances in pediatrics
• How no treatment can be the best treatment in some cases
• The importance of factual information in medicine
• His goals for Doctorpedia’s Pediatrics channel as CMO
• What he does to stay healthy

Highlights

• “The college I went to, Haverford College, was founded by Quakers. I think, looking back at my upbringing, both through Catholic education as well as the Quaker exposure that I had in college, that that probably had a lot to do with [my passion for service].”
• “I go to church most weeks. To me, it’s just a time to be by myself and my thoughts and to think about how my week and my month has been going. So I am still religious in that sense, but to me, the tenets of Christianity and the morality of it are the things that stay with me more.”
• “I think what makes a good pediatrician a good pediatrician is availability and accessibility.”
• “In this day and age, many parents currently use a lot of social media platforms and physician rating programs. And I think you have to take those with a grain of salt because sometimes that information isn’t a hundred percent valid or accurate in many cases, but like many things in life, you find the people whose opinions you trust.”
• “Over time, pediatricians all find their own particular tricks of the trade. So to me, a lot of it is how you relate to the child.”
• “I would say trust is probably number 1, 2, 3, 4, and 5 in order for my patients, presumably when I see a patient and determine the treatment plan is necessary for a particular condition, I believe that my treatment plan is appropriate. It’s only gonna work if the patient and family believe me, trust me, and go out and act upon the treatment plan.”
• “There’s good studies to show that in certain age groups, as many as 80% of ear infections will go away with doing nothing. So I think if anything, over time, we’re learning that sometimes doing nothing can be actually as helpful as doing something, which is hard for doctors.”
• “My goal and my interest in participating in the Doctorpedia project is I think over my 30 year career, that I have developed a certain amount of experience. And I think I look at my role as a pediatrician to be the deliverer of common sense.”
• “So I think that there is room in the [healthcare] space, so to speak, for there to be information that is based on scientifically valid information, but is delivered in a common sense way. Our goal is to provide information that [parents] can then bring to their healthcare provider and ask questions and be able to come up with decisions as to how they want to impact the health of their children, but hopefully doing it coming from a place where they started with information that was correct and valid.”
• “I try to be a role model for my own children. I won’t pretend that I have the healthiest diet. I try, but I am known to have somewhat of a sweet tooth, but I try to find the right balance of good nutrition and exercising regularly, which I do. I really do schedule good sleep into my schedule, which is probably something not a lot of adults do, but there’s so much science around the value of sleep that I think that’s important. So again, role modeling for my own children, as well as obviously teaching patients the right way to create healthy lifestyle choices, I think it comes down to those things of nutrition, exercise and sleep are kind of the mainstays of being healthy.”

Relevant Links

• Doctorpedia Spotlight Interview
• Doctor Profile

Episode Transcript

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only, and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.

Daniel Lobell: (00:22)
Hello, and welcome to the Doctorpedia podcast. I’m your host Daniel Lobell, and I’m honored today to be speaking with Dr. Thomas McDonagh. How are you?

Dr. Thomas McDonagh: (00:30)
I’m great. Thank you.

Daniel Lobell: (00:31)
It’s a pleasure to have you on the show. You are, I believe the second pediatric doctor that I’ll have interviewed for Doctorpedia. So I’m very interested, I feel like I have a slight background for once when I’m talking to the doctor in what you do, but of course it’s only just a taste and I’m excited to hear much, much more. Before we go into any of that. I always ask the doctors a little bit about their background. So let’s start with where you grew up.

Dr. Thomas McDonagh: (00:58)
Sure. I grew up on Long Island in a very small town, Bellerose Village. Small meaning there were probably about 300 or 400 families in the entire town. I lived there pretty much throughout my entire childhood. I actually was born in New York City, moved to Pennsylvania between the ages of one and four. So my family moved to Bellerose Village.

Daniel Lobell: (01:20)
That’s a big move for a child. You must’ve been a very bright kid to orchestrate such a thing.

Dr. Thomas McDonagh: (01:27)
[Thomas laughs] I kind of forgot the part of my life in New York City and Pennsylvania, I don’t have too many memories of that part. So pretty much I consider the majority of my childhood to have been on Long Island.

Daniel Lobell: (01:38)
Right. I have a similar background. I’m also originally from New York city and my family moved to Long Beach, Long Island right before I turned six. So I also grew up on the island. How’d you like it? Did you like Long Island? Were you a fan?

Dr. Thomas McDonagh: (01:54)
Yeah, I did. I live on Long Island now, so I made the decision to come back and raise my family here. So yeah, I have a really fun memory of my childhood, where I grew up and I live on Huntington now, a little bit different part of the island, but I still am a big fan of Long Island. Absolutely.

Daniel Lobell: (02:13)
Yeah. Huntington’s really nice. And a final stop on the LIRR I believe.

Dr. Thomas McDonagh: (02:18)
It is for one section. I have the luxury that my work commute is only three and a half minutes by car. So I actually don’t spend too much time on the LIRR, but getting into the city from Huntington is pretty easy, absolutely.

Daniel Lobell: (02:32)
See, Long Beach is also a final Long Island Railroad destination. So those are the good ones where you can fall asleep on the train if you’re ever coming back from the city.

Dr. Thomas McDonagh: (02:43)
[Thomas laughs] And not worry about it. Absolutely.

Daniel Lobell: (02:45)
Yeah. Unless you sleep so soundly that when you get there, you’re still asleep and then it takes you back to the city and you’re like, “What happened? We never left?” But I think that’s probably pretty rare.

Dr. Thomas McDonagh: (02:55)
A little bit safer than falling asleep on the subway in New York City, so…. You never know where you’ll end up if you fall asleep on a subway car, but at least on the Huntington branch, the LIRR is pretty safe.

Daniel Lobell: (03:07)
Yeah. They still have those big, comfy red and blue chairs?

Dr. Thomas McDonagh: (03:11)
On the LIRR? They actually, they’ve redone a bunch of the cars. I think they redo equipment over time. So it depends a lot on which train actually comes through, and the time that you’re getting on.

Daniel Lobell: (03:23)
Fair point, I guess that’s inevitable. So you never left Long Island or did you leave and come back?

Dr. Thomas McDonagh: (03:30)
I did. Actually, so I went to college in Pennsylvania. I went to medical school at Columbia in New York City. So I came back to New York then, and then I did my pediatric training in Pennsylvania. So I lived in Philadelphia for four years. And then after I got married, my wife and I came back to Long Island and I have been living and working on Long Island for the past 30 years.

Daniel Lobell: (03:53)
One thing that I thought was very interesting reading up on you is that you said you knew you wanted to be a pediatrician from the time you were in eighth grade.

Dr. Thomas McDonagh: (04:01)
Yeah.

Daniel Lobell: (04:02)
That seems like a rare goal for an eighth grader, but perhaps not. Is that typical when you speak to other pediatricians?

Dr. Thomas McDonagh: (04:09)
Yeah, I would say it’s definitely not typical. I mean, just knowing you even want go into medicine when you’re in eighth grade, you’re 12 or 13, is pretty unusual. And even for people who kind of have a sense that they might want to be a doctor, to already have decided what kind of doctor at such a young age is unusual. And when people ask me, “How could that be?” I don’t really — I actually don’t have an answer. A lot of people in medicine have a role model or somebody who they kind of knew when they were young, they may have had a pediatrician that was a role model. And my pediatrician wasn’t my role model in any way whatsoever. I actually only saw my pediatrician every year or every other year. My dad actually was a physician, but he actually was in corporate medicine. He practiced for a very short period of time. And he actually spent the majority of his career working for Exxon, eventually becoming the medical director and vice president of the company. So although he was a role model in other aspects of my life, he really wasn’t a role model as a practicing physician specifically.

Daniel Lobell: (05:12)
What is the head medical officer at Exxon? Is that like if there’s a gas explosion?

Dr. Thomas McDonagh: (05:19)
[Thomas chuckles] So when I was growing up and my mom told me my dad, or my father told me he worked for Exxon, what I thought that meant was that if somebody was driving into the gas station and ran into the gas pump, he would kind of run out with his little black bag and he was the doctor who would take care of them. [Daniel chuckles] So that’s not exactly what he did. So in corporate medicine, he was in charge of creating corporate policy in terms of employee health, as well as making decisions about the company’s health policies related to product development, a bunch of other things. So it was very much a corporate governorship kind of role… Although he did provide some direct medical care to some of the employees, it was really more of a corporate governance role than it was an actual delivery of medical care role.

Daniel Lobell: (06:07)
That’s interesting.

Dr. Thomas McDonagh: (06:09)
Yeah. So kind of going back to how I knew I wanted to be a pediatrician when I was in eighth grade, I don’t really know why. I just have a strong recollection and certainly throughout high school and college, kind of tested that, there certainly were other things I thought of doing, but medicine really was the career pretty much throughout my high school / college years that I really always came back to that interested me the most.

Daniel Lobell: (06:32)
I wonder if you were on the playground, looking around at the other kids and being like, “These kids are not being well taken care of. I think I could do better.” [Both chuckle] “Who’s your doctor?”

Dr. Thomas McDonagh: (06:42)
I don’t have that memory, but yeah, who knows? So it could have been handed out like cards back then, but…

Daniel Lobell: (06:47)
It might be more common for a kid to say I want to be a doctor, but for a kid to want to be a pediatrician specifically, I think is kind of funny.

Dr. Thomas McDonagh: (06:53)
Yeah, I agree. It’s definitely out of the ordinary. And as I said, I don’t really have a clear explanation for why, but I guess it stuck.

Daniel Lobell: (07:00)
“You gotta get that cough looked at, Jimmy. You know what, I’m going into medicine for, for kids. That’s it.” [Thomas chuckles] So you mentioned in an interview that I read that you had a Catholic upbringing and you were also fairly influenced by Quaker principles and that instilled a passion for service in you. Can you talk a little bit about that?

Dr. Thomas McDonagh: (07:20)
Sure. Yeah. So the Quaker influence was a college that I went to, Haverford College, was founded by Quakers and currently does not have a formal role within the Quaker religion, but still, a lot of Quaker traditions are still a part of the way that the school is run and the way that the student body runs itself. My favorite memories of college come back to a very strong honor code, which is kind of based in a lot of Quaker principles, as well as the principles of service. So throughout my adult years, I have tried to give back into my community in many ways. I’ve served in many volunteer organizations, a lot of youth sports activities. I was on my school district school board for nine years. I’ve served as an officer in different community organizations. And I think, looking back at my upbringing, both through Catholic education as well as the Quaker exposure that I had in college, that that probably had a lot to do with it.

Daniel Lobell: (08:24)
Was it a big oatmeal cafeteria scene there?

Dr. Thomas McDonagh: (08:24)
[Thomas laughs] You would think, but no, I don’t think I had any oatmeal in college whatsoever. And they didn’t have that guy with the Quaker hat either on campus.

Daniel Lobell: (08:37)
Oh, too bad, that wasn’t the Dean?

Daniel Lobell: (08:42)
[Both chuckle] So you had a pretty good idea of what you wanted to do since you were a kid and you wound up following that. Unlike me, I didn’t wind up becoming, I don’t know, a lot of the crazy ideas I had when I was a kid. One of the more normal ones being a veterinarian. But it sounds like you have incredible follow-through. Like you knew what you wanted to do. You set your goals on it and you stayed the course. Is that a correct assumption or were there times where you just were like, “Nah, I’m done with the doctor thing,” and you came back to it.

Dr. Thomas McDonagh: (09:11)
You know, the time that you have to really kind of make a commitment that that’s the path you want to take is towards the end of college, when you have to really firm up and kind of go down the path of the application to medical school and taking standardized tests. And there really wasn’t a firm commitment in my mind until probably halfway through college, that’s for sure that’s what I was going to do. The famous question is if you didn’t do what you currently do, if I wasn’t going to be a doctor, what would I have done with my life? And when I was growing up, like most kids, I had fantasies about being a professional athlete, certainly, and I played a bunch of sports growing up. I was never good enough, that was kind of really the reality. But outside of that, to me, much of being a physician is about being an educator.

Dr. Thomas McDonagh: (09:58)
And probably I would have gone into some form of being an educator if I didn’t end up being in medicine. I always tell the story, if you ask my mother what I should be, she wanted me not just to be a priest, but to be a Bishop because it wasn’t good enough to be just a priest. I would actually have to be the Bishop, of course. So I guess I was under some pressure when I was young to do that, but I never really gave that particular thought any serious credence over time. Yeah, I kind of was committed to medicine and had other thoughts, but it always came back to that as really being for me the best combination of what I think my talents are, what my interests were in terms of science, being in medicine gives me an opportunity to provide service and it gives me an opportunity to educate on a regular basis. That kind of combines a lot of the different components of what I thought I wanted to do as I got older.

Daniel Lobell: (10:49)
Does faith still play an important role in your life?

Dr. Thomas McDonagh: (10:54)
It does. Not in a very pious way. I actually do go to church most weeks. To me, it’s just a time to kind of be by myself and my thoughts and to think about how my week and my month has been going. So I am still religious in that sense, but to me, kind of the tenets of Christianity and the morality of it are probably the things that stay with me more, rather than the pious acts of being a Catholic really aren’t — the entrapments of Catholicism aren’t that important to me. But I think the tenets of Catholicism and Christianity are important to me.

Daniel Lobell: (11:27)
As a father yourself, do you find that you apply many aspects of your profession to your own family? And if so, what are they?

Dr. Thomas McDonagh: (11:35)
Oh sure. So I have four kids. They’re not really kids — my children range in age from almost 16 to almost 30. So they have been my experiment over time, as I freely tell them and admit to my patients. So that’s kind of interesting, when you start in a specialty like pediatrics, when you finish your training, there’s lots of things you’re really good at. So when I started being a pediatrician in practice, if you needed to be resuscitated in my office, if you needed to have a central line put in, if you needed to be intubated, those are all the really good things that you’re trained to do when you’re in hospital-based training. But in general pediatric practice, obviously you don’t really do that. So the questions that a lot of parents are asking, “How old should my child be when I buy shoes for him, how do I get my child to sleep through the night?” You actually don’t learn any of that when you’re in training. So a lot of that is kind of an acquired wisdom that you develop over time. And being a parent has been a huge source of that opportunity for me to test different ideas. So I use a lot of my parenting experience in how that I approach teaching parents in my practice, how to raise their children, being a parent, I think has helped me significantly be a good pediatrician.

Daniel Lobell: (12:55)
What advice would you give people who are looking for a pediatrician for their kids? What should they be looking out for?

Dr. Thomas McDonagh: (13:02)
Yeah, so I think what makes a good pediatrician a good pediatrician is availability and accessibility. So parents have questions. They have questions 24/7. So obviously you can’t be available to every family 24/7, or you couldn’t have your own personal life.

Daniel Lobell: (13:21)
Why not?

Dr. Thomas McDonagh: (13:21)
[Both chuckle] Well, you could try… My wife might have a different viewpoint on that, but being available, being accessible is extremely important. You don’t have to be — the famous expression, you don’t have to be a brain surgeon, you don’t have to be the smartest person in the world, but you have to be smart enough to be able to figure out certain things, but I think you need to be relatable. And I think that what parents want is somebody who has common sense. How do you pick a pediatrician who has common sense and who is available? It’s really hard to do that by opening up a book and there’s your managed care plan and there’s 20 choices.

Dr. Thomas McDonagh: (13:54)
So how would you know which of those pediatricians are going to have those characteristics? So it’s really about doing your homework, and your homework means talking to neighbors, talking to work colleagues and asking those kinds of questions. If you call, does your pediatrician call you back the same day or do they call you back like in a week? If you call and you have a question, does the pediatrician call you back or does the receptionist call you back? If your child is sick, will they see you the same day, or do they tell you “No, I’m going home and having dinner and I’ll see you tomorrow?” So there are things you can easily ascertain by gaining the experience of people who you trust. In this day and age, many parents currently use a lot of social media platforms and physician rating programs. And I think you have to take those with a grain of salt because sometimes that information isn’t a hundred percent valid or accurate in many cases, but like many things in life, you find the people whose opinions you trust, whether those, again, be neighbors or work colleagues, and if 10 people in your community go to the same pediatrician and 9 out of 10 say they love that pediatrician, that’s probably a good place to start in terms of finding somebody.

Daniel Lobell: (15:06)
What have you found in your years of practice that have been sort of tweaks that you’ve made to your own style that have been most helpful or have best facilitated you to become the doctor you are today?

Dr. Thomas McDonagh: (15:22)
Great question. I think pediatrics itself has evolved significantly over 30 years. And I look in the past five years specifically, as the biggest change is a huge emphasis on the behavioral health needs of children and young adults. So certainly if I look back 10 years or so ago, when I would see patients for routine exams, the amount of time I would spend asking questions about their mental and behavioral health, whether they’re anxious, whether they’re depressed, whether they’re sad, peer relationship issues…. Didn’t spend a lot of time on that. It was really more nuts and bolts, you know, “Do you eat healthy? Do you exercise? Are you brushing your teeth?” But I think because of the epidemic of behavioral health issues in young adults and children, it certainly has become a significant part of my practice now. And something that I’ve had to educate myself about in terms of how to address my patients’ needs, but a focus on that has been a significant change recently in the way that I practice and approach patients.

Daniel Lobell: (16:27)
Are we talking specifically with regards to like ADHD or autism or is there a broader spectrum of…

Dr. Thomas McDonagh: (16:36)
Yeah, so generally, behavioral health for the most part in pediatrics, I would say the main three diagnoses that fall into that would be ADHD, depression, and anxiety. And then there’s kind of permutations of those things, clearly a whole nother area are areas of developmental concern. So that would include autism and other issues around abnormal developmental milestones, et cetera. So that too has required a re-education of myself and fellow pediatricians to understand how to better make early diagnosis and to refer patients on for specialized care when it’s necessary. Certainly autism existed 20 years ago, but the increased incidence and increased appropriate attention to early diagnosis and early treatment over the past 10 years certainly has made that as well as approach to behavioral health, the approach to developmental concerns consumes a lot more time in practice than it did 10 or 20 years ago

Daniel Lobell: (17:33)
With all the advances in medicine, how far away do you think we are from them not having to put the wooden stick in the kid’s mouth and say, “ah?”

Dr. Thomas McDonagh: (17:43)
Aha. Really good question. So actually my trick to doing that, it’s actually not even the wood stick. I hardly ever use the wood stick except for a newborn. And I don’t think they have sophisticated enough taste buds to know what I’m doing, but strep testing is one of the big things that there was a great fear of among children, so one of my tricks that I have acquired over time is to invent flavored Q-tips so I can convince many five and six year olds that I’m going to actually give them a chocolate Q-tip and it actually works pretty well. I’ve actually had a couple of college students come back to me and ask me why, when they went to student health, the student health doctor in the infirmary didn’t have the same chocolate Q-tips that I did.

Daniel Lobell: (18:21)
[Daniel chuckles] You gotta patent those.

Dr. Thomas McDonagh: (18:24)
I didn’t feel it was time to burst their bubble to let them know I had been leading down the wrong path for so many years, but I let that slide.

Daniel Lobell: (18:31)
What are some of the tricks you use — that’s a good one right there. What are some other tricks you use to help relate to children when they come into the office?

Dr. Thomas McDonagh: (18:40)
Yeah, so I mean over time, I’d say pediatricians all find their own particular tricks of the trade. So to me, a lot of it is how you relate to the child. So depending on their comfort level in the exam and their age, it just starts with something as simple as, where does the child sit during the time that I examine them? For younger kids, I never have them sit on the exam table. They always sit on their parent’s lap and I can examine them in that position virtually as well as I can on an exam table. So I’ve done that until kids are 7, 8, 9, 10 years of age, sometimes until they’re totally comfortable sitting by themselves. So a lot of it is gaining trust. So having them feel more comfortable in the environment, in the exam room, and then we all have our other tricks in terms of things like pretending that Q-tips are flavored or looking for things in kids’ ears. And there’s lots of different kind of comedic interludes in the course of a pediatric exam that are often necessary to make kids more comfortable, because if they’re screaming and uncomfortable, it’s difficult to kind of collect the information that we need to, either verbally or through physical exam.

Daniel Lobell: (19:57)
Yeah. I imagine you do have to have a good sense of humor for the job.

Dr. Thomas McDonagh: (20:01)
You do, and you have to not take yourself too seriously because kids will usually put you in your place pretty quickly and being peed upon and puked upon periodically also gives one a good sense of one’s worth in the office. So yes, it’s important not to take yourself too seriously during the course of the day.

Daniel Lobell: (20:17)
How many siblings did you grow up with?

Dr. Thomas McDonagh: (20:19)
Two brothers, two sisters. I was actually the famous middle child among the five of us.

Daniel Lobell: (20:23)
Huh. Well, had you said you were the oldest, I might’ve thought that might’ve been the impetus for you becoming a pediatrician because you’d want to take care of your younger — although you do have younger siblings.

Dr. Thomas McDonagh: (20:35)
Yeah. So we’re actually somewhat evenly spaced out among the five of us, but no, that wasn’t the trigger. You’re going to still try and figure out why it was that I knew I wanted to be a pediatrician so young.

Daniel Lobell: (20:46)
Well, yeah, it’s such an interesting puzzle to try and put together. Because for a child to want to treat children is interesting. But what are you think are some of the main challenges that being a pediatrician poses as opposed to being a general care physician for adults?

Dr. Thomas McDonagh: (21:03)
Yeah, so I think maybe two things. So one is that, as a pediatrician, you actually have two patients. I have the child or the young adult that we actually, in my practice —

Daniel Lobell: (21:14)
Let me guess, and their imaginary friend? [Daniel chuckles]

Dr. Thomas McDonagh: (21:17)
Uh, no, actually sometimes we do take the stuffed animal friend that comes along for the ride.

Daniel Lobell: (21:21)
I think you’re gonna say the parent. [Daniel chuckles]

Dr. Thomas McDonagh: (21:24)
The parent, that’s right. And the parent is a much harder patient than the child probably 99 out of a hundred times. And it would not be unusual for me to spend the majority of time speaking more to the parent and kind of allaying the parent’s fears and trying to address the child’s needs in any specific way. So that creates sometimes a conflict in the sense of, especially as you’re looking at school age and older children, their agenda and their needs are a little bit different than the concern and the need of the parent. So when you’re looking at kids 14, 15, and 16, who are clearly independent in their own mind and fully able to express what their desires and their needs are, and that often does conflict with parental needs and desires, especially as children are kind of flexing their muscles of independence.

Dr. Thomas McDonagh: (22:14)
So that’s definitely one thing in pediatrics that’s clearly different. And you could argue, maybe if you have very elderly parents, which I do. So if you’re going to a geriatrician with your senior citizen, very elderly parent who maybe has some form of dementia, probably almost reenacts itself in that same way in adult medicine. And then for younger kids, the issue is that history is difficult to obtain, obviously. So how do we make decisions in medicine? It’s a combination of taking a good history, doing the physical exam, using laboratory information and data that we objectively can collect. But if you’re evaluating a two week old, it’s a guess what the child’s feeling obviously. So it makes things a little bit harder than if it’s an older child or an adult, or you can rely on a report of the way that they’re feeling as additional information to figure out what’s wrong.

Daniel Lobell: (23:07)
Right. What are some of the advances that are happening right now in pediatric medicine that you’re most excited about?

Dr. Thomas McDonagh: (23:14)
Advances in pediatric medicine? So, I mean, certainly immunization is, for a pediatrician, one of the most important tools that we have to maintain health. There are new immunizations that come out periodically, obviously getting into the whole COVID discussion, which vaccination in some of my patients is possible at the moment. And hopefully more over time will be. But if you look at emerging infectious diseases as a public health threat, certainly the huge benefit of immunization for both emerging infectious disease as well as previously existing infections for which vaccinations become available is old news because we’ve used vaccinations for so many years, but more vaccinations coming out is certainly a great tool for general pediatricians. And I think the attention to behavioral health and the way that behavioral health care is integrated into primary care is probably something that is emerging and still is not necessarily always done a hundred percent well, but is getting much better year to year.

Daniel Lobell: (24:26)
Can you go into that a little bit more?

Dr. Thomas McDonagh: (24:28)
Yeah. So if you look back, say, two years ago, when, before, when I saw patients in my office who had attention problems or depression, I would say, “Mrs. Jones, I think Johnny is depressed.” And I’d give you a list of psychologists to make an appointment with. And unfortunately, delivery of mental and behavioral health care in the United States is difficult in many ways. Accessing a specialist who has an appointment who participates in one’s insurance plan can be difficult. Often the outcome of that would be, Mrs. Jones would try, but wouldn’t get an appointment, and her son’s needs would never be met because they weren’t able to get an appointment with an appropriate specialist. More and more, behavioral health teams are incorporated into primary care offices. So in my office, we actually have a licensed clinical social worker who can directly interact with patients, provide therapy and connect patients to resources in the community when those are necessary. So it really brings the ability to deliver care for those who need such care much more efficiently than we were able to do before.

Daniel Lobell: (25:41)
You know, it’s funny, as you’re talking about this, I’m thinking back to an old friend of mine from the New York comedy scene named Steve Marshall, who, he’s a comedian and his slogan is “Don’t behave.” I wonder if he’d be a useful countermeasure for you to have to go up against. [Both chuckle] Yeah, it’s funny. Some people are still fighting the behavioral battle even into adulthood. What do you think are the most important facets of the doctor patient relationship?

Dr. Thomas McDonagh: (26:13)
I would say trust is probably number 1, 2, 3, 4, and 5 in order for my patients, presumably when I see a patient and determine the treatment plan is necessary for a particular condition, I believe that my treatment plan is appropriate. It’s only gonna work if the patient and family believe me, trust me, and go out and act upon the treatment plan. So that’s something as simple as, they think, a parent that their child is seriously ill and I don’t, and they have to trust that I know what I’m talking about and not run to the emergency room if I tell them that I don’t believe that it’s necessary. Something as simple as your child has an ear infection and they should take an antibiotic. Well, antibiotics, aren’t always good for you. So they really, they have no idea if their child has an ear infection so they have to trust that I am able to make that diagnosis accurately.

Dr. Thomas McDonagh: (27:13)
And then it extends to other things that are more significant in terms of issues, again, around behavioral health and those kinds of things, as kids are getting older where the repercussions of not treating certain conditions appropriately are more significant than a simple ear infection might be. And takes time, and that’s the value of being in primary care is I see my patients until they’re 22. I’m now old enough, sad to say, in my career that I take care of children of patients I used to take care of when they were kids and teenagers, which is a pretty cool thing.

Daniel Lobell: (27:49)
Yeah, I think it’s pretty cool.

Dr. Thomas McDonagh: (27:50)
Well, that’s clearly a sign of trust that not only did they trust that I took care of them, but they’re bringing their own child to me so many years later. But again, I think in less than a family and you need to earn that trust. It’s not certainly given to you. Without that trust I think that being able to be effective as a physician is difficult.

Daniel Lobell: (28:11)
Yeah. You mentioned ear infections a lot. And as you talk about it, I think back to my own childhood and my brothers, my younger brothers, and I remember yes, ear infections were a big thing when you’re a kid. Have there been any advances with regards to treating children’s ear infections or minimizing them? Because it seems to be almost an epidemic for children.

Dr. Thomas McDonagh: (28:33)
So actually, perhaps the revolution that is taking place is no treatment for ear infections and perhaps we were over-treating. So I think back early in my career, the treatment plan was, you were given antibiotic after antibiotic, and if you had two or three ear infections, you’re actually put on preventative antibiotics. So it was not unusual for kids to be on antibiotics like for three months in a row to try and prevent another ear infection. So certainly over time, physicians have learned that overuse of antibiotics has a significant downside. So there are now more tough standards in terms of the diagnosis of acute ear infections, as well as indications for when antibiotics are necessary and clear treatment plans that are actually not prescribing an antibiotic. But the treatment plan is observation since there’s good studies to show that in certain age groups, as many as 80% of ear infections will go away with doing nothing.

Dr. Thomas McDonagh: (29:33)
And just recently there was a study published just a week or two ago that one of the treatments that probably you remember many of your friends experiencing is having tubes put in their ears, which is a surgical procedure that is, and was, the most common surgical procedure for children in the United States year after year. And they now have determined that in the way that the study was performed, that children who were not treated with tubes in their ears pretty much had a similar outcome to the children who did have surgery. So it kind of questioned the whole validity and value of doing such a procedure. So I think if anything, over time, we’re learning that sometimes doing nothing can be actually as helpful as doing something, which is hard for doctors.

Daniel Lobell: (30:19)
Yeah. I was gonna say, more breakthroughs like that and you’ll be out of business.

Dr. Thomas McDonagh: (30:23)
Exactly. We’re all trained to do something. So you diagnose the problem and doing nothing is certainly kind of not in our toolkit typically, but sometimes I guess nature is a good and better feeler than anything that we can do.

Daniel Lobell: (30:35)
I may become a doctor if it keeps turning this way.

Dr. Thomas McDonagh: (30:43)
[Thomas chuckles] Just do nothing! [Both chuckle]

Daniel Lobell: (30:43)
Sorry, nothing we can do here. Have a nice day.

Dr. Thomas McDonagh: (30:46)
Yeah, and you put your sign up outside. I am Dr. Do Nothing, the best doctor in town. [Daniel chuckles]

Daniel Lobell: (30:51)
“This guy is really great. He really does nothing!”

Dr. Thomas McDonagh: (30:53)
Exactly! [Both chuckle]

Daniel Lobell: (30:59)
What do you wish your patients knew coming in?

Dr. Thomas McDonagh: (31:01)
Coming in to see me?

Daniel Lobell: (31:02)
Yeah.

Dr. Thomas McDonagh: (31:03)
I would say what I would like them to know is what sources of information they should trust. And this world we live in currently, whether it be social media or so many other outlets of news and information, the validity of much of that information is certainly in question. And I love having discussions with my patients about different topics in medicine and outside of medicine. And it’s difficult conversations to have when people come to it with pre-formed judgements based on information that I don’t really believe is valid. So the common discussion revolves around immunizations and vaccine hesitancy. And when families tell me, “Well, I don’t want to do the vaccinations that are recommended today,” and I ask why, and they tell me why, and often the information that they’re making a decision based on is just, at least in my experience, just factually incorrect.

Dr. Thomas McDonagh: (32:05)
I still remember one of my favorite discussions was a family that told me they didn’t want their child to get the polio vaccinations. And I said, “Well, why is that?” And they said, “Well, the vaccine doesn’t work.” And I said, “Well, what do you mean?” They said, “Oh, there’s no evidence that the vaccine works.” And I said, “Well, how do you explain in the 1920s that there was polio everywhere, and then the vaccine was invented and there isn’t polio anymore?” “Oh, it’s just a coincidence.” So it’s hard. And I understand how families struggle to try and find correct information and, what do I wish my families knew? I wish they would take the time to validate the information from which they’re making decisions about their child’s health and their own health.

Daniel Lobell: (32:48)
It’s a perfect lead in to get into Doctorpedia.

Dr. Thomas McDonagh: (32:51)
It is a perfect lead in because that certainly is the goal of Doctorpedia. It’s not to be the exclusive source of such information because there are plenty of sources of information out there on the world. We all have a different idea as to what is valid and correct, but I think there are some things that are clearly correct and some things that are clearly not correct. And in the world of social media, anybody has the opportunity to post information and to pretend that it’s factually correct when it may not be.

Daniel Lobell: (33:19)
Yeah. And with regards to the online health space, you do have so many people going on websites like — and not to single them out, but WebMD. And I bring that up because I used to do that, where they go and self-diagnose and before you know it they’ve got 10 different diseases before they even come and see the doctor. So you are now working as a CMO of the Pediatric channel at Doctorpedia, is that correct?

Dr. Thomas McDonagh: (33:45)
That’s correct.

Daniel Lobell: (33:46)
So what are some of your goals with that channel and what can we look forward to?

Dr. Thomas McDonagh: (33:51)
So I think that is my goal and my interest in participating in the Doctorpedia project is I think over my 30 year career, that I have developed a certain amount of experience. And I think I look at my role as a pediatrician to be the deliver of common sense. And I think that there is a role for answers to common questions from a common sense standpoint that parents are looking for, whether it be simple things like, how do you take care of a colicky one month old? How do you get a six month old to sleep through the night? What do you do if your two-year-old refuses to eat chicken and you want them to eat chicken…

Daniel Lobell: (34:35)
What do you do, by the way?

Dr. Thomas McDonagh: (34:35)
Very good question. Sometimes you don’t fight the fight when it comes down to. [Both chuckle] So I think that there is room in the space, so to speak, for there to be information that is based on scientifically valid information, but is delivered in a common sense way. And that is something that I think I’ve developed a fair amount of experience over the years that I think I contribute in that way, in terms of the goal of the Pediatrics channel between myself and the other pediatricians that will participate in delivering content. I think that that is our goal, is to really not make decisions because we’re not going to be the healthcare provider for people who read or review our content, but is to provide information that they can then bring to their healthcare provider and ask questions and be able to come up with decisions as to how they want to impact the health of their children, but hopefully doing it coming from a place where they started with information that was correct and valid.

Daniel Lobell: (35:40)
Yeah. Well that sounds pretty good. I think there’s an old saying, “Common sense is not so common or at least not easy to find.” So that’ll be nice to aggregate it to a channel where we can go as parents. I’m assuming that the channel will be geared towards parents, not towards kids, correct?

Dr. Thomas McDonagh: (35:56)
Yeah, so both, to some degree. So certainly we plan to develop a part of the channel for young adults, for themselves to be able to access their own information around questions that are pertinent to young adults, but much of it will be dedicated to providing information for parents and consumed by parents more so than the patient.

Daniel Lobell: (36:16)
It’s not going to be like a clown jumping out in there. “Hey kids, this is an ear infection!” [Daniel chuckles]

Dr. Thomas McDonagh: (36:26)
I don’t know, I have to see what our video team can do.

Daniel Lobell: (36:26)
It might be fun.

Dr. Thomas McDonagh: (36:27)
That’s not my skillset, but we’ll ask them if that would please you.

Daniel Lobell: (36:32)
[Daniel chuckles] Could be entertaining.

Dr. Thomas McDonagh: (36:33)
Are you volunteering to be the clown?

Daniel Lobell: (36:43)
I wasn’t, but negotiations can be made. [Both laugh]

Dr. Thomas McDonagh: (36:43)
Send me a video of you having done it. And we’ll see what we can do.

Daniel Lobell: (36:47)
[Daniel laughs] I’ll put it out on the back burner for now, but I appreciate the offer. Has COVID changed the way you practice and if so, how so?

Dr. Thomas McDonagh: (36:56)
Yeah. So COVID has been a challenge, obviously in so many ways for people, whether it be personal challenges, their personal health challenges, family health challenges, nobody obviously could have ever seen COVID coming and how it has changed the delivery of healthcare and the landscape throughout the country and the world. So in pediatrics a bunch of things have changed. So just the flow of the way that we see patients has changed, that we don’t have patients congregating in our waiting room. People now, I practice in suburbia, so people hang out in the parking lot in their car until an office room is available for them. So it’s changed a little bit in terms of the mechanics of delivering care. I think the one thing that has changed is the use of telehealth has obviously ramped up rather significantly because of COVID and how much that will persist post COVID, I think is debatable.

Dr. Thomas McDonagh: (37:53)
There is a role for it in pediatrics. Not a huge, huge role in my mind. A lot of pediatrics really needs to be, in my mind, hands on, and really being able to have more of a personal interaction than I’m comfortable doing by telehealth and video. But there are some simple things that you can do through telehealth. Actually, telepsychiatry is really, really common and effective. So going back to delivery of behavioral healthcare services, that’s something that telehealth is great for. So I think that is one thing that COVID will change going forward is how much telehealth we do. Outside of that I think that COVID kind of hopefully drifts into the background over the next year or two. I that for the most part pediatrics will return to the way that it was previous, other than the telehealth component.

Daniel Lobell: (38:42)
Yeah. How much of what you do — I kind of got a sense of this with regards to what you were describing when you talked about ear infections, but how much of what you do to treat patients these days is more naturalistic opposed to medication based?

Dr. Thomas McDonagh: (38:58)
Yeah. As I always say to people, my favorite prescription is reassurance, not an antibiotic. And that’s just based on the reality that in pediatrics for infections, the large majority are viral infections for which there is no medicine to cure it, with a couple of limited exceptions. So much of my day is really providing reassurance and trying to tell parents why they don’t need prescription medication and finding a way to let them know that their child will be fine, being very specific and letting them know what to expect, which I think is probably one of the most important things that a physician can do. So I will say, “This is your child’s second day of fever. Typically a virus will cause fever for four days. So your child should have no fever within two days. If your child still has a fever in two days, that is when you definitely need to reach out to me.” Actually kind of one of the things I am most known for in the community is I call all of my patients after I see them for a second visit to make sure that they have recovered fully which probably isn’t a routine across most physician practice patterns.

Dr. Thomas McDonagh: (40:03)
But to me, it’s a way to reach out. And my patients kind of are aware of that and know that I’ll be calling to check in to kind of make sure that the disease process did run its course when it should. And again, coming back to the trust issue, I think that kind of gives them a comfort level that they know that they’re not kind of out there on their own, trying to figure out if Johnny is getting better when Johnny should be. So letting them know what to expect and confirming that things improved when they should is a good way to be able to discourage patients from trying to access medication that their child doesn’t really need.

Daniel Lobell: (40:39)
Yeah. I think that’s a huge level of commitment that is rare to find these days. That’s a very nice thing to do. I wish my doctors would call me up and check in on me afterwards.

Dr. Thomas McDonagh: (40:52)
I don’t think that happens in adult medicine very often.

Daniel Lobell: (40:55)
I’d just like a phone call, for crying out loud. [Both chuckle] What is the greatest compliment a patient can give you?

Dr. Thomas McDonagh: (41:05)
I think in some ways indirectly, as I had said previously, now I’m at the point in my career where prior patients of mine trust me enough to bring their own children to see me. So kind of having people make it obvious that they have trusted me over such a long period of time probably would be kind of a nonverbal way of providing very positive feedback. Actually, I had a very interesting experience just about a week or two ago. A mother came to me with her newborn and she said, “You probably don’t remember me, but I was a nanny for a family. And I used to come to their appointments as the nanny of the children. And I knew that whenever I had a child, that you’re going to be the pediatrician.” And five years later, she did come to me in that role. So it is that kind of indirect feedback, that’s probably the best compliment.

Daniel Lobell: (42:00)
Actions speak louder than words. And speaking of actions, doctor, I’m going to wrap this interview by asking you what I asked all the doctors to wrap these interviews, which is, what actions do you take to stay healthy in your own life?

Dr. Thomas McDonagh: (42:13)
Yeah, great question. So I try to be a role model for my own children. I won’t pretend that I have the healthiest diet. I try, but I am known to have somewhat of a sweet tooth, but I try to find the right balance of good nutrition and exercising regularly, which I do do. I really do schedule good sleep into my schedule, which is probably something not a lot of adults do, but there’s so much science around the value of sleep that I think that’s important. So again, role modeling for my own children, as well as obviously teaching patients the right way to create healthy lifestyle choices, I think it comes down to those things of nutrition, exercise and sleep are kind of the mainstays of being healthy.

Daniel Lobell: (43:01)
Yeah. Well, what about for fun? What do you do?

Dr. Thomas McDonagh: (43:05)
Yeah, so the bad news about being a pediatrician is there’s not a lot of extra time in my life and my schedule, but when I am not working, I try and spend as much time with my family as I can. My three oldest children are now adults and not living at home. When they were younger there was certainly a lot of commitments of being with them. And as I had said previously, I’ve coached a lot of their youth sports. My daughter, who is almost 16, is still home. So I try and spend time with her. And outside of family time, I play sports still, as I’m getting older and my knee is getting more arthritic over the years, it’s a little bit harder, but…

Daniel Lobell: (43:42)
I’ve got some advice for you. Don’t do anything.

Dr. Thomas McDonagh: (43:46)
[Both laugh] That is actually my goal. I’m trying to avoid a knee replacement. So I am trying to do nothing. If I play golf, I play tennis. I love spectator sports. So I’m a big New York Mets fan, Jets fan, an Islanders fan. I have season tickets to see a few of those teams. So I love sports, both participating as well as spectating.

Daniel Lobell: (44:08)
You gotta go for the Nets too. If you got Mets and Jets, you may as well throw in Nets.

Dr. Thomas McDonagh: (44:13)
Yeah…. Pro basketball is not my thing. I love college basketball. So actually one of my bonding experiences with my kids has been going to the NCAA March Madness tournament every year. So we usually travel around the Northeast and spend a weekend watching the first and second round in the NCAA tournament, which is the time of the year that I like the most.

Daniel Lobell: (44:31)
Well between Mets and Jets, you probably have enough disappointment anyway.

Dr. Thomas McDonagh: (44:35)
Uh, yes, there is definitely a lot of experience of pain in my life. [Both chuckle] So good to learn how to deal with pain.

Daniel Lobell: (44:45)
Doctor, it’s been an absolute pleasure speaking with you today. Thank you so much for your time and your wisdom.

Dr. Thomas McDonagh: (44:51)
Thank you. And I’ll be looking forward to that clown video. [Both chuckle]

Daniel Lobell: (44:54)
Don’t hold your breath.

Daniel Lobell: (45:01)
This podcast, or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice since every person is unique. Please consult your healthcare professional for any personal or specific needs.