In this video, Mikhail Varshavski, DO -- who goes by "Dr. Mike" on social media -- reviews common pitfalls for inexperienced physicians.
Following is a partial transcript of the video (note that errors are possible):
Varshavski: It's officially my 10-year anniversary of becoming a doctor and over the last 10 years I have treated thousands of patients, but I have also trained many doctors on seeing thousands of patients, and I see the same themes coming up of young doctors repeating the same mistakes. Today I thought it would be cool to talk about the 10 most common mistakes I see young doctors make. A huge thanks to Pri-Med for sponsoring this video.
1. Wanting to solve everything in one visit. It's very tempting to have a patient come in, especially one you don't know, and want to be the person that solves everything that's bothering them. However, we have to be realistic and practical because we have time limitations, we have other patients we need to see, and sometimes it's just not feasible to transfer all the necessary information to one patient in one visit.
Prime example: patient comes in for an annual physical and we make a diagnosis of diabetes for the very first time. They also have back pain. They also have foot pain. These are multiple problems that each require their individual assessments of the subjective (what's going on in the patient's life), objective (doing a proper physical exam with special tests as necessary), then putting it together (an assessment), then a plan in place to not only diagnose, but also treat some of these conditions.
In those moments, I have to constantly remind young doctors to say, "Don't try and tackle all of this in one visit." But also it's very difficult for one patient to get so much new information thrown at them at once, so many new lifestyle recommendations, that they won't be able to keep all of the information in their minds, but also will likely make mistakes.
But the most important part is setting that good through-line of, "Here is what to expect on this visit. Here is what to expect on the follow-up," so that you have a good continuity of care.
2. Placing an overemphasis on numbers -- aka labs -- and not the actual patient. So many times a resident will come into precept and say, "Oh, I'm getting routine labs and I'm checking a thyroid level." I have to ask, "Why are we checking a thyroid level?" This is not a screening test. Screening tests are used on people who are not having symptoms so that we can intervene before a problem happens. But thyroid hormone testing isn't really a screening test. This is more of a diagnostic test when someone is having symptoms of what could be a thyroid disorder that then you would order to check if a thyroid condition exists.
But so many times I see young doctors order a thyroid hormone test on a patient that's not having symptoms and the thyroid test comes up slightly off. The young doctor wants to treat this number, but they're not actually asking the patient if they feel unwell. If a patient feels great and their thyroid hormone is slightly off, this does not mean that we should right away jump to giving them a medication.
Not to mention, when you're overly focused on numbers, you may not be paying enough attention to the person's mental health state. It's very easy to get really focused on making a diagnosis of numbers, giving medications for those numbers, and not actually seeing how your information is landing on the patient and how they are reacting to their new diagnosis.
3. Forgetting that we have general guidance given to us, and based off these general guidelines, we then apply them to individuals. Just because we're given a general guideline -- an algorithm, if you will -- of how to help many patients with a condition, or how to prevent specific instances like heart attacks from happening in patients, doesn't mean that they'll always apply to the individuals sitting in front of us. There are barriers certain people face, whether socio-economical or mental health. There are personal choices that people make. Not everyone has to make the hyper-optimal choice that you think is best for their health. Your goal as a doctor is to educate the patient on the benefits and harms, and allow them to make the best decisions for themselves.
4. Young doctors constantly forget that reassurance and education is a medical treatment. So many times a resident will come in and talk about a patient's condition, and explain that there is not much we can do. What most commonly comes to mind is like an upper respiratory infection caused by a virus. Yeah, we can make a recommendation of staying well-hydrated, getting sleep, perhaps some supportive care, with some over-the-counter options or natural remedies for symptom control. But in reality the treatment for most viruses, outside of flu and COVID, are symptomatic management and reassurance, and they think that they need to prescribe something for the patient in order for them to go home happy. That's not true.
If you give a patient good reassurance, explaining why you're making the decision to not prescribe an antibiotic, treatments for the things that are bothering them from a symptom perspective, guidance on red flags of what to look out for, when to call 911 versus when to come back to the office, this is what is arming a patient to do best for their own health. This is medical treatment. Just because you're not prescribing something on a prescription pad or sending one electronically doesn't mean you're not helping the person.
I actually talked about this in more detail recently when I was speaking at Pri-Med South, the primary care CME/CE conference and expo in Florida who sponsored this video. I did a deep dive into how I make use of social media as a tool in my life as a practicing physician. I discussed that I did have initial skepticism about being labeled an influencer, but then my journey of creating content online opened up a world of opportunities to be a better doctor. I use inspiration for my real-life patient encounters to come up with ideas for content just like this. Researching conditions for future videos allows me to expand my knowledge and be a better doctor for my patients. It's two completely different parts of my life that directly feed off of one another.
, is a board-certified family physician and social media influencer with more than 11 million subscribers.