- It's officially my 10-year anniversary
of becoming a doctor,
and over the last 10 years,
I've treated thousands of patients,
but I've also trained many doctors
on seeing thousands of patients,
and I see the same themes coming up
of young doctors repeating the same mistakes.
So today I thought it would be cool
to talk about the 10 most common mistakes
I see young doctors make.
Huge thanks to Pri-Med for sponsoring this video.
Wanting to solve everything in one visit.
It's very tempting to have a patient come in,
especially one you don't know,
and wanna 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's what to expect on this visit,
here's what to expect on the follow-up,
so that you have a good continuity of care.
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.
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's landing on the patient,
and how they're reacting to their new diagnosis.
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 socioeconomical 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.
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's not much we can do.
Most commonly comes to mind 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.
I also shed light into my YouTube analytics so you can see
what the behind-the-scenes numbers
of this YouTube channel looks like,
and how more physicians can own the title of influencer.
I'm really proud of the entire presentation,
and I was so excited to share it
with the audience in Florida, but now also with you.
You can actually watch my presentation in its entirety,
and not just for fun either.
If you're a clinician,
you can actually receive CME credit for it.
That's right, Doctor Mike videos are officially accredited
as education for clinicians.
Well, not all of them, but this one is.
I'm still working on getting my meme reviews
to count for AP credit.
I'm staying home today. I have mood poisoning.
Click the link in the description to get started below
with a free account on Pri-Med,
and watch my presentation now.
Not knowing why they're treating a condition.
Young doctors usually think that they're treating strep
to help someone feel better sooner,
to prevent the infection from getting worse.
The reality is, we treat strep in those cases,
because we're trying to prevent rheumatic fever
and other complications related to strep.
But the reality is most people from a mild strep infection
would get better on their own.
If you don't know why you're giving a treatment,
it's very difficult to properly discuss the harms
and benefits with the patient,
and that's all ultimately the goal.
Your goal as a doctor is not to bark orders at a patient.
It's why you wanna recommend
a specific treatment versus another,
and then get the patient on board with saying
that they actually agree with this plan.
So if you think you're giving the medication for them
to feel better sooner, and that's not true,
you're technically misguiding your patient.
In fact, there's been some evidence showing
when giving antibiotics for strep versus not,
only reduces symptoms by about a day.
So it's not even that big of a difference,
but it's those complications we worry about.
Young doctors frequently forget
to check their own biases at the door.
This is kind of a problem for all doctors,
but I see in young doctors a lot when they're nervous
to have difficult discussions with patients.
For example, they'll be presenting about a case
of a 25-year-old that comes in for an annual physical.
Then we'll talk about sexual history.
They say they have one partner,
they're in a monogamous relationship,
and they talk about tests that they're ordering
for preventive health screenings,
and I ask, "What about STI testing,
sexually transmitted infection screening?"
They say, "Well, I didn't ask about testing that."
I said, "Why?"
They said, well, they're in a monogamous relationship.
I'm like, so, do we know if their partner
is in a monogamous relationship?
Do we know in the past before this partner,
could they have had an infection
that has been lingering?
They say, "Oh, I don't know.
But it's an uncomfortable question to ask."
It totally can be if we make it uncomfortable,
but if instead we make it part of our everyday practice
to say, look, if you're sexually active,
we still recommend doing STI screening testing,
even if you have no symptoms,
even if you're with one partner,
and that's my recommendation.
The patient can choose to not wanna do the testing,
but the recommendation should still be made.
And to say that you have no biases is just untrue.
All humans have them.
The idea is to be as aware of them as possible
so that you could be as forthcoming
as you can be with your patient.
Over- and under-ordering labs.
Sometimes I have residents come in and say,
"Oh, I'm ordering that routine lab work
that I told you about."
I'm like, "Well, what's part of the routine lab work?"
And they're like, "Oh, I gotta repeat CBC."
This patient is 25 years old.
They're young, they're healthy.
There's no reason why we should be checking
their CBC so often.
It creates unnecessary harm for potential false positives.
It creates a cost to the healthcare system.
In fact, there's a whole Choosing Wisely campaign
that has been put out that actually tells us
when we shouldn't be ordering tests unnecessarily,
'cause they drive up costs,
and cause harm in many instances.
At the same time,
I see young doctors forgetting certain systemic conditions
can impact different systems of the body,
and they get very pigeonholed
on to what the diagnosis must be.
For example, if a patient comes in
with palpitations of their heart,
they order all the correct tests of the heart.
But how about checking thyroid levels
to see if the patient's hyperthyroid?
'Cause that could be contributing to a fast heart rate.
Like that sort of connection is oftentimes missed,
because they're so micro-focused, they forget to zoom out,
and think about a holistic approach
of treating the whole patient.
Not taking leadership roles in healthcare.
This has been one of the biggest changes
within the field of healthcare as a whole,
whereas 30 years ago,
doctors used to run medical centers, medical offices.
They'd be in charge.
They'd be in the C-suite, the executive suite.
That has slowly shifted,
and doctors have left the leadership positions,
and went more into the labor field.
This created a few problems.
The people who are in charge
have not really spent enough time being clinicians,
being on the ground, seeing what's happening,
interacting with patients, and as a result,
the policies they end up instituting
actually end up harming us as doctors
or even patients themselves, usually in the way
of good intentions leading to bad outcomes.
So I encourage young doctors to take the initiative
of getting involved.
It doesn't mean you have
to give up your role as a clinician.
You could still see patients during part-time of the week
or the month, and then use that other time
to be a leader in the field, advocate for patients,
advocate for doctors,
and make radical change in the system
that is so badly broken.
Making that good old assumption of the physical exam.
You know what happens when you assume, right?
You make a donkey
outta you and me. (donkey brays)
A classic example is, patient is telling me
about they have an ongoing wound that's healing.
I'll ask the resident, "How is the wound doing?"
They'll tell me everything the patient said,
but they didn't actually examine the wound themselves.
I'm like, how do you know that it's getting better?
We'll open it up and we see that there's signs
of cellulitis happening, and the patient needs antibiotics.
Had we ignored that, the wound could have festered,
and that infection could have spread to the bone,
leading to an osteomyelitis,
leading to an extended hospital stay with IV antibiotics.
So we always have to visualize and do the physical exam.
Oh my God.
So often, young doctors don't think
about their own safety and health,
and I know we're thinking safety
as if like making sure there's a clear exit to the room.
All that is important,
because nurses, doctors, frontline doctors,
do experience a fair share of assault.
It's really messed up,
especially working in an emergency room setting.
But something that we don't think about
is the position with which you work.
So many times I'll have young dentists come in,
and they have terrible back pains
and issues with their joints,
because they're in uncomfortable positions
for a very long period of time.
Change your position, adjust the table.
Make yourself feel comfortable
so that you're performing at your best.
Also, if you're handling sharps around a patient,
make sure their child is not running around out of control,
'cause they could easily nudge your elbow,
leading to a needle stick situation, where potentially,
some of the patient's blood ends up inside of you.
That could be very problematic,
leading to needing to take HIV prophylaxis medication
that have potential side effects.
When treating patients, yes,
think about the patient first and foremost,
but you also have to be comfortable
during the time you're performing treatments and exams,
because ultimately, if you start failing,
you're gonna end up failing the patient as well.
Huge thanks to Pri-Med for sponsoring this video.
Don't forget to click the link in the description
to check out my presentation,
and here's an amazing TikTok reaction video
that will raise your blood pressure
because you're laughing so hard.
Click here, check it out,
and as always, stay happy and healthy.
(upbeat hip-hop music)