My Wildest Patient Encounters

— YouTuber and physician Dr. Mike reflects on his medical career

by Mikhail Varshavski, DO May 12, 2023

In this video, Mikhail Varshavski, DO — who goes by “Dr. Mike” on social media — celebrates his 10-year physician anniversary by recounting several of his most memorable patient stories.

Following is a partial transcript of the video (note that errors are possible):

Varshavski: I’m coming up on 10 years of being a practicing doctor and I have had some incredible patient encounters, wildest patient encounters, and weird patient encounters. I thought I’d share a few of them right now. Let’s get started. Peewoop!

This story still haunts me to this day that it happened in the way that it did because it really shouldn’t have went down this way. This happened actually when I was a student and I was rotating at this medical facility.

I walked into the room and I’m like, “What’s going on? You guys are pretty banged up.” And they said, “Well, we were involved in a car accident coming back from Florida.” The husband was behind the wheel of the car and actually fell asleep and ended up crashing the car at a very high rate of speed. They said, “Well, we think we’re okay and we kind of went to the local hospital where we crashed” — they were somewhere down south — “but we felt like they didn’t do a full evaluation that we thought was satisfactory so we came here.”

I see that the male patient has a fractured clavicle. The female patient has a broken humerus and so much so that I think it damaged her nerve plexus because she has a wrist drop. There was significant injury that was visualized on all of these tests. There were hip x-rays and abdominal CT scans. But the one thing that wasn’t there, which shocked me, was a head CT scan.

I go back into the precepting room, which is where you talk to all the senior doctors, and I said, “Look, let me dig into this case. I really looked through all the scans. I looked through all the records, the intake forms, and I see that the female patient is on Plavix.” That’s a blood-thinning medication. “She is on a blood-thinning medication, just got into an accident at a high rate of speed, and did not get a CT scan. This is definitely wrong.”

I present the case to my attending. My attending is a family medicine doctor and firmly agrees. He says I cannot believe, is outraged. He said we absolutely got to get them to the ER.

The next day I come into work and I’m so curious to see what has happened. I open the medical record to see what happened with this case and I see that those patients left against medical advice, meaning that they signed a form saying that I don’t want to be here, that I’m leaving before the doctor has cleared me to leave.

The ER doctor said that the family medicine doctor doesn’t know what they’re talking about. “You’re fine now. It’s been over 24 hours since your car accident. Because you’re not showing any symptoms, there is no use to getting a CT scan and that you’re going to be fine.”

I’m like, “Look, this is going to sound really annoying, but I think you should go back to the ER.” They are like, “Well, look. Can we talk to your senior physician?” I’m like, “He is not here today. But as a med student, I’m telling you, you really should go to the ER because you are on blood thinners. Your husband wasn’t in great shape either. I really think both of you need to get scanned. Because I have another attending physician that’s here right now in the hospital, we can meet you and get you scanned even if the ER doctor this time says no.”

The female patient has actually been admitted into the neuro-ICU because it turned out that after getting the CT scan, she was actually having a very slow bleed into her brain as a result of being on the anticoagulation medicine Plavix. They had to do an emergency craniotomy, which is with them opening up the skull and relieving the pressure. Had they not done that she could have died and probably would have died, to be honest. I was like, “Oh my god! Did I just save a life because of all this?”

The craniotomy went well. The neuro-ICU stay went well. Everyone ended up recovering. All this stuff had a very happy ending. But because this was what we classify as a near miss, we actually had to file reports with our system in the computer where we report these near misses. We met with the head of the emergency department to talk about why this happened and created policies to make sure this never happens again.

I was working in my clinic late one evening and what I like to do before I start my hours is actually look through who is on my schedule, look through what’s going on in their medical history to make sure I’m not missing anything when I walk into the room. I saw on my schedule at the end of the day was a young patient, a young girl that was coming in for like a sore throat. I didn’t think anything of it.

When I look later in the day, that patient switched to a different patient, a male patient with a very similar name. When I walked into the room, I right away got a little bit of a strange sense that something else was going on because the patient was acting a little bit reserved. I said, let’s investigate.

I introduce myself, I start asking the questions, and the patient abruptly, abruptly shifts the conversation and says, “Doctor, I have to admit the real reason I’m here. I’m aware that your mom has passed.” I’m like thinking where is this possibly going to go.

“Well, I’m here because I actually have a message from her to you and I think it’s really important that I share it.” At this moment, I’m really confused because I don’t know what to do. I want to be professional. At the same time, I know that this patient is being unprofessional and I don’t know exactly what my next steps should be. I kind of gathered myself and I said, “I appreciate you doing that, but I am here working and I have to take care of patients who are having illness and need my help. While I’m appreciative of the message, I’m not interested and I have to move on to the next patient. I hope that’s okay with you.”

To my surprise, the patient was, “That’s perfectly fine. I’m okay with you doing that, but I just wanted to say that I needed to get that off my chest and share that with you.” This totally threw me, but we moved on and we kept taking care of other patients.

Mike Varshavski, DOis a board-certified family physician and social media influencer with more than 10 million subscribers.