This transcript has been edited for clarity.
Robert Glatter, MD: Welcome. I'm Dr Robert Glatter, medical advisor for Medscape Emergency Medicine. Today, we have Dr Mikhail Varshavski, otherwise known as "Doctor Mike," who is a family medicine physician and well-known social media medical influencer.
He's joining us to discuss how he has spent the past several years debunking medical misinformation, helping to allow people and healthcare providers alike make better-informed decisions about their own healthcare during the pandemic and beyond.
Welcome, Dr Mike. It's a pleasure to have you join us.
Mikhail Varshavski, DO: Thank you so much, Dr Glatter. I'm really excited to be here to speak on a subject that I'm incredibly passionate about.
Glatter: I want to start by asking you about how you approach patients when they come to you with bits of medical misinformation and myths that don't clinically make sense.
Varshavski: The main reason why I got into posting videos on social media was because of my frustration of seeing patients being misled on something that they've seen online or even on television, thinking that was a shortcut to success for them to have a healthy outcome. In reality, that success would only come through putting in some level of effort, whether it means getting a good night's sleep; eating a healthy, varied diet; or putting in the work to go to the gym. It's very tempting for them to see a shortcut miracle cure-all supplement on social media and wonder, Why is my doctor not recommending me that?
It was my experiences during my residency that really inspired me to say, we need to do a better job in media at debunking this misinformation. I think it stemmed from the fact that there was an absence of quality, evidence-based physicians online doing it effectively.
Glatter: I think that's important. Traditional medical and healthcare systems have shied away from social media in the beginning of things. I think you're aware of this, and now it seems like every hospital is online, on TikTok, Instagram, or Facebook. That really is the way to get to the population and to reach your audience. Clearly, now that there's been this bandwagon that everyone has jumped on, as you point out, it's very important to have evidence-based and accurate information.
Could you highlight some of the most egregious examples of medical misinformation from videos that you've encountered on various social media platforms?
Spread of Outrageous Conspiracy Theories
Varshavski: For me, the scariest ones are the ones that start debunking the trust that we have with medical institutions that start spreading conspiracy theories, whether it's about the COVID-19 vaccines or COVID-19 testing. Right now, the problem of misinformation has been extremely highlighted because of the pandemic that we're in and the importance of fighting back against that misinformation.
For me, that was a goal even prior to the pandemic, but it was quickly accelerated with the need to put out accurate information. That's why, despite me being a younger doctor, the viewership on the videos educating on the misinformation that comes surrounding the vaccines are in the millions. These are millions of people that are skeptical. They don't know what to believe. They're looking for some guidance.
Recently, there was a frightening report that younger demographics are using TikTok as their main search tool. They no longer go on Google and type in "COVID-19 vaccine." They now do it on TikTok. That's very dangerous, because that's a place where I've seen misinformation thrive.
Glatter: Absolutely. If you're going to use TikTok as a search engine, that's really problematic. I think that's very important that you bring that up. This is an uphill battle. As social media evolves and they have the search capability, this is what we're dealing with.
Varshavski: We as doctors can look at a video of a social media wellness influencer talking about different types of water being more acidic than others, and that you need to drink "basic" water. We can see how ridiculous that is because we know that once the water goes into your stomach, there are gastric juices there that are so acidic that it doesn't matter if your water is a pH of 6, 7 or 8, but the average person doesn't know that. They feel like they have to spend what limited health budget they have on that water as opposed to joining a gym or buying the healthier vegetables as opposed to the processed foods in the supermarket.
It's really about guiding people with our experience but doing it in a relatable way. That's where I seem to have the most success.
Glatter: That's a very important point you just brought up: being relatable. People are sometimes flooded with statistics, data, and papers. In other videos, I believe you mentioned this — getting to the human level and connecting with patients. That's something that you are excellent at. Maybe you can expand on that.
Varshavski: As a family medicine provider, I learned early on that even if you have a patient that fundamentally disagrees with you on a given topic, highlighting that disagreement early on only serves to make the problem worse.
If I have a patient that's coming in that is vaccine hesitant, my goal isn't to flood them with misinformation and prove them wrong. It's instead to find points upon which we agree. Saying that the illnesses that we're looking to prevent with vaccines are dangerous — boom, we agreed. Talking about that their children's health is what I'm trying to optimize as best as I can — boom, we agreed on something else. It's very easy from our training (and we have very limited communications training) to just give the statistical data that we know to be true, but then the patient might not know to be true. Instead, it's finding lines of communication upon which we agree and work outward from there.
One of the biggest policy changes that I've seen happen across certain offices, both pediatric and family medicine, is stopping the practice of removing patients if they are vaccine hesitant. Before, this used to be a policy, and now what we've realized is by excluding them from our practice, we're essentially guaranteeing that they're not going to get good evidence-based care in the future.
Developing Patient Trust
Glatter: To just remove a patient because they don't agree with your views is not appropriate. I think having that open discussion is important for developing that trust and restoring that trust in mainstream medicine.
A problem I see is that many Generation Z-ers and millennials don't have family physicians or internists; they just go to urgent care centers. Without that grounding, they can't establish that relationship. That's a problem, especially with the plethora of urgent care. Maybe you can comment on this.
Varshavski: Urgent cares fill an absolute gap in care in our current healthcare debacle, if you will. Many younger folks rely on them as a quick fix for their chronic problems. Quick fixes for chronic problems are nonexistent. If it took 10 years to create a problem, it's not going to go away with a single urgent care visit. Sure, you could put a Band-Aid on the problem, but you're never going to get a solution.
That's my goal as a primary care doctor. What I try and highlight, even when I'm doing videos reacting to The Simpsons or watching the show Survivor, it's explaining in a transparent, relatable manner, using something that's very known to the audience like these shows, what my thought process is like. What I think about when a patient walks in through my door with a certain problem, the types of questions that I'll ask, the reasons for certain tests that I would run vs not run.
When patients start getting on the same page as to your mindset and your thought process, that's where you get good outcomes. It's interesting that we're speaking about this from a very medical-heavy focus vs a patient focus, because we also see that malpractice lawsuits drop when you are open and transparent with your patients, when you give your reasoning as to why right now you don't think they warrant that CT scan for their abdominal pain when they're worried about appendicitis. It's only upon them seeing your mindset and the reasoning as to why you're choosing not to order it or choosing to order it that they will they feel like they are in control of their health and they're on the same team as you, as opposed to in a very antagonistic relationship.
Glatter: Right. It's not talking above them, but talking to them as a human being and how you want to be spoken to. Let's face it, there's a large amount of medical jargon. It's scary, and it's hard to use plain English to just talk to patients. We all try to focus on that. People in the media, like yourself, have a knack and a great ability to just talk plainly and to talk normally and not use medicalese and all this jargon, which scares patients quite a bit.
Varshavski: I think I'm lucky in the sense that being a younger doctor, I haven't spent decades speaking only to other doctors and other specialists. I still am accustomed to using the common language for many of these conditions in ways that I've learned in my training.
Because of that, I feel like I have a clearer way to describe certain illnesses to patients. I remember even for myself as a med student, being in a room with one of the top cardiologists in our hospital system, they're explaining to a patient their diagnosis and the potential treatments, and everything is spot on. Science, it's all there. But then when they walk out, the patient looks at me and they say, "What did they say? I have no idea."
I kind of had to translate there, and I realized that there is a gap in this knowledge. That's not to say we need to throw away the basic sciences and medical school education. It's to say that we definitely need to find a way to incorporate better lines of communication.
Simplify Messages, but Don't Infantilize Your Audience
Glatter: I think communicating with patients, and doing media as you do, gives you the ability to connect with people and to bring things down to their level. We're by no means saying that patients are not smart or able to grasp concepts, but we just want to make them very simple, very down to earth, and things that they can relate to.
Varshavski: I also would almost push against trying to simplify or oversimplify or being paternalistic in that nature to our patients. What ends up happening in mass media communication is that if you start infantilizing your audience, they will pick up on that and they will see through it because we as humans have a naturally good BS detector.
Early on in the pandemic, the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) were making recommendations that were correct at the time with the evidence that we had, but they were doing it with some level of foresight into predicting what the viewers would do with that information. When you do that and you infantilize and you present the information as if you know all, that's where you start running into trouble, as we've seen.
Glatter: Science changes; it evolves. That's one of the basic tenets we learn in our medical training. The public wants the definitive answer, but often we don't have the definitive answer, and it's very frustrating. I'm sure you can relate to that.
Varshavski: That's probably the most frustrating part of debunking misinformation, because for me to prove that something doesn't work is much harder, if not impossible, than for them to just say that it works. You know, I could say, "But just by sitting here, you'll get so much stronger." For me to prove that wrong, I would have to run randomized controlled studies to prove that, whereas they can say whatever they want.
It's about explaining why I think that is not correct and take some liberties because in science, again, we can't say that this is definitely untrue, but we can say based off our scientific opinion, based on the lack of research, we're saying it's untrue.
More Medical Practices Jumping on the Social Media Bandwagon
Glatter: Many medical practices now are online, either Instagram or TikTok, and they're flooding our feeds. They, in some ways, are trying to grab Generation Z-ers or millennials who don't want traditional medical care in the office setting.
How do you feel that these medical establishments or these practices are doing right now? What's your assessment of their online presence?
Varshavski: Their online presence of encouraging people to seek out care, especially from a primary care provider, is amazing and I want that to happen more often.
Where I run into trouble is with these medical websites and practices where you essentially self-diagnose with a condition and make a request for a medication. When you start, as a patient, asking for a medication before knowing what your true diagnosis is, what the risks are for the medicine, what other potential diagnoses could be on the differential, that's where you run into trouble.
I've seen these websites pop up for a $20 visit where it's not even really a visit, and suddenly they're prescribing you finasteride for hair loss and they're prescribing you sildenafil for you to have erections. The problem with that is when those patients come into my office, I might be able to write the same prescription and I might want to write the same prescription, but at the same time, I would be doing some education or perhaps ruling out other conditions, like diabetes, and making sure that they're not having a neurologic or proinflammatory state.
There's a large amount of medicine that is missed virtually, but there's definitely utilization for certain visits. I love, with my patients who are diabetic, to have a visit to check on how their sugars are doing, if we're just going to make a small medication adjustment. As a follow-up, this could be a great tool.
It's not a great tool when a patient wants to make a virtual visit for abdominal pain. I cannot do a proper assessment with a virtual visit, and that's where we need to really be thorough and almost skeptical of the commercialization of online medicine, because it's very easy to get good reimbursement now but not very good to do a quality physical exam.
Glatter: I agree. I think access is certainly there, but making sure people have long-term follow up, as you allude to, is important. Grabbing them and giving them access is one thing, but really the finer points like you're discussing and that you just mentioned regarding medical conditions are very important.
Varshavski: I'm hoping that by watching some of my silly TikTok reaction videos or medical memes, I'm using some of the principles that a lot of the snake oil salesmen have used to pollute the medical media space and instead use it for good. All these miracle cure-all potion marketers are amazing at grabbing attention, keeping attention, and encouraging follow-through. If I can learn what they do well and use the same tactics on my YouTube channel for evidence-based medicine, I think that's a win for everybody.
I will say in the future, some of the social media platforms are going to be working with major organizations like the World Health Organization (WHO) and the National Academy of Medicine, to find better ways to verify these talking heads that are spouting medical information, whether it's right or wrong, on social media, and validate whether or not they are who they say they are.
At the end of the day, anyone can put on a white coat and say medical-sounding words. The question is, is this a real person? Do they have a license? Were they educated properly? Currently, on social media, that's very difficult to tell, but I'm hoping in the future months that problem can be at least somewhat ameliorated.
Glatter: It's almost like having an accreditation. You've been given that stamp of approval, so to speak. I think you're kind of alluding to that, that you've passed certain conditions or you have certain basic tenets and principles you adhere to, and they are trusted sites. Similar to what Twitter has done, they verify physicians, and I think in a general context, have that stamp of approval.
Varshavski: Otherwise, I feel for my patients because if they're looking up, whether it's on TikTok or Google or YouTube medical information, I actually want to encourage that. I love that they're interested about their health. I want to keep pushing that passion forward.
There are older doctors that I work with that say, "Stop going on social media, stop doing it. Don't do a Google search before you come in."
No, do it. Get your questions down on paper before you come in so that you're more prepared for the visit. Who doesn't want a more engaged patient like that? I think that only is going to yield better and better outcomes.
Restoring Public Trust
Glatter: I agree with you. Let them have the questions and pose them to you, and then you can inform them. This brings up the issue of restoring trust in mainstream medicine and by doing this, by being receptive to people who do go on social media for information (which we all do), to just validate and verify it.
Varshavski: Much of that stems from a very simple act, that I actually partnered with the WHO on, that's called Pause Before You Share. As you're aware, we have this rational mind that takes a little bit longer to kick in and takes a little bit more metabolic effort to properly think through. Then we have our emotional reasoning centers where we're quick to judge, quick to get angry, and quick to share something that outrages us.
By taking a moment before you share, you could actually stop the spread of misinformation or at least slow the spread of misinformation, because ultimately it's these factors that these algorithms use to decide what to make explode, what to share to its viewers. If we can decrease those signals on our own with certain efforts, like just taking a pause, I think that's a win for everybody.
Glatter: One thing recently I read was that people's trust in the CDC, for example, has plummeted. We all know this, obviously, with communication failures. I think reestablishing this through valid means on social media with trusted organizations like you're alluding to and physicians that represent these organizations might be a step in the right direction.
Varshavski: I think it needs to start with transparency. Transparency solves so many problems. Whether we're talking about lowering pharmaceutical costs or improving the trust that individuals have with the CDC, it needs to start with transparency and honesty and the decreasing of politicization of these topics.
That's not to say politics aren't a part of health. In fact, politics are a crucial component of public health. It's important to not villainize certain parties because, again, by villainizing someone who disagrees with you, you're essentially doing what we were talking about at the beginning of this conversation, where you have a patient that comes in with an opposing viewpoint and instead of finding points to agree upon, you're starting the conversation with the patient disliking you very much. That's essentially what happened over the past few years.
I say that from a perspective of someone that worked with the Trump administration putting out information about COVID-19, and the Biden administration. Both of them allowed me to interview Dr Fauci on my channels, and we had very open discussions. This is the point of transparency that we need to hit hardest.
Dr Fauci did not ask for my questions in advance. He did not ask to see the videos before they were published. This is a person that he doesn't know well and I'm going to ask hard questions, and that's the kind of leadership we need to continually see from these major organizations.
Glatter: I completely agree. I saw your interviews with Dr Fauci, and they were excellent. I also saw your interview with Dr Murthy, our surgeon general, and I thought that was right on point. I think getting more of these officials on social media channels to reach the public at large would be a step in the right direction because they need to hear them.
Final Advice on Social Media
Varshavski: I'm hoping that your viewers get excited about this as a potential tool to reach millions of people. I'm one person, but I see 40 patients a week in my limited part-time practice. On social media, my viewership ranges from 60 to 100 million views a month, and that's evidence-based, accurate information. I will never as a physician be able to educate that many people in my practice.
Glatter: That number — we're talking about well over one third of the US population. That's incredible, Dr Mike. I really appreciate you sharing that.
Varshavski: Thank you so much. It's not to say everyone needs to be on social media, because it's certainly not easy. Many people think it's something you could just do in your spare time. It's just like running any other business. It takes commitment, time, energy, and understanding of what works and what doesn't.
If you have a passion for it, there are ways to find out more. There are organizations that are looking to teach medical professionals how to be better at this, and I encourage everyone to seek out that information if they are passionate about it.
Glatter: Well, this has been great. I really appreciate your joining us to educate our viewers and give our audience your point of view and how you've been so successful in the world of social media. Thank you, again, for joining us. We truly appreciate it.
Varshavski: Thank you so much, Dr Glatter. Have a great one.
Robert D. Glatter, MD, is assistant professor of emergency medicine at Lenox Hill Hospital in New York City and at Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York. He is an editorial advisor and hosts the Hot Topics in EM series on Medscape. He is also a medical contributor for Forbes.
Mikhail Varshavski, DO, is a family medicine physician at the Overlook Medical Center in Summit, New Jersey. Also known as Doctor Mike, he is a well-known social media medical influencer who has over 10 million followers engaging with his every move on Instagram and his YouTube videos.
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Cite this: Robert D. Glatter, Mike Varshavski. 'Doctor Mike,' With 10M+ Viewers, Shares His Social Media Tips - Medscape - Dec 01, 2022.
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