I have lots of questions, and I mean lots. So I asked them to a Doctor. He is a board certified and practicing Family Medicine doctor (residency in Family Medicine and a fellowship in OB/GYN, currently working as OB/GYN in the Hospital, as well as family medicine, running a free clinic for those who cannot afford care or are experiencing homelesness.) Answers by myself through research and not by the Doc are marked with ||
This is essentially SIWIKF: Medical Edition and will be updated/completed given time.

NOTE: This is not medical advice. Talk to your doctor. Don’t be stupid and take medical advice from a random internet blog with like 5 posts.

Why use desiccated thyroid instead of synthroid

|| Generally the only time when desiccated thyroid is used is when the patient cannot produce enough T3

Why would brand name levothroxine (synthroid) be prescribed instead of generic?

From endocrinologist: Some people are very sensitive to levothroxine when they have certain levels or conditions. To start out, prescribing brand names with known absoption rates is a good tool to detect if the medication is working or not. Many people do just fine on generics both to begin with and as recurring doses.

Should naturopaths be allowed to prescribe

No. They do not have sufficient training to know the impact and interactions of modern pharmaceuticals.

Are you allowed to take pics during surgery

|| Uh no. HIPAA. (Unless the pictures are documentation, which may include “patient education”. Really depends if the Doctor wants to do the work of taking the picture during the procedure.)

If a foreign antibody was introduced to a body, what would happen?

|| It would go to work! That is the basis behind treatment with Monoclonal Antibodies.

Allergist believes everyone who has allergies should have an epi pen. Agree/disagree

Agree-ish. EpiPens are expensive and sometimes in limited supply, but if you have a chance of having more than a mild allergic reaction, you should see an Allergist and they will often prescribe EpiPens.

Love/hate epic

Generally dislike. It is really bulky and tries to do too much.

Why do doctors hate flexeril

It is the cheap way out. It neurologically tricks the body in treating the symptoms by relaxing the muscles rather than the cause.

Do Doctors know how to read western blot results?

We are trained, but it is not generally a skill that is kept up to date ||Nowadays there are lab interpretations on the results.

Are specialized supplements good/bad/neutral

In all likelyhood, they aren’t doing much either good or bad, because they don’t do much in the first place.

Can “binders” like activated charcoal assist in antibiotic usage

Possibly, but they can also do some harm in binding to medications that you are taking.

Do you enjoy the complicated medical cases or do you prefer to assist in common medical needs

I prefer a mix of both.

At some point is medicine just “do what makes you feel better”

|| Yes, and that is known as palliative care/hospice/end of life care.

From a medical standpoint: would you support Universal Heath Care

I would support universal primary healthcare, and I think the UK’s NHS model works the best for both medical staff and patients. I would support free primary care, and referrals thereafter, but not coverage for non medically necessary elective/cosmetic surgeries. Included in the care would be mental health (psychologist and psychiatrist if needed) as well as rehab every time.

Besides toxicity, what is the danger of taking too high of a dose of antibiotics or other drugs

See Theraputic Range

Do probiotics help when on antibiotics

Yes, probiotics can help avoid/alleviate antibiotic associated diarrhea (AAD). Usually a refrigerated live probiotic is recommended.

Is the danger of antibiotic resistance from humans or animals taking antibiotics

Both, but it heavily depends on the bacteria.

Why do ultrasounds cost so much to the patient?

Everything in medicine costs a lot because of the insurance system, but ultrasound machines are extremely expensive. (10s to 100s of thousands of dollars)

Why are blood tests for genetic disorders such a hassle compared to other labs

|| Genetics use much more expensive equipment to process samples.

Are patient recommendations helpful or annoying

They can be helpful based on past experiences if they are having a repeat or chronic condition, but the course of action usually stays the same.

Would you take/recommend a non essential vaccine like Lyme

Usually no. Everything is about risk-reward. If the person goes hiking or is out in nature a lot? Yes.

Do people who have had the chickenpox vaccine need the shingles shot

Yes. The vaccine is a live but weakened version of the virus, so it can still live on and cause shingles.

Are generics as good as the original? / Quality Problems with generics

They legally have to be as good as the original in order to be approved. Any quality problems are dealt with by the FDA and taken off market.

What is the USP in a cream? HFA in inhaler. HCL in duloxetine.

HFA is the Propellant: hydrofluoroalkane, || HCL is the salt hydrochloride, and USP means the drug was made in accordance with the United States Pharmacopeia

Can you overhydrate on electrolyte drinks?

|| Unknown. Overhydration danger comes from a lack of electrolytes, but at some point, you are ingesting too much liquid for your kidneys to handle. Unaware of a case where this has been observed/tested.

Why a rheumatologist instead of immunologist for autoimmune diseases

|| Autoimmune diseases usually fall under the same umbrella as rheumatic diseases, so they are treated by rheumatology

Why is cymbalta 60/twice a day instead of 120/once

|| Half life is 12 hrs (most SSRIs have a half life double or more of that), increased risk of liver toxicity

Pain killers for long term use when over the counter isn’t enough

|| Opioid maintenance therapy is a tricky balance best left to rheumatologists, palliative care, or other specialists..

Where do doctors go to learn about new conditions/diseases/labs/treatments/medicines?

Usually medical journals, uptodate, or epocrates.

Has a patient ever told you about a medication that you haven’t considered that they saw from a commercial

I am sure this has happened in the past, but there is not a case that comes to mind.

When administering medication from a vial why do some people insert air to draw medication and some people don’t

|| This is used to create pressure in the vial to push all medication into the syringe easier. source

Do females ever feel uncomfortable with a male OB/GYN?

Certainly, some do. There are cases where women have been raped or abused by men and do not feel comfortable (and vice versa). But for the most part, no because we are professionals doing our job of keeping people healthy and helping them get better.

Did you ever preform abortions as an OB/GYN?

No, I was able to opt out and have someone else preform it. In case of a miscarriage, yes. I have noticed a trend of a lot of doctors opting out of preforming abortions because they are against the idea, with Nurse Practitioners or Physician Assistants preforming the procedure instead.

What was/is your stance as a ob/gyn about elective abortion? When is the cutoff?

I am not in favor. Learning about human embryogenesis leads me to believe that life begins at fertilization. I believe this issue, as complicated as it is, should be discussed more in a constructive and productive manner.

Are doctor to doctors visits any different than a normal patient

Absolutely. Think of it as two professionals talking to each other.

Can you just order your own labs

Doctors can order things for themselves just like they order medications, labs, imaging, etc for anyone else.

Does going on immunosuppressants, like when you have cancer, help with autoimmune symptoms

Yes, but you usually don’t notice the reduction of symptoms when you are dealing with the symptoms of cancer. Immunosuppressants are used regularly in the treatment of certain autoimmune diseases.

Why do anesthesiologists always wear their little hats

They are always going from one case to the next, so what is the need to take it off?

Is there any basis behind the higher pH water

|| Nope. Your blood pH has to be within a very specific range in order for you to survive (7.35 to 7.45). “physiology textbooks would describe a pH outside the range 7.00–7.70 as being incompatible with life.” 1 2

Why are coronary arteries even necessary when there is blood flowing in the heart?

The muscle of the heart is very thick and dense and blood cannot flow to the outer layers of the heart from the inside.

How rare are hypochondriacs

Not sure about diagnosed hypochondriacs, but many come in a little too worried about the smallest of things.

How rare are opioid seekers in Family Medicine

Not that rare.

Do you manage prescriptions for your family/self

Absolutely. The only drugs that I do not prescribe for my family (even though I am allowed to) are drugs like opioids because it is highly frowned upon.

Do you practice medicine on your family?

Yes, I do practice medicine on my family.

As a FM doc, do you ever have to be in the hospital or on call?

A couple times a year ||Its usually determined by the practice/company/institution that you work for.

How much do doctors learn about nutrition and the side effects of deficiencies

|| A lot, especially when it comes to deficiencies.

When doctors ask what meds are you on should I give them the generic or brand name? And what about drugs that I’m not actively taking? What about prescribed creams and nasal sprays?

Give them everything so that they can do a check for interactions. If the generic name is short, I would give them that.

Patient difference between internal medicine and family medicine

Family medicine tends to deal with all ages from embryo to geriatric, while internal medicine tends to go from adulthood to geriatric.

Is there a drug that works quickly and short term for panic attacks. Midazolam?

Colnzapam, vallium, Ativan, buspir, hydroxyzine pamoate. Hydroxyzine is an interesting one because it is an antihistimine (not a benzodiazepine) that is kind of ‘dirty’ and works as an anxiolytic.

How often do you get “my (relative/friend) is a doctor and they say (wrong thing)”

Not that often

Who should get the title of doctor? What is the limit? Chiro, phd, PA, DPT

MD should be the lowest. PhDs absolutely deserve it because it is a crazy amount of work.

Which is better. Going to a psychiatrist or going to a psychologist and asking primary care for meds

Psychologists are great at managing mild to moderate mental disorders and working with primary care to distribute drugs if needed, but if the diagnosis is severe or you are maxed out on certain drugs, psychiatrists are more trained in that area. || Both are professionals and are trained in different but overlapping areas. You can generally spend more time with and see a psychologist more.

Do doctors always/Have to use the proper anatomy? Like cheek bone vs zygomatic arch

Unless specificity is needed, you can generally use the common name.

If someone takes aspirin a lot for pain, do they get some of the benefits of the low dose aspirin therapy?

Yes. Low dose aspirin therapy is the minimum amount needed for the therapeutic effects.

How do I not come off as a hypochondriac

Don’t suggest a diagnosis or solution. Give the Doctor your symptoms and let the Doctor do what they do best.

Why is Vicodin prescribed more than Vicoprofen post surgery? Wouldn’t an NSAID be helpful post surgery?

Antiplatelet effects of NSAIDs could be dangerous post surgery.

Is it addiction if someone craves drugs to not be in pain (like chronic pain patients)

Not really. It is natural to not want to be in pain.

Feeling more alert and better mood on opioids rather than mellow

|| If someone is in less pain, they will be more alert then if they were in pain.

Is there an actual name for spoon theory

No, but the properties of spoon theory are similar to how fibromyalgia and some chronic illnesses are managed.

Why do some people do better when they take their pain (like opioids for chronic pain) medication at night?

If the person is getting poor sleep due to pain, a good night’s sleep can make a world of difference.

How much is too much opioids?

Falling asleep is too much. The goal is to get you to be able to function and heal, to ease, not erase pain.

Why isn’t narcan nasal spray more widely available? How do you get it in an emergency besides an ER?

It can sometimes be tough for Doctors to get it, so it might be a supply issue, though I am not sure. ||There is a standing order from all but one or two state’s surgeon generals, so you can go a pharmacy and ask for it.

If you don’t know a condition, where do you go to look it up?

|| Although likely rare of complete lack of knowledge of a condition, many doctors use UpToDate and Epocrates (or similar services designed for physicans) to get a refresher on the knowledge.

Can I trust things posted in reputable medical journals as fact?

To a degree. There is selective bias in what gets published. For reputable journals it can be added to your knowledge as fact for the group the study tested.

Do allergists have a way to give you immunizations that you are allergic to

Yes, they give it in small quantities over a period of time and watch for/treat any symptoms of allergic reaction and adjust accordingly.

Thoughts on the Q word (quiet). Don’t say it, or use it to avoid a Voldemort situation

I use it all the time, though a lot of my co-workers avoid it. I like to mess around with them and use it.

Who do some doctors use aneroid (manual) blood pressure monitors still (as opposed to digital)?

For the most part tradition, because it was what we were trained on.

Have you dealt with patients with long haul covid? Did they improve after the vaccine/booster?

Yes, and unfortunately, they do not improve with the vaccine or booster.

What drug is it that teens/adults use to get work done: Aderall or Xanax

|| Adderall

From an insurance claim, what is actually paid to a Doctor?

The price billed to insurance is usually a absurdly large number in order to get medicare to pay more (if medicare sees a price go up nationally, they may raise the price). The “Discounted” price is what the insurance company is actually agreed upon with the Doctor.

Is prednisone (and predisone derivatives) an immunosuppressant in the short term?

Not in the short term. A lot of the effects like moon-face and immunosuppressive effects are only when used at a very high dose for 3 weeks or more. Those cases the drugs are usually used in treatment for cancer.

What are the signs that a lower strength tretinoin is needed?

Dryness, with the biggest sign being peeling. Ideally with almost all medications the preferred dose is the minimum effective dose so a ramp up for tolerance and efficacy is sometimes tried with tretinoin.

Does tretinoin help heal scars faster?

Tretinoin may help scars heal a little better in the short term once fully healed (like around 2 months for small scars, no risk of reopening) by balancing out the composition of tissues forming, like how tretinoin normally works. After a while, like a year, tretinoin is not likely to do anything but it can’t really hurt to try. Just be wary for dryness. || It does not seem like there is a conclusive answer. May have to do some pubmed searches for this.

Does triple-antibiotic (neosporin) slow wound healing?

It may slow wound healing by killing the helpful bacteria that naturally live on your skin and should generally not be used unless a wound is infected. The main reasons that triple antibiotic is not broadly recommend are allergic reactions, and better wound care. If it is a small wound it should just be cleaned with soap and water, pat dry, then covered in vaseline or aquaphor with no covering unless the vaseline would rub off. Larger and deeper wounds should be looked at by a professional and they may decide to use antibiotic and a wound care regimen that fits the injury.

Last Updated: 2023-08-31