Physician Competency

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Most physicians are incompetent. There; I said it. If you read howardisms on a regular basis, you might have already suspected this. Lots of evidence indicates that substandard or inappropriate care occurs in most patient-physician encounters (up to 80% of encounters). The wrong diagnoses are made far too often. Suboptimal or incorrect therapies are too […]

Four Tips for Using A Quantitative HCG Test

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Pregnancy tests come in three varieties: a urine qualitative test (it’s either positive or negative), a serum qualitative test (again, either positive or negative), and a serum quantitative test (with a specific numeric result). I see far too many serum quantitative hCGs ordered in clinical practice (by OBs, ER docs, etc.) and this implies that […]

Have We ARRIVEd at 39 Weeks?

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  Confused by the ARRIVE Trial presented this past week at SMFM? Don’t be. It’s unclear what impact this trial will ultimately have on recommendations from ACOG or the Society of Maternal-Fetal Medicine, but it is clear that it adds little to the present debate. I have written about this debate already in a three part […]

Birth Control and Weight Gain

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I spend a considerable amount of my day trying to convince women that whatever their current complaint might be is not related to their birth control. For many reproductive-age women, the only medication they use is birth control. So, it’s unfortunately natural that whenever they have a problem they tend to blame it on birth […]

Things Science Has Proven

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It seems like there is no end to the constant attacks on science recently. So, I have decided to make an exhaustive list of the principles, laws, and theories that Science has proven. These issues have been settled by Science and are not open for debate or challenge. Read through the list below and make […]

The Medical Hype Cycle (The Herrell Curve?)

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When a breakthrough innovation, new test, or new treatment is discovered in medicine, its adoption often follows a typical pattern. This pattern is demonstrated graphically on the illustration below. I have adapted this concept from the Hype Cycle used to describe new technologies in business but with some important modifications. A new discovery is made […]

Williams Obstetrics and Male Chauvinism

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As a collector of old Ob/Gyn textbooks, I am absolutely amazed at some of the male chauvinistic gems they contain. Here’s a good one from 1934 (Thorek’s Surgical Errors and Safeguards): He was discussing vaginal repairs, of course. The same author was wise enough to point out a couple of paragraphs later that “Many useless surgeries […]