Male Circumcision

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Egyptian depiction of circumcision from 1360 BC I get this question a lot and have avoided writing about it for some time. But, alas, we mustn’t be afraid of a little controversy on howardisms. So here goes: Should we electively circumcise newborn boys? All decisions in medicine should be made through an ethical framework that balances […]

Subchorionic Hematomas, Lakes, and all that Jazz…

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Two things drive me crazy, and a third vexes my soul: Over-diagnosis of subchorionic hematoma; Inappropriate counseling and recommendations regarding subchorionic hematoma; And inappropriate management of placental lakes. Not a week goes by that I don’t see a patient who has presented to an emergency department somewhere, diagnosed with a (questionable) subchorionic hematoma or placental […]

Levels of Evidence

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If you read (or produce) scientific literature, you are hopefully aware of and use some system to appreciate how good a particular type of study is. Most “Levels of Evidence” charts organize different types of evidence into some sort of 5 tier system, with the highest level of evidence, Level 1, being the best. Level […]

Ten Things I’ve Learned About Maternal Mortality

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I’ve attended two conferences in the last 3 weeks that largely revolved around maternal mortality in the United States. About 700 women each year die in the United States during or around the time they give birth. For those of who practice Obstetrics, we believe that even one is too many. I’ve been reading and […]

Four Tips for Removing a Nexplanon

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Nexplanon removal should be a relatively straightforward and easy procedure. However, there are a few things you can do to make the job even easier. Number four is my favorite. Here are four tips for removing a Nexplanon. 1. Pick the right spot. Move the device by pushing on the distal end to see where […]

The Serena Syndrome

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(Note: I have no personal knowledge of Serena Williams’ pregnancy or the care she received. This article is based on publicly available information only and many details are surmised.) Serena Williams recently had a baby. Apparently, she almost died. Here’s how Serena herself described what happened: I almost died after giving birth to my daughter, […]

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 […]