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RECENT POSTS
* A Patient’s Guide to Picking an OB/GYN* OB Potpourri 5.0
* Better Birth Control Counseling * Updates on Vaginal Hysterectomy * Some Thoughts About Science * No, you shouldn’t eat your placenta… * Yes, Vitamin D is a Scam * Stop Making Me Look Bad, Guys * The Quadruple Aim and Perverse Incentives * How To Be An Amazing Doctor In One Easy Step * Aluminum Doesn’t Cause Autism * Problem Solving: Free Your Mind * Should I Vaccinate My Child? * How to Read Headlines* Male Circumcision
* Four Tips for Preventing Perineal Trauma: The Grip * Subchorionic Hematomas, Lakes, and all that Jazz… * Levels of Evidence * Ten Things I’ve Learned About Maternal Mortality * Four Tips for Removing a Nexplanon * The Serena Syndrome * Physician Competency * Four Tips for Using A Quantitative HCG Test * Help! How Can I Do Fewer Cesareans?!!? * Have We ARRIVEd at 39 Weeks? * Birth Control and Weight Gain * Regression to the Mean * Things Science Has Proven * The Medical Hype Cycle (The Herrell Curve?) * Fact Check: Mercury Content in Flu Shot * Williams Obstetrics and Male Chauvinism* Child Mortality
* Historic Decline in Maternal Mortality * Four Tips for Performing a Hysterosalpingogram (HSG)* IUD Facts
* Fact Check: Caffeine and Fibrocystic Change? * Simplified Vaginal Hysterectomy: The Book* The AMH Syndrome
* Afraid of anesthesia? Read this … (or the story of Victoria) * Afraid of Pitocin? Read this… (or the story of Charlotte) * It’s All in the Counseling … * Four Tips to Reduce Pain After Laparoscopy * Four Tips for Correctly Diagnosing Uterine Anomalies * How I Lost 40 Pounds* OB Potpourri 4.0
* What Amelia Earhart Teaches Us About Medical Evidence * Four Tips to Reduce Your Cesarean Delivery Rate * Four Tips for Correctly Diagnosing Vaginitis * Four Tips for Initial Laparoscopic Entry * Four Tips for Easy Postpartum Tubal Ligation * Four Tips to Avoid Air Knots* Dieting Myths
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* Prophylactic Salpingectomy? * Five Neat Tricks to Live Longer and Healthier Lives * The Hippocratic Oath * Fake News (aka, Ob/Gyn Clickbait) * The Facts Speak For Themselves * Ethical Considerations of Childhood Vaccination* Is Howard Lazy?
* Four Types of Physicians* Bed Rest
* Unintended Consequences * When Did Breastfeeding Become a Disease? * From One Extreme to the Other…* OB Potpourri 3.0
* Dreams of a Better World… * Appeal to Experience, or Insight versus Awareness * Oh my …. Really? * An Air of Legitimacy, A Hindrance to Progress * Is Hydration Useful for the Management of Oligohydramnios? Or Should We Even Care?* Prevailing Bias
* Secrets of the Menstrual Cycle * Post-Truth, Alt-Health* Speed in Surgery
* The Lost Purpose of a Chief Resident* Data Dreams
* To Cysto or Not To Cysto …. * Four Tips for A Non-Descending Uterus * What’s Your Best Guess? * Paved With Good Intentions … Or, How Do I Do A Vaginal Delivery? * Ten Ways To Reduce The Cost of Healthcare * People Still Matter * I Read It On The Internet… * It’s Perfect! Very accurate, with a low false positive rate… * What’s Old Is New Again * The Percentile Fallacy * Sample Operative Notes * How Should I Do A Breast Exam? * Four Tips For Vaginal Hysterectomy * What The 2016 Election Can Teach Us About Science * The Financial Impact of Not Utilizing Evidence-Based Medicine * Which Drug Should I Prescribe? * Debiasing Strategies* Cognitive Bias
* Trends…
* How Do I Know If A Study Is Valid? * Lessons Learned From Magnesium * Magnesium (Part 3): To Prevent Cerebral Palsy * Magnesium (Part 2): To Prevent Preterm Labor * Magnesium (Part 1): To Prevent Maternal Seizure* Quote
* Simplified Vaginal Hysterectomy * Penis Captivus and The Cult of Personality in Medicine * The Real Risks of Hormone Replacement Therapy * Post-Tubal Ligation Syndrome (Or, Post-IUD Syndrome) * What Birth Control Should I Prescribe?* One Too Many?
* What Should Be Done At Routine Prenatal Visits? * The Myth of the Black Cloud and Other Superstitions * Risk, or The Game of Life? * Will The Real Cowboy Please Stand Up? Harmful Practices and Harmful Culture in OB/Gyn * To Induce or Not To Induce: The 39 Weeks “Debate” (Part 3) * To Induce or Not To Induce: The 39 Weeks “Debate” (Part 2) * To Induce or Not To Induce: The 39 Weeks “Debate” (Part 1) * Should We Administer Betamethasone to Women at Risk of LatePreterm Birth?
* The Physician As Teacher * A Little Skepticism, Please * A Tale of Two Teachers * Cancer Screenings and Over-diagnosis: Pick The Outcome ThatMatters
* How Do I Make a Differential Diagnosis? Or, Pelvic Pain * It’s Either Normal … Or It Isn’t? Watch Out For The Drift * Reducing Cesareans Infographic * Clinical Reasoning: The Scope of the Problem * How Should I Pick a Specialty? * Reader Questions (#1) * Words Matter, or When Should I Order Labs for Preeclampsia? * How and Where You Ask The Question Matters: Confirmation Bias * You Can’t Trust What You Read About Nutrition * The Ethics of Deviating From Guidelines* Quote
* How Do I Diagnose A UTI? * Teaching Adult Learners: Lessons From Yoda * Measuring How Well A Test Works, or How To Find a Hipster * Prenatal Antidepressants and Autism? Mi dispiace! * Primer: How To Systematically Read A Scientific Paper * How Do I Diagnose Ruptured Membranes? Bayesian Statistics at itsBest
* Odds Ratios Versus Relative Risk * Do The NHS Birth Recommendations Have Meaning for The US? Or, The Safety of Home Birth * Power Laws, Decision Making, and Anxiety * How Should I Do A Cesarean Delivery? * What Should Be Done At The Yearly Visit? * The Illusion of Causality * Teaching Tool: The Stanford Medicine 25 * Important Paper: The PORTO Study * Absolute Risk Versus Relative Risk: A Clinical ExampleLATEST #FOURTIPS
FOUR TIPS FOR PREVENTING PERINEAL TRAUMA: THE GRIP FOUR TIPS FOR REMOVING A NEXPLANON FOUR TIPS FOR USING A QUANTITATIVE HCG TEST FOUR TIPS FOR PERFORMING A HYSTEROSALPINGOGRAM (HSG) A PATIENT’S GUIDE TO PICKING AN OB/GYN Published on : August 27, 2019August 27, 2019 Published by : Howard Herrell, MD Over the years, I have frequently been asked by women how they should pick an obstetrician-gynecologist. Or, sometimes they will ask how to tell if the one they are currently going to is any good. This is an important question because the average woman who seeks care from an obstetrician-gynecologist is at a huge disadvantage Categorized in : OB/GynOB POTPOURRI 5.0
Published on : April 17, 2019April 17, 2019Published by :
Howard Herrell, MD
In this edition of Potpourri, let’s talk about a few things that have a similar theme: common practices that have been adopted without scientific evidence which have now been proven worthless. Delayed pushing Delayed pushing or “laboring down” is when a woman is encouraged to wait to push for some time after she is completely Categorized in : OB/Gyn BETTER BIRTH CONTROL COUNSELING Published on : April 1, 2019April 16, 2019 Published by : Howard Herrell, MD There are no free lunches in life; sorry. Everything has its pluses and minuses. There are no medicines that are completely safe, and there is no life without medicines that is completely safe. All of us weigh risks and benefits every time we make a decision: what to eat for lunch, what car to drive, Categorized in : OB/Gyn UPDATES ON VAGINAL HYSTERECTOMY Published on : September 22, 2018 Published by : Howard Herrell, MD Here are some recent studies about the route of hysterectomy and their implications for vaginal hysterectomy. Cuff dehiscence rates A new study this month from Finland looked at cuff dehiscence rates from 13,645 hysterectomies. They found the following rates of vaginal cuff dehiscence: Vaginal hysterectomy (VH): 0.05% (n=4150) Abdominal hysterectomy (AH): 0.02% (n=5538) Laparoscopic hysterectomy Categorized in : Evidence Based MedicineOB/Gyn
SOME THOUGHTS ABOUT SCIENCE Published on : September 17, 2018 Published by : Howard Herrell, MD I get frustrated daily with the misuse of science by both scientists and non-scientists. Every good social media argument has someone claiming “science” in a gotcha moment, usually not understanding what science even is. Every medical conference I attend is smattered with folks holding their coffee cups with both hands smattering about “data” while not Categorized in : Cognitive BiasEvidence Based
Medicine
Other
Stuff
NO, YOU SHOULDN’T EAT YOUR PLACENTA… Published on : September 4, 2018 Published by : Howard Herrell, MD A small pilot study of the effects of eating the placenta after birth (usually through encapsulation) was published this week. Not surprisingly, the study, published in Women and Birth, an Australian midwifery journal, found that consuming one’s placenta had no effect on maternal mood, maternal fatigue, or maternal-infant bonding, despite the bias of the authors towards Categorized in : Evidence Based MedicineOB/Gyn
YES, VITAMIN D IS A SCAM Published on : August 23, 2018 Published by : Howard Herrell, MD Vitamin D. This is exactly the sort of thing I write about regularly that drives me crazy. Physicians and patients never seem to appreciate when they are being manipulated and used by others for financial gain. This excellent new exposé in the New York Times details the conflicts of interest, behind-the-scenes payments, and denial-of-science behind Categorized in : Diet Evidence Based Medicine STOP MAKING ME LOOK BAD, GUYS Published on : August 18, 2018August 19, 2018 Published by : Howard Herrell, MD It, unfortunately, happens that a physician who works hard to practice evidence-based medicine sometimes appear as an outlier compared to other physicians. In Obstetrics, this is most palpable when patients present who have had care with others doctors in the current or a previous pregnancy. They, naturally, compare what I do to what the other guys did. So, I’m Categorized in : Evidence Based MedicineOB/Gyn
THE QUADRUPLE AIM AND PERVERSE INCENTIVES Published on : July 20, 2018July 20, 2018 Published by : Howard Herrell, MD There are a lot of things wrong with medicine today. A lot. But they aren’t the things most people typically focus on. I genuinely believe that the number one problem with our healthcare system is the people in it and how they are compelled to behave. I started down this somewhat offensive pathway here in Categorized in : Evidence Based MedicineOther
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HOW TO BE AN AMAZING DOCTOR IN ONE EASY STEP Published on : June 30, 2018June 30, 2018 Published by : Howard Herrell, MD In the movie Edge of Darkness, Mel Gibson plays a cop whose daughter was murdered in front of him. During the movie, he uncovers the conspiracy that led to her murder and he discovers that one of his closest and oldest friends, Bill, a fellow cop, was in on it. In a dramatic scene in his Categorized in : Evidence Based MedicineOther
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* A Patient’s Guide to Picking an OB/GYN* OB Potpourri 5.0
* Better Birth Control Counseling * Updates on Vaginal Hysterectomy * Some Thoughts About Science * No, you shouldn’t eat your placenta… * Yes, Vitamin D is a Scam * Stop Making Me Look Bad, Guys * The Quadruple Aim and Perverse Incentives * How To Be An Amazing Doctor In One Easy Step * Aluminum Doesn’t Cause Autism * Problem Solving: Free Your Mind * Should I Vaccinate My Child? * How to Read Headlines* Male Circumcision
* Four Tips for Preventing Perineal Trauma: The Grip * Subchorionic Hematomas, Lakes, and all that Jazz… * Levels of Evidence * Ten Things I’ve Learned About Maternal Mortality * Four Tips for Removing a Nexplanon * The Serena Syndrome * Physician Competency * Four Tips for Using A Quantitative HCG Test * Help! How Can I Do Fewer Cesareans?!!? * Have We ARRIVEd at 39 Weeks? * Birth Control and Weight Gain * Regression to the Mean * Things Science Has Proven * The Medical Hype Cycle (The Herrell Curve?) * Fact Check: Mercury Content in Flu Shot * Williams Obstetrics and Male Chauvinism* Child Mortality
* Historic Decline in Maternal Mortality * Four Tips for Performing a Hysterosalpingogram (HSG)* IUD Facts
* Fact Check: Caffeine and Fibrocystic Change? * Simplified Vaginal Hysterectomy: The Book* The AMH Syndrome
* Afraid of anesthesia? Read this … (or the story of Victoria) * Afraid of Pitocin? Read this… (or the story of Charlotte) * It’s All in the Counseling … * Four Tips to Reduce Pain After Laparoscopy * Four Tips for Correctly Diagnosing Uterine Anomalies * How I Lost 40 Pounds* OB Potpourri 4.0
* What Amelia Earhart Teaches Us About Medical Evidence * Four Tips to Reduce Your Cesarean Delivery Rate * Four Tips for Correctly Diagnosing Vaginitis * Four Tips for Initial Laparoscopic Entry * Four Tips for Easy Postpartum Tubal LigationARCHIVES
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LEVELS OF EVIDENCE
Published on : 8 Apr 2018 Published by : Howard Herrell, MD 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" Evidence Based MedicineStats
REGRESSION TO THE MEAN Published on : 27 Dec 2017 Published by : Howard Herrell, MD In life, we don’t tend to notice the mediocre or the average; rather, we notice extremes. We never think about the weather on an average day, but we always takeCognitive Bias
OB/Gyn Stats
RISK, OR THE GAME OF LIFE? Published on : 11 Jul 2016 Published by : Howard Herrell, MD The ideal physician is not risk-averse but rather is a risk-mitigator. Risk is inescapable. We have to be able to understand risks in real terms and also be able toBIAS
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SOME THOUGHTS ABOUT SCIENCE Published on : 17 Sep 2018 Published by : Howard Herrell, MD I get frustrated daily with the misuse of science by both scientists and non-scientists. Every good social media argument has someone claiming "science" in a gotcha moment, usually not understandingCognitive Bias
Evidence Based MedicineTeaching Tools
PROBLEM SOLVING: FREE YOUR MIND Published on : 12 May 2018 Published by : Howard Herrell, MD Here was a conversation in recent car ride: Daughter: Penny has 5 children, 1st is January, 2nd kid February, 3rd is called March, 4th is April. What is the name ofCognitive Bias
HOW TO READ HEADLINES Published on : 1 May 2018 Published by : Howard Herrell, MD Headlines are everything. They frame the way we read an article, how we remember it, and whether we choose to read it in the first place.In the world of
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