Robert Centor, MD

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Our primary care and scope of practice debates make no sense

Physician

July 19, 2013

The Wall Street Journal has a question that I cannot really answer in their article, Nurse Practitioners and Primary Care.

This question has an implicit assumption that primary care is one thing, and that that thing is relatively straightforward and simple. I have written about this problem incessantly for the past 11 years on this blog. The term primary care has become the equivalent of a Rorshach test. When we …

The third year of medical school serves a wonderful purpose

Robert Centor, MD

Education

July 4, 2013

I still think that the third year of medical school serves a wonderful purpose. I never learned more during my entire school experience (perhaps I learned more as an intern, but that is post-graduate).

Danielle Ofri writes through darkened lenses: The Darkest Year of Medical School.

So for the non-physician readers let me give my opinions on the third year of medical school. After two years of mostly classroom experiences, our …

It’s time to redesign medical residency

Robert Centor, MD

Education

June 26, 2013

Once upon a time (actually when I did my residency), we worked long hours, were taught well and learned from our patients. Residency training had minimal rules. When we looked for a residency we took work load into consideration. Some residencies were more challenging than others. I choose a busy residency because I thought (back then) that I needed to see sufficient numbers of patients to become a good internist.

Our …

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It’s time to redesign medical residency

The unintended consequences of well meaning regulation

Robert Centor, MD

Policy

June 18, 2013

Why do we never consider unintended consequences? Whether we are thinking of legislation or physician led guideline panels, or governing bodies (like ACGME), the lack of consideration of unintended consequences remains mind numbing.

Let me provide some examples.

Please read this articles about how the war on drugs has fueled the hepatitis C epidemic. One could also argue that this war damages more young people than the drugs themselves.

Many illicit …

How to stop medical students from becoming jaded

Robert Centor, MD

Education

June 12, 2013

Recent research suggests that medical students lose empathy during the third (the main clinical year) of school.

Talking with end of the year third year students might make you think differently. Understanding the psychological changes that likely occur during the third year should make you think differently.

Medicine seems easy during the pre-clinical years. You get smokers to stop and prevent COPD and coronary artery disease. Patients just need to listen to …

Practice hassles are threatening our profession

Robert Centor, MD

Physician

May 23, 2013

Do you know anyone who has tried to find an internist recently? Good luck. Internists are either overflowing with patients, switching to retainer medicine, switching to hospital medicine or quitting. Internists are frustrated, burned out, and unhappy with the external transformation of our wonderful profession.

We spend 20 years in school, and then 3 years of residency training. We learned to think and apply our cognitive expertise to the diagnosis and …

How the silent exodus will worsen the doctor shortage

Robert Centor, MD

Policy

May 3, 2013

American Medical News has an important article – Will a “silent exodus” from medicine worsen doctor shortage?

Frustrated by mounting regulation, declining pay, loss of autonomy and uncertainty about the effect of health system reform, doctors are cutting back the number of hours they work and how many patients they see.

Between 2008 and 2012, the average number of hours physicians worked fell by 5.9%, from 57 hours a week to 53, and doctors …

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How the silent exodus will worsen the doctor shortage

Why mentoring takes a village

Robert Centor, MD

Education

April 18, 2013

One of my many mentors died recently: Will Deal, former dean of UAB School of Medicine, passes away at 76.

I had seen him 6 days before at a restaurant – he seemed in perfect health. We made lunch plans.

As I have thought about Will over the past 4 days, I thought about mentoring, because he mentored so many people. I thought about intern applicants who ask about …

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Why mentoring takes a village

Will robots reduce the need for doctors?

Robert Centor, MD

Physician

April 7, 2013

A reader sent me this question: “Yesterday, after my MCAT class, two biomedical engineering students and I talked about this article and the future of medicine. We debated whether such robots could reduce the need for doctors by 80%.”

When I read such predictions I chuckle at the naivety of those who make such pronouncements. The computer advocates do not really understand medical care and diagnosis.

What do we do that computers/robots …

Make the correct diagnosis by unleashing your inner Columbo

Robert Centor, MD

Physician

January 23, 2013

You have to forgive me, it’s not me, it’s my mind, it’s very slow, and I have to pin everything down.
-Lieutenant Columbo

With his rumpled raincoat, ever-present cigar, bumbling demeanor and Sherlock Holmesian powers of deduction, disarmingly polite homicide detective Lieutenant Columbo took on some of the most cunning murderers in Los Angeles most of whom made one …

Decrease burnout through a better understanding of who physicians are

Robert Centor, MD

Physician

November 13, 2012

Physician a burnout has great current interest. Many authors are worrying about burnout and therefore writing about this problem.

What are the common root causes of burnout? Primarily burnout comes from loss of control and overwhelming undesirable activities.

Burnout occurs when the job becomes overwhelming.

Burnout likely is increasing because many physicians feel that they do not control their lives. Too often the current finances of medicine “force” physicians to spend inadequate time …

Reasons why doctors overtreat and overtest

Robert Centor, MD

Physician

November 7, 2012

The New York Times recently had an important and provocative piece, “Overtreatment Is Taking a Harmful Toll.”

The title is a bit misleading. The article focuses more on overtesting. We test too much and we treat too much.

The article, while mostly accurate, does not really explain the reasons for the problem. Unless we can accept and understand the underlying reasons for these problems, we cannot successful correct these problems.

Let …

Does your attending physician really know how to teach?

Robert Centor, MD

Education

October 8, 2012

Our educational system rewards zebra finding more than conserving financial resources. Too many academicians think zebras first and then default back to the obvious diagnosis.

One problem stems from our educational process being haphazard. Rarely do we select attending physicians for teaching skills, or teaching philosophy. We get faculty generally from three buckets:

Research future: Can they get grants funded and produce important research?
Clinical expertise: Will they attract complex patients to the …
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Does your attending physician really know how to teach?

Patients and physicians often forget that time is our friend

Robert Centor, MD

Physician

August 7, 2012

Too often I see both generalist physicians and subspecialists failing to fall back on the basic principles of a careful history and physical and then understand what specific tests to order.

One can blame academe somewhat. Too many subspecialty consults in academic centers end with a laundry list of tests, excluding almost anything that could ever be part of the differential diagnosis.

One can blame the payment system. The generalist physician, rather …

When patients have concerns that trump their disease

Robert Centor, MD

Physician

June 27, 2012

How often does this occur? A patient comes into the hospital with a chronic disease, or two or three. The patient has worsening of their disease(s) because they have not taken their medicines. They say that the medications are too expensive, but they have been smoking and/or drinking and/or using cocaine. Usually they also have a DSM-IV diagnosis or two.

You can fill in more information about the patient, unstable social …

Is it a crime that retainer physicians make more money?

Robert Centor, MD

Physician

November 29, 2011

Many readers know that I co-authored an Annals of Internal Medicine article on retainer medicine. The article has received (as expected) mixed reviews, because the concept causes angst for some physicians.

I believe (and I will not speak in this rant for my co-author) that retainer medicine emerged because of the current payment system. Retainer medicine is a response to burnout. Yes, many retainer physicians are making more money. Is …

An opportunity for hospitalists to improve patient care

Robert Centor, MD

Physician

August 18, 2011

Some hospitalists are in denial. Some hospitalists have become methodologic critics. But all hospitalists should take the findings of the recent Annals of Internal Medicine article seriously. We should not argue about the article, but rather ask whether these findings point out a weak point in our care of patients.

This article provides an opportunity, not a scolding:

In an accompanying editorial, two other researchers from the VA Medical Center in …

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An opportunity for hospitalists to improve patient care

Why the third year is the greatest year of medical school

Robert Centor, MD

Education

August 10, 2011

This post is dedicated to the many 3rd year students whom I have had the privilege to teach over the past 35 years. They continue to inspire me to help them become great physicians. They care.

The third year of medical school is wonderful, but it is a year of great change. Those readers who are physicians will completely understand, and I will try to explain to the non-physicians.

During the third …

Our future health depends on the success of hospital medicine

Robert Centor, MD

Physician

May 19, 2011

Over the past few years I have talked with many hospitalists. I know many hospitalist leaders and have many hard working hospitalists.

Most classic general internists have viewed the hospitalist movement with skepticism. Many outpatient internists express jealousy over the salaries and work hours of most hospitalists.

But here is what most non-hospitalists do not understand. In most hospitals in this country hospitalists …

Primary care physicians are rebelling against the system

Robert Centor, MD

Physician

March 6, 2011

I believe primary care docs are rebelling against the system. The system has made primary care physicians suffer emotionally and financially. The system has taken the greatest form of medical care – that consisting of continuity, comprehensiveness, complexity and completeness – and denigrated it.

Now I talk about “the system” in an anthropomorphic sense, but “the system” is virtual. “The system” has no conscious, it is not deliberate, rather it represents …

Robert Centor, MD

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