Robert Centor posted an article on DB’s Medical Rants - Dec 16, 2009, 7:35 am
Interesting patient presented recently.  He is HIV+ and has a 10 day history of large volume watery diarrhea. On the 3rd day his BMP showed.  On admission his HCO3 was 19. Electrolyte panel...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 15, 2009, 7:02 am
Try as I might, I cannot become a policy wonk.  Yesterday, I heard a health system leader say that he had given up following the politics of health care reform – he was just wasting time.&n...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 12, 2009, 2:15 pm
I just finished reading A Whole New Mind by Dan Pink.  The book has its strengths and weaknesses, but it does make some very good points about right brain function. Medicine is not a left brain ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 11, 2009, 6:08 am
Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences Somehow I missed this one.  This article has parallel important analyses. Unintended consequ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 9, 2009, 6:09 am
KevinMD thinks not – Adding more residency slots won’t improve primary care numbers He makes an important point – unless we fix the "job" we will not have more primary care physicia...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 9, 2009, 5:25 am
We all agonize over the cost of health care.  Each Senator has a unique, uneducated perspective on health care costs. Controlling costs can be done once we all understand that someone must ration...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 8, 2009, 7:13 am
Some time ago, I was making post call rounds.  The team presented a patient admitted from the oncology service.  He was in his 50s and had new chest pain.  He described the chest pain a...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 6, 2009, 8:59 am
Med-Peds has a very nice review of adolescent pharyngitis – The rediscovery of pharyngitis in adolescents and Arcanobacterium hemolyticum Albert Fuchs provides a nice summary of my recent articl...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 6, 2009, 8:56 am
Lisa Sanders came to Alabama this past week and gave Grand Rounds both in Huntsville and Birmingham  We had a chance to talk about diagnosis, House, and influences.  I found out that she lov...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 5, 2009, 1:16 pm
Joe Elia of Journal Watch interviewed me earlier this week.  The podcast discussing the pharyngitis article – Podcast 68: Change your approach to pharyngitis in adolescents and young adults...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 4, 2009, 7:55 am
Almost 30 years later, I have a renewed passion for adolescent and young adult pharyngitis.  I remember how naive I was doing my first sore throat study.  I look at my writing and shudder. ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 3, 2009, 3:37 pm
Readers know how excited I am to finally have my pharyngitis paper published in the Annals of Internal Medicine.  I have decided to write the story behind the article for educational purposes.&nb...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 3, 2009, 7:48 am
Role of Evidence-Based Medicine in Informing Clinical Decision-Making Addressed by American College of Physicians in House Testimony The ACP testified on the "breast cancer screening controversy".&n...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 2, 2009, 11:07 am
As usual I enjoyed my VA "tour of duty".  We saw a reasonable variety of clinical problems with the notable exception of female patients.  We had some interesting decisions to make that requ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Dec 1, 2009, 9:23 am
55 yo man with SC disease and membranous nephritis.  He is taking an ACE inhibitor to decrease his urine protein and delay progression of renal disease.  We saw these labs Electrolyte panel...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 30, 2009, 4:43 pm
Go to Annals of internal Medicine and click on audio summary Related posts:Expand the pharyngitis paradigm UAB videoMy first podcastMy first podcast – about db’s Medrants Related posts:E...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 30, 2009, 4:30 pm
UAB Physician Urges Changes in Diagnosis for Sore Throat in Young Adults
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 30, 2009, 11:49 am
Yesterday we spent significant time on our 8 patients.  All had issues that required thought and some required doing some reading.  We had our first opportunity to use a new drug – Met...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 29, 2009, 6:20 am
Long morning, we were post call and had 8 new patients.  The team did a great job! I saw one patient whom I had seen in 2000.  The VA EMR is a wonder, I could read my old notes. New patien...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 28, 2009, 3:50 pm
In an ongoing email exchange I wrote: … opined that the answer for primary care would not exist within "fee for service(FFS)". If we follow Deep Throat's admonition and "follow the money", ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 28, 2009, 3:35 pm
Yesterday we focused on the oliguric patient.  I will provide the essence of that chalk talk. For the purpose of this talk, we define oliguria as < 500 cc / day or 20 cc / hr Always consider ob...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 28, 2009, 6:13 am
Do hospitalists really provide better care? In which I challenge hospitalists to perform important new studies concerning the best models for hospitalist groups.  I hope those who read this int...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 27, 2009, 6:27 am
Several issues presented from the patient discussed over the past 2 days.  The patient is greatly improved.  His laboratory tests have improved greatly, as has his mental status and ability ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 25, 2009, 11:58 am
Day 11 involved discussing 5 new patients, and continuing plans on the remaining patients. One patient brought out some important teaching points.  The patient is in his 70s and came in for weak...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 24, 2009, 12:07 pm
We were on call on day 10.  I saw one new patient – a 38-year-old man with abdominal pain.  His pain started in the middle of the night – it was sharp, mid-epigastric without rad...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 23, 2009, 5:59 am
So yesterday was day 9.  We have 4 patients, relatively stable, on call today.  We did have a major teaching point. We have a patient with legitimate severe pain.  The intern had writt...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 22, 2009, 1:16 pm
One of my current interns and former medical students first authors this case report – Peritonsilar abscess requiring intensive care unit admission caused by group C and G Streptococcus: a case ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 22, 2009, 11:05 am
I received this tweet: Do you have any recommendations on how an MS3 should approach an attending to request something like your 2 hour commitment for ed I actually do not have any recommendations.&...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 22, 2009, 10:43 am
Relatively easy day – just the resident, 1 intern and me rounding on 6 patients.  We had an interesting acid-base puzzle.  The patient is in his 50s and has known hep C positivity (pos...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 21, 2009, 6:52 am
Last night we went to see The Blind Side.  All 4 in my party loved the movie.  As I often do after seeing a movie, I read reviews on returning home.  The reviews were generally positive...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 21, 2009, 6:34 am
Day #7 was a classic post-call day – we had 9 new patients.  Fortunately I had seen 2 patients on Day #6, which ameliorated the challenge. Post-call rounds after busy days have a very diff...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 20, 2009, 5:43 am
Day 6 we admit again.  When I left yesterday we had 4 patients already. Rounds yesterday focused mostly on teaching.  As an attending, I make a 2 hour commitment to my teams.  They get...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 19, 2009, 1:09 pm
Screening Policy Won’t Change, U.S. Officials Say The White House disagrees with the USPHTF on political grounds.  These new recommendations are based on careful scientific analysis. Memb...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 13, 2009, 7:05 am
This is a classic ABG sequence: ABG Admission (on 2 L O2) Day 2 (Bipap 100%) ABGs on successive days pH 7.28 7.52 pCO2 89 52 pO2 60 373 HCO3 42 42           &nbs...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 12, 2009, 6:47 am
I spent yesterday afternoon driving and unwinding from three and a half intense days participating and teaching in the Academic Hospitalist Academy.  We first contemplated this course 3 years ago...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 9, 2009, 4:11 am
Yesterday was the first day of the inaugural academic hospitalist academy.  We have 78 attendees, meeting our goal. The enthusiasm and energy yesterday was great.  We have a group of young ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 9, 2009, 4:08 am
I have added chapter 4 – this is a case I recently discussed on this site.  Given the lack of previous commentary, I have not changed my explanation at all. To remind everyone – the ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 6, 2009, 7:45 am
The ACGME has published an open letter concerning work hours (h/t to @FutureDocs).  I highly recommend reading this letter, which I found balanced and nuanced.  Nasca Letter Here are the bi...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 5, 2009, 8:41 am
The Coming Shortage of Doctors Nice try article in the Wall Street Journal.  We already have a doctor shortage, and it is worsening. The writer tried hard, but missed the point.  He did n...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 5, 2009, 8:22 am
Monday night I had dinner with 7 medical students (5 4th year students and 2 3rd year students).  Three plan on doing general surgery, one radiology, one internal medicine, and the 2 third year s...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 4, 2009, 11:40 am
I just added chapter 3 to the acid base book – please provide some feedback positive or negative.
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 3, 2009, 3:28 pm
If I need medical care, I would be wary of seeking it from an ‘expert’.  Their notoriety is often from research, publications, medical conference speaking gigs and a tincture of self-...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 3, 2009, 6:31 am
Why do I enjoy the overturning of conventional wisdom?  I guess I have a form of schadenfreude.  Here goes another one – Aspirin 'only for heart patients' Low-dose aspirin is...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 2, 2009, 10:32 am
I took this quote from Bob Sutton's web site – Work Matters The best test of a person's character is how he or she treats those with less power. I like it so much that I have added it...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 2, 2009, 10:28 am
The astute readers knows that I have started with a false dichotomy.  I took the title from this rant – Intuition vs. Data-Driven Decision-Making: Some Rough Ideas I like this paragraph: ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 1, 2009, 2:39 pm
Perplexing pain “They took out my ovaries,” the 46-year-old woman told the doctor. “And my appendix, and most of my colon. I had several exploratory surgeries where the doctors were just trying...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Nov 1, 2009, 5:23 am
Success!!  My resolution last year led to a year of exercise – The Thanksgiving Resolution – year 3. Last year I started on November 1.  In the past 12 months I exercised 194 days.  I ...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Oct 31, 2009, 7:27 pm
Readers know that I love teaching acid-base and electrolytes.  For several years my students and residents have encouraged me to collect my teaching philosophy on paper. Today I started the project....
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Oct 31, 2009, 6:31 am
The patient is a 38 year old man admitted with a bleeding ulcer. It is 3 days later, he is otherwise stable and has these labs. He has known polycystic kidney disease with an estimated GFR of 30. H...
Comment - Like

Robert Centor posted an article on DB’s Medical Rants - Oct 29, 2009, 5:54 am
Both Kevin and Gruntdoc have weighed in on this article Incentives promote unnecessary, excessive tests in the ER – Kevin Reviewing the Great ER Caper: Just to be sure. By the way: “Just to...
Comment - Like