Robert M. Centor

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Lessons learned from the National Champions

Better wordsmiths than me would have a difficult time explaining my joy in Monday night’s championship game. Virginia’s coach, Tony Bennett, stresses playing each possession without regard to future possessions. Nurses can make us better; clerks can make us better; the cleaning staff helps everyone. We all try to minimize them, but when they occur we must learn from them for our own sake and more importantly for the next patient’s sake.

Fictional detectives as diagnostic models

When Dr. Mark Shapiro wanted to complement Dr. Gurpreet Dhaliwal for his diagnostic expertise, he labelled their podcast discussion – Gurpreet Dhaliwal, The Sherlock Holmes of Medicine Studying fictional detectives helps me understand some basic principles of diagnostic excellence. Many years ago I described this as reading the textbook description of the patient’s diagnosis and finding that it does not fit. When that happens, the patient is not wrong, rather you are reading on the wrong page. When this happens, we need more data, or as Sherlock said in the Adventure of the Copper Beeches, “Data! Data!

Confusion after gastric bypass with Roux-en-Y

The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food. Patients presenting with hyperammonemic encephalopathy after Roux-en-Y gastric bypass surgery presented with overlapping clinical and laboratory findings. Common features included: (1) weight loss following successful Roux-en-Y gastric bypass for obesity; (2) hyperammonemic encephalopathy accompanied by elevated plasma glutamine levels; (3) absence of cirrhosis; (4) hypoalbuminemia; and (5) low plasma zinc levels. Studies of the ornithine  transcarbamylase cycle show that zinc is an important co-factor. Like to many patients with successful bypass surgery the patient presented was not taking supplementary vitamins with trace metals.

The role of podcasts in medical education

Obviously I am very biased, hosting a podcast now for 8 months, and being a guest on two other popular podcasts – The Curbsiders and The Clinical Problem Solvers. Soon thereafter, two things happened: The Curbsiders started their podcast and the Annals of Internal Medicine asked me to develop a podcast. When the Curbsiders asked me to appear on episode #16 of their new podcast in October 2016, I jumped at the chance and started my love affair with medical podcasts. In addition to the 2 podcasts above, I particularly love The Clinical Problem Solvers, because each week they provide a highly selected Morning Report case to solve.

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