American College of Physicians: Internal Medicine — Doctors for Adults ®

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Internist stirs passions, debates with a medical blog

One internist's blog helps him connect with a farflung virtual community—and giveD free rein to his inner 'rant'

From the May ACP Observer, copyright 2006 by the American College of Physicians.

By Janet Colwell

To colleagues at the University of Alabama facilities in Huntsville and Birmingham, Robert M. Centor, FACP, is a respected academician and administrator, serving as associate dean of the Huntsville regional medical campus, director of general internal medicine in Birmingham and attending at the Birmingham VA Hospital.

But to hundreds of Web surfers, Dr. Centor is the "DB" of "DB's Medical Rants," a Web log—or blog—he created in 2002 to broadcast his views on health care and medicine far beyond traditional academia. ("DB," the site explains, stands for both "da boss," a nickname bestowed by colleagues, and "Dr. Bob," a moniker given him by golfing buddies.)

Along with studding his www.medrants.com site with quotes from Friedrich Nietzsche and the Talking Heads, Dr. Centor comments on medical issues—and connects with a virtual community of physicians and consumers, garnering as many as 800 "hits" a day. Recent postings included his take on a study targeting an antibiotic used in severe asthma attacks, his "extreme dislike" of direct-to-consumer television ad and his optimism about Massachusetts' landmark plan for universal access.

"I wanted the opportunity to be outrageous," said Dr. Centor. "When you have a blog, you don't have to worry about an editor because you're the editor and the judge and the jury."

Building a community

That doesn't mean he doesn't get feedback. His postings—often several a day—draw comments from consumers, other physicians and malpractice lawyers.

One rant on a study in the July 2005 issue of Archives of Neurology, for example, inspired 23 comments. (The study described incidents of Parkinson's patients who developed compulsive gambling urges while taking pramipexole dihydrochloride or similar drugs.)

Many comments were from patients anxious to tell their own story. "People are really interested in communicating about what's happened to them," said Dr. Centor, who is incoming president of the Society of General Internal Medicine. "Sometimes a comment will spur a rant or people will comment on an idea and I'll turn it into another article."

Many of the same physicians frequent the site, but the "regulars" tend to change over time, said Dr. Centor. "Some even start their own blogs."

Taking the plunge

The blogging impulse came to him one day while he was browsing the Internet and stumbled across other blogs. A self-proclaimed early adaptor of technology—he bought his first Apple computer back in 1981—he registered with blogger.com, a free online tool for creating personal blogs.

At first, he wrote about anything that popped into his head, but was then inspired by Medpundit, a blog by a family physician, to zero in on medicine. (Experts estimate that there are now hundreds of physician blogs.) Medrants includes a link to Medpundit as well as several other medical blogs.

Dr. Centor squeezes in blogging time whenever he has a break in his schedule, usually in the early mornings. He may post immediately in response to an issue he finds in medical literature or national newspapers or take more time to formulate an argument. In the freewheeling blogsphere, there are few hard-and-fast rules.

"My only guideline is my own common sense," said Dr. Center, noting that he sometimes deletes inappropriate reader postings. He's not afraid to mention product names, for example, but goes to great lengths to obscure patient identities when describing clinical cases.

"I think the anonymity of the Web leads to a more honest interchange of ideas," he said. "Sometimes that interchange is uncomfortable but we should not always resort to polite discourse."

The results sometimes rankle readers. In one rant last year, for instance, Dr. Centor riffed on the trouble physicians have getting some patients to comply with treatment plans.

"Not every patient opts for a treatment strategy that I would personally choose," he wrote. "I must accept that, and do my best to help the patient achieve his/her desires." Many of the physicians who responded applauded the notion that patients are ultimately responsible for their own health.

A few, though, disagreed. "I have a big issue with your comment on 'how well a patient does is mostly up to them,'" wrote one reader with several chronically ill relatives. "These people depend on experts to manage their care."

Such discussions make blogging worthwhile. "I didn't know that I was capable of being passionate about my opinions," said Dr. Centor, who has published research on medical decision-making and the diagnosis and management of pharyngitis. "Perhaps the most satisfying outcome of blogging comes from the sense that I am stimulating my readers, and myself, to think critically about issues in health care."

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