Yes. Medium format requires a different approach from 35mm. DOF is much thinner, especially when shooting at wide apertures. (At f/4, it is a challenge to keep both eyes in focus in a MF portrait.) I almost never shoot with an aperture wider than f/5.6 -- if you miss focus by even a millimeter wide-open, it will ruin the image.
Focusing with a center spot before framing is a habit that you must break, *especially* if shooting medium format at wide apertures. Think about the geometry. The focal plane is basically perpendicular to the line of sight. When you focus with a center spot on a subject's eye, then rotate the camera to put the subject off-center, the focal point will land on the subject's ear. At f/4 this will be painfully obvious.
So, yes, my advice is to reinstall the screen without the center spot, and teach yourself how to see focus on the screen without the crutch of a center spot. It might not solve your problem. You still might have camera issues, even after reinstalling the original screen. But you will rule out user error and be a better photographer for it.
Cool! will try that, also if I use a split image like the standard mamiya 645 focusing screen can I still use this same method without looking at the split image? that way I have both options?