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

Tuesday, December 1, 2015

Go hard or go home

“My grandmother swears up and down that somehow I got dropped on my head.” She laughed and shook her head. “Like it had to be some kind of explanation for me being like this.”

Since she'd chuckled first, she gave me the green light to laugh, too. “When did you first know?” I asked.

“I don't remember ever not knowing. And if they'd just stopped ignoring what was right in front of them, my granny and them woulda known, too.”

She pushed down hard on the bed and scooched her bottom back. Then she reached for her cell phone on the tray table, turned on the camera and changed the direction so that she could use it as a mirror. The minute she saw her face, she shook her head and shuddered.

“I look a hot ass mess.”

“You've been sick.”

“Still, chile. I look crazy.”

I leaned back in the chair and watched as she pulled the screen close to her face to study her eyes. The false eyelashes she'd been wearing when she arrived at the hospital were half on and half off. First she tried pressing them back down with her thumb a few times, then groaned. “Uggggh!”

Her biceps bulged out when she lifted her slight arms. That and her voice were probably the only immediate signs that she was born with a Y chromosome. And yes, perhaps her square jaw could be a clue, but mostly she was delicate and feminine. Perhaps more so than many genotypic females I know.

“Your lashes lasted a whole lot longer than the ones I've had before. I just wore some recently and they made me crazy.”

“You got to use the right glue and get ‘em in the right place. Honey, but these here? These thangs can't be saved.” With both hands she gripped the edges of each lash between her thumb and index finger and zipped them off of her eye lids simultaneously. “Oh well! I'm still cute!” She threw her head back and let out a raspy laugh and coughed a bit. I nodded my head in affirmation.

After that, we both just sat there for a beat, saying nothing. My eyes rested on the almost cartoonish eyelashes that lay on the blanket before her. They were so big, bold and unmistakable. A clear declaration saying, “I am here. And screw you if you don't like it.” I decided that I liked that. My eyes came back up and met hers. We both smiled.

“You know … you're doing so much better, Ms. Nika. I think we can probably discharge you this morning if your labs look good.”

“Hmmm. Okay. Let me work on some things then.”

“Do you have a place to go?”

“Me? I mean, not exactly yet. But I always make it happen. I always do what I got to do to survive.”

I paused when she said that, not knowing what to say. Instead I just twisted my mouth and waited to see if she had more to add. Instead of expounding on her living situation, she yawned with both arms outstretched and went back to our original conversation.

“I used to have this little backpack when I was like 4 or 5. It was light blue and it had trucks on it. My granny got it for me to take to pre-school or kindergarten or something like that. And you know? I used to hold it on my forearm like a pocket book. And I had some Vaseline and ChapStick and would pretend like it was makeup.”

“When you were 5?”

“Or younger. I just always was like this. Not just a girl. A lady, you know? From even when I was little. So I spent my whole life just trying my hardest to do me. And be me.”

“Makes sense. That's bold.”

“Bold? Meh. Mostly it's just fucked up. Because you get kicked out of the house and then you find people who act like they accept you. Some, I mean a few, really do. Some just think you're funny and interesting like some kind of movie when it's your life.”

I swallowed hard on that part because I wondered where I fell. Immediately I felt bad for saying such a cookie-cutter statement about being “bold.” Even though I believed she was.

“That's deep.” That's what I said since that's all I could think to say.

“I see, like, regular females walking around sometimes and think, You don't even appreciate it. Like you don't appreciate being a lady. You know what I'm saying? Walking around in sweatpants and T-shirts. Or clothes that don't fit good. I saw this 1 girl who I could tell had a great body and felt mad. She looked all frumpy and crazy. Like, how this chick get to be a girl from the start and treat it like this?”

I'd never even thought of that. Quickly I imagined the sweats and UGG boots I'd worn to run errands the day before. This was a new perspective, even if I wasn't sure what to do with it. Either way, I love it when my patients give me new things to think about.

Ms. Nika went on. “People think they know but they don't. Like, they see me with my girlfriends and we all laughing and ki-ki-ing with our heels on and our lashes. We strutting hard and serving side eyes and slaying it and the people who ain't in our world they just stand by and stare. Like we some kind of aliens. But, see, when this is your world? Like, when you make your mind up to dress like who you know you been in your heart since you was little and be like what you feel inside? You go all the way. At least, I see it like that.”

“I get it.”

“Like, go hard or go the fuck home, you know? And then when folks looking all hard at you and saying dumb shit like, ‘That's really a dude,’ I just sashay even harder. ‘Cause they don't even know that me still looking like a boy but dressed like a girl still look and feel a million times better to me than dressing like a boy and feeling like a girl. Even when I can't get meds, you know, hormones and you can see a little bit of hair on my face, that's better than … it's better than … “

“The alternative?” I interjected.

“Yes. That. Anything is better than that. So it's not that it's so brave or so bold or whatever. It's just what I have to do to live and feel alive. Do that even make sense?”

I felt my eyes welling up. Partly because I felt so tremendously grateful for her transparency. But mostly because it did make sense. Being authentic was like oxygen for her. And the more I thought about what parts of my life I love the most, I realized that being my true self was always a part of it.


“Now, Dr. Mannings. What you up in here crying for?”

She reached for my hand and I let her. Right away I noticed her long acrylic nails and how they contrasted my short, square unpolished manicure. It made my eyes sting more.

I tried to say something but nothing came out. So I just shrugged. Finally, I eked out a few words. “You're beautiful.

And that? That made her cry. Which made me cry for real.


And so we just sat there holding hands, sniffling and not saying much else. Not even fully sure why we both felt so emotional but deciding to just roll with it (like ladies often do.)


You know? I'm not even sure why I felt the need to write about this today. But you know? I'm just so astounded by the many facets of humankind and how much people have to teach one another. I'm so grateful to Ms. Nika for letting me in a little. I will never see a transgender person the same way again.

I won't.

For the rest of that week, I wore a bold red lip. Kind of as an homage to Ms. Nika. And every time someone commented to me about it, I gave a knowing smile. But really in my head I was saying, “Go hard or go the fuck home, you know?”


Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.

Labels: , , ,


Friday, November 20, 2015

Getting diagnostic help through sharing the patient's story

Recently, we had a new patient admission whose presentation confused the entire team. We developed a differential diagnosis, but really did not have great confidence that we were moving in the right direction. We thought we had a good idea of what diagnoses we could not afford to miss. We ordered a few tests to exclude those can't miss diagnoses, but all the tests did not provide an answer. We accomplished this strategy within a few hours.

My resident and I happened upon 2 physicians in the physician's lunch room. One was a resident; another, a subspecialist. Being confused, we shared the story with our colleagues.

The other resident suggested a possibility that we had not considered. I immediately pulled up DynaMed Plus (disclaimer, I am on the editorial board and all ACP members get DynaMed Plus for free for the next 2 years) to investigate this possibility. I think that I had heard about the possibility, but unfortunately had not really learned enough on that subject.

The research confirmed the suggestion. We proceeded to make this possibility our #1 diagnostic target, because it is very treatable and potentially deadly if we missed it.

Of course, the resident was correct. Our lunch conversation made a potentially long and hazardous hospitalization much shorter and with a great outcome for the patient.

As I think about diagnostic dilemmas, I realize that I often “run the story” by colleagues, residents and even students. Sometimes the process of telling the story helps me better understand; sometimes the listener asks a key question; often the listener expands the differential diagnosis.

A couple of months ago, a former student (now an intern) approached me after a teaching conference. He wanted to share a patient story to see if I had any good ideas. His resident and he told me the story. In that instance, I had the proper knowledge to help, and once again the patient benefited.

In both cases, I have told the stories multiple times since. In the first case, most physicians go down the same paths that we originally did. Yesterday, I presented the story to a chief medical resident who had seen a similar patient as a student. He got the answer immediately.

For the second case, few people know the information that allowed me to point the team in the right direction. The presentation was 1 that I particularly had thought about and studied because I have a passion for acid-base and electrolytes.

Our sports role models should not be individual sport champions, but rather the “glue guys” in team sports. ”Glue guys” strive at all times to do whatever is necessary to help the team. The enemy is ignorance of the correct diagnosis. Victory is getting to the proper diagnosis. We cannot afford to have ego about how we get there, rather we must take advantage of interpersonal “crowd sourcing” if that helps the patient.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.

Labels: , , , , , ,


Thursday, November 19, 2015


“Inchworm, inchworm
Measuring the marigolds
You and your arithmetic
you'll probably go far.
Inchworm, inchworm
Measuring the marigolds
seems to me you'd stop and see
how beautiful they are.”
—Originally performed by Danny Kaye in the 1952 film Hans Christian Andersen

This morning I was in the Primary Care Center seeing a patient with 1 of my favorite residents. The patient was there for a follow-up and despite being on medication already, her blood pressure was high. She was already on 1 medication for it but it appeared that this wasn't enough. And the plan my very able resident had put together was evidence based and perfect reasonable. He wanted to add on a diuretic, or a water pill, to her regimen.

And that was mostly cool.

Except. She was wearing a ring with 6 different colored gem stones. And next to her chair was a red metallic cane with a black rubber stopper on the end. Though mild enough to not warrant joint replacement, the osteoarthritis in her hip was significant enough to cause her to use that walking stick for assistance in her ambulation.

“You want to give her a diuretic?”

“That or a calcium channel blocker. I mean, had she not been a diabetic, my first line monotherapy would have been a water pill, you know?”

I nodded and jutted out my lip.

“That's reasonable, right?” This resident, who is now a senior, was asking this as a rhetorical question. He'd been at this long enough in this clinic to know that it was perfectly reasonable to start an African-American lady with normal kidney function on a water pill for her blood pressure.”Dr. M, what do you have against hydrochlorothiazide?”

I chuckled and shrugged. “Nothing, man. I was just thinking about her Mother's ring with the 6 birth stones and her fancy red cane, that's all.”

He squinted his eyes at me for a beat and then pressed his lips together. “I get what you're saying, Dr. M. But she gets around really well with that cane. Seriously, she trucks it. Honestly, I think she can make it to the restroom, even with a water pill making her have to go a little more.”

“Okay. But did she have 6 vaginal deliveries? Because that's a game changer.” I raised my eyebrows after that question.

“You know? I don't know. But my guess is yeah, she did. Hmmm … okay. Gotcha.”

So that resident went back and chatted with that lady. And he learned that, like many women who pushed out 6 babies, even without arthritis making it harder to get to the commode, urge incontinence was a bit of an issue. Or better yet, it was a major issue. Given that fact, a water pill wasn't something that she felt too excited about, and since there were other options, we went with 1 of those instead.


You know? I noticed that ring but never had a big conversation about it. I just saw that it had those 6 stones and that it said “MOM” on it. And I did point it out and call it pretty at which point she said that her children had given it to her more than 20 years before. And that she'd always loved it.

And I could see why. I really could.


“2 and 2 are 4
4 and 4 are 8
8 and 8 are 16
16 and 16 are 32.”

You know? I am not the smartest person in my hospital by a long shot. I forget all the details of certain medical facts and have to look up stuff that many other people have long since committed to memory. I blank on the names of research trials and read probably just as much as a resident to jog my memory or teach me new things when I'm on the hospital service.


I do love people and, for that reason, I notice them and the stuff around them. I do.

Today when I parked in the garage at Grady for that clinic session I was a little late. This older gentleman who appeared to be also heading into work at some office part of the hospital system held the elevator for me which I appreciated. And when I got on, he looked right at me and said in the warmest, brightest way, “Good morning!” And the way his eyes twinkled under his salt and pepper eyebrows, I immediately knew it would be just that.

His shoes were shined. I knew it because my husband shines his shoes and irons everything he wears each day, so I sort of appreciate it when a man is attentive to such things. For a minute I felt slightly embarrassed when he caught me looking at his feet. But then I decided that it wasn't a big deal that he did.

“You shine your shoes,” I said it with a confident smirk.

He threw his head back and laughed deep and hearty. “That I do.”

“My husband gets his shoes shined every chance he gets.”

“Sounds like my kind of gentleman. Military?”

My eyes enlarged. “Wow. Yes. Previously in the army.”

Just then the elevator opened. “Same here,” he replied while gesturing for me to exit first.

“Alright then, sir. You have a great day.”

“It's already done,” he responded and waved good bye.

And that was that.

Right after that, from the corner of my eye, I saw 1 of our residents helping this lady figure out the payment system on the new electronic parking meters. They were both leaned over and peering into that contraption studying the LED lights and trying to make sense of it all. It looked like it was taking a lot of time but he was patient, I could tell just from his body language. I could tell she appreciated it. I did, too.

It had been raining for the last couple of days. The concrete was still brown and damp and the grass was glistening. The air felt more autumnal and crisp which I liked. The heels of my boots were clicking on the asphalt. I'd decided that I'd move into my fall-season attire regardless of the weather. So I was glad that, on this day, the climate seemed to be on the same page with that decision.

As I hustled by, I saw that a broken umbrella was lying on the grass, probably the aftermath of a gust of wind or from some frustrated person who'd reached their wits end with a dollar store special. It looked salvageable if you asked me.

“I like your boots!” That's what this man sitting on one of the smoking area benches called out to me between puffs on his cigarette. And it was kind of sweet, too, because the way he was smiling at me felt sincere and not fresh.

“‘‘Preciate that!” I called back.

“Go ‘head, then, Bootsy Collins!” He laughed loud and so did I. Because I know who Bootsy Collins is. And him saying that was pretty funny.

And that was that.

So yeah. I do this every day. Like, I walk through and around Grady and I just look and notice and take stuff in. The sights, the sounds, the scents, the all of it. I see flowers on window sills and allow myself to appreciate the tiny miracles happening in that place every day. And now it has become a habit. Which I love.

See, medicine is so serious, you know? I mean, you're trusted with caring for human beings and for making decisions that could hurt them if you aren't careful. You want to make the right diagnosis, prescribe the right treatment and stay up on all of the latest medical literature. And that, all of that, requires a level of precision, focus, and diligence that makes it hard to notice much else.


But medicine also opens you up to humankind in the very best ways. Especially at a place like Grady. There are some days where I get so bogged down with the medicine and the details that I forget that part. I neglect to notice the birthstone ring or to have a little small talk about whether or not the Falcons are better than the Saints. When I'm in that place, I miss things. No, not life or death things, but still things that just might change the trajectory of everything. Like the freckles sprinkled across a patient's nose that could create a space for us to start calling each other “cousins” since I have them, too. Which would be bad since sometimes I might be the only “cousin” or family that patient has. So yeah, whenever I get like that, I know it's not ideal. Like, even if the medicine is accurate and evidence-based, without the humanistic component it never reaches the gold standard.

Does this even make sense? Lord, have mercy. I know I'm rambling.

But yeah. It's kind of like that inchworm, you know? Measuring these gorgeous marigolds and never once marveling at their beauty whilst making meticulous measurements. I have always loved that song and sing it to my children to this day. I sing it as a reminder because these same lessons apply to every aspect of our lives--particularly family. So busy focusing on the to-do lists that we don't take in the experience. So consumed with making sure our kids are clean and have homework ready and are safe that we don't enjoy them. Yeah. Kind of like that inchworm.

Two and 2 are indeed 4. And 4 and 4 indeed make 8. But what about the marigolds?

At the very end of that clinic visit that patient told me about her grandchildren. Three of the 11 that she had were now in college. And that was a big deal because neither she nor any of her 6 children had attended college. And I told her that she should be proud and she replied that she was indeed very proud. I also loved when she said, “I'm especially proud that I raised the kids who are raising my grandkids.”


After clinic when I crossed the street, it was drizzling again. I popped open my umbrella and began hustling toward our faculty office building. Then, I caught a glimpse of a man in tattered clothing walking down Jesse Hill Jr. Drive in the opposite direction. He was holding what I am sure was the same umbrella that I'd seen earlier on the lawn that morning, and it was keeping him dry. And when he saw me looking in his direction, he waved at me and then called out in my direction, “I like your boots, doctor!”

And in an equally booming voice, I replied, “Bootsy Collins!”

He stomped his foot 3 times and laughed at that. He even slapped his thigh for emphasis. Which I think might have been the best thing I saw all day. In fact, I know it was. Because this probably homeless gentleman had something to protect him from the rain and he also had enough joy in his soul to still smile on a wet and wintry day.

I loved it all.
“Inchworm, inchworm
Measuring the marigolds
You and your arithmetic
you'll probably go far.
Inchworm, inchworm
Measuring the marigolds
seems to me you'd stop and see
how beautiful they are.”

I hope I never get too caught up in the arithmetic of life. Because these marigolds around me? Man. They're too beautiful to overlook.


Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.

Labels: , , ,


It's time to kill MRSA exceptionalism

For nearly 2 decades, we've lived in a delusional state where many in the field of infection prevention somehow believed that methicillin-resistant Staphylococcus aureus (MRSA) was so much worse than methicillin-sensitive Staphylococcus aureus (MSSA) that it needed to be treated in a special way. We needed to find all those who are colonized and isolate them (aka search and destroy). We needed to wrap ourselves in plastic before entering their room. We needed to destroy any unused disposable products that remained in the room at the time of hospital discharge. We needed to terminally clean the room in a special way. And on and on and on … all because MRSA was special. We didn't need to do any of those special things for plain old MSSA.

Some of us have been baffled by this magical thinking from the start. After all, MRSA and MSSA are transmitted in exactly the same ways. We're even more baffled after we see the evidence that in the endemic setting search and destroy doesn't work and contact precautions don't work either. And can anyone honestly say that MSSA invasive infections are benign?

A new multicenter study of invasive S. aureus infections in hospitalized infants published in JAMA Pediatrics should drive another nail in the coffin of MRSA exceptionalism (free full text here). Nearly 4,000 infected babies were studied and outcomes were compared between MSSA and MRSA infections. MSSA infections were nearly 3 times more common. Although there was no difference in mortality rates between the 2 groups, twice as many babies died of MSSA infections.

We need to quit chasing pathogen-based approaches (vertical strategies) to infection prevention and focus on horizontal strategies that reduce infections from all pathogens (e.g., hand hygiene, stethoscope disinfection, bare below the elbows, chlorhexidine bathing). Because all pathogens are important. I often joke that I've never had a patient tell me that they don't want a MRSA infection, but they'll take an MSSA. And that is definitive proof that patients figured out that MRSA exceptionalism was a bad idea long before most hospital epidemiologists.

Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on improving the quality and safety of health care, and sees patients in the inpatient and outpatient settings. This post originally appeared at the blog Controversies in Hospital Infection Prevention.

Labels: , , , , ,


Wednesday, November 18, 2015

White coats contribute to the unsafe hierarchical culture in health care

Following on the heels of Mike's bare-below the elbows debate at IDWeek, I posted a quick survey to gauge your impression of the level of acceptable harm associated with white coats. I'm still working on the power calculations that will be informed by the survey, but wanted to say thank you to the many who answered the questions. In the meantime, I also wanted to post the comments left by you, our readers. I've posted almost all of the comments thus far apart from those with swearing or those that mention their answers to question #1 of the survey.

One thing that struck me when reading the comments is that the white coat is a symbol that perpetuates hierarchy and is part of an unsafe culture. We need to create healthcare systems without hierarchy and it seems that the white coat contributes to a system where 58% of nurses that see harm are afraid to speak up ”and people need to be able to speak up.” Thus, even if you are in the minority who believes that white coats are not involved in pathogen transmission, your white coat might be harming patients by contributing to an unsafe hierarchal culture.

An interesting patient-centered quote that seems to run counter to the current thinking associating white coats with professionalism: ”If there are better options that would reduce transmission of infection then burn the white coats. As a patient I dislike them, intensely. Reminds me of a butcher shop or auto mechanic, not reassuring at all.”

Pro White Coat:

“Not an issue as long as changed daily and sleeves rolled up above the elbow and they don't carry medical equipment in the pockets”

“The white coat continues to be an important identifier of the profession, and symbols are important”

“It is certainly useful to carry things but also represents antiquated power hierarchy. Although there is no evidence, it plausible that they could transmit infections. Then again so could stethoscopes which have more direct patient contact.”

“Can't prove it is causing resistance—and I think patients like it”

“Needs an RCT. Anything else is nonsense … unless we say all health care providers put on and remove scrubs at work”

“We have white coats with short sleeves. This is no problem in my opinion. But bare below the elbows has become the standard in most Dutch hospitals. Probably the turning point was a documentary with a hidden camera showing that healthcare workers knew that hand hygiene was important that they should not wear jewelry, but they just didn't take the rules serious. Sometimes we don't need science but a good mirror and public response”

“Fashion item”

Pro Bare Below Elbow (OK with eliminating White Coats):

“It's merely a badge of authority and seniority masquerading as cleanliness and something “sciencey”

“A disease-ridden, antiquated symbol. They project the same professional and scientific insecurity as when doctors started wearing them to appropriate the public legitimacy of science.”

“I appreciate that for many, the white coat is a status symbol and helps create an instant first impression on patients. That being said, times are changing. The physician is not the most important person in the room. The healthcare team is what should be the focus now. Tear off the coat and tear down the hierarchy”

“I understand white coats as a part of PPE when you don't want to get something on yourself or to prevent things on you from spreading. But when the white coat goes EVERYWHERE you go, it doesn't maintain its protective qualities. Also, as a pharmacist, I'd much rather have normal, professional or consulting covnersations as a professionally dressed human than a white coat.”

“If it's a vector for microorganisms, eliminate it. Simple”

“Not necessary. Wear scrubs like everyone else. If your ego needs the coat, get therapy”

“I hate it. Adds to elitism and difference. Separates us from our humanness”

“White gets filthy too quickly”

“In the past, it was a status symbol for physicians; this is now translated to our students, ancillary staff and physician extenders. It is not represent amount of fundamental knowledge or the ability to care for patients. It was an extension of the laboratory part of our profession transitioned from black coats earlier in the last century. Currently, it is nothing more than a status symbol or accessory”

“White coats offer no benefit. We should try to prevent infections by any means necessary”

“I don't think white coats are necessary, but then I'm also not American!”

“Don't wear them in Australia. If you're worried about getting dirty, wear scrubs”

“It's part of a bygone age”

“Given the association with pathogenic transmissions, I am appalled we are still handing them out to our medical trainees!”

“I work at a pediatric hospital where most physicians do not wear white coats. Anecdotally, pediatricians seem to eschew white coats in order to be more friendly and approachable. Don't know what impact this has on HAI at our hospital”

“Doctors don't walk around with head mirrors anymore; the white coat makes about as much sense to me. Why do we still have this thing that exists for no other reason than a vector for disease?!”

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.

Labels: , , , ,


Older Posts   


Contact ACP Hospitalist

Send comments to ACP Hospitalist staff at

Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

Powered by Blogger

RSS feed