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Annals Beyond the Guidelines

Grand Rounds Discussions From the Beth Israel Deaconess Medical Center

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About Beyond the Guidelines

Beyond the Guidelines is a multimedia feature based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC).

Each educational feature focuses on the care of a patient who "falls between the cracks" in available evidence and for whom the optimal clinical management is unclear. Such situations include those in which a guideline finds evidence insufficient to make a recommendation, a patient does not fit criteria mapped out in recommendations, or different organizations provide conflicting recommendations. Clinical experts provide opinions and comment on how they would approach the patient's care.

Series Editor, Annals

Deborah Cotton, MD, MPH

Deborah Cotton, MD, MPH
Deputy Editor,
Annals of Internal Medicine

Dr. Deborah Cotton is Professor of Medicine at the Boston University School of Medicine, where she received her MD in 1976. After internal medicine residency at the Beth Israel Hospital in Boston and fellowship training at the National Institute of Allergy and Infectious Diseases and the National Cancer Institute, she received her MPH from Johns Hopkins University. Dr. Cotton returned to the Beth Israel in 1986 as Clinical Director for AIDS. In 1993 she joined the Infectious Diseases Division at Massachusetts General Hospital before being recruited back to the Boston University Medical Campus in 1998 as Assistant Provost for Clinical Research and later Chief, Medical Service, Boston VA Healthcare System. Board certified in internal medicine and infectious diseases, Dr. Cotton’s research has focused on the clinical epidemiology of HIV, hepatitis C, and infections of the immunosuppressed host. She became a Deputy Editor of Annals of Internal Medicine in 2009.

Series Editor, BIDMC

Risa Burns, MD, MPH

Risa Burns, MD, MPH
Division of General Medicine and Primary Care, BIDMC
Assistant Professor of Medicine, Harvard Medical School

Risa Burns, MD, MPH, is a general internist in the Division of General Medicine and Primary Care at BIDMC and an Assistant Professor of Medicine at Harvard Medical School. She received her medical degree at Wayne State University and completed her medical residency at George Washington University in Washington DC and went on to complete a general medicine fellowship and masters in public health at Boston University. After completing her fellowship, Dr. Burns joined the faculty at Boston University Medical Center where she conducted research on racial variations in the diagnosis and treatment of breast cancer. Dr. Burns joined the faculty at Beth Israel in 1996. Dr. Burns is an active teacher-clinician at BIDMC where she is involved in teaching medical housestaff while maintaining a primary care practice. Most recently, she has been integral in starting the new Beyond the Guideline series with Annals of Internal Medicine.

Series Assistant Editors, BIDMC

Howard Libman, MD

Howard Libman, MD
Division of General Medicine and Primary Care, BIDMC
Professor of Medicine, Harvard Medical School

Dr. Howard Libman is Chief of the Education Section of the Beth Israel Deaconess Medical Center (BIDMC) Division of General Medicine and Primary Care, Director of Ambulatory Training of the BIDMC Internal Medicine Residency Program, and Professor of Medicine at Harvard Medical School. Dr. Libman received his medical degree from Case Western Reserve University School of Medicine and completed residency training in internal medicine at University Hospitals of Cleveland and fellowship training in infectious diseases at Boston University Affiliated Hospitals. Since 1993 he has been a primary care physician and clinician educator at BIDMC. His career has focused on training medical residents and students in primary care, caring for persons with HIV infection, and educating health care practitioners in this field.

Eileen Reynolds, MD

Eileen Reynolds, MD
Division of General Medicine and Primary Care, BIDMC
Vice Chair for Education, Department of Medicine BIDMC

Dr. Eileen Reynolds moved into the role of Vice Chair for Education after spending 13 years as the Program Director of the Internal Medicine Residency Training Program at Beth Israel Deaconess Medical Center. She is a Harvard College and Harvard Medical School graduate who completed her primary care residency in internal medicine at UCSF. Prior to joining the faculty at BIDMC in 2000, she was the initial Program Director for the Primary Care Internal Medicine Residency Program at the University of Pennsylvania. Her research activities relate to feedback, evaluation, and mentorship of residents and the future of medical training; her clinical practice is in general internal medicine and women’s health. She also directs BIDMC’s Linde Family Fellowship in Primary Care Leadership, and is one of the editors of the long-running JAMA series based at BIDMC, Clinical Crossroads. Dr. Reynolds is married to a head and neck cancer surgeon and has two soccer-playing sons. Their family dog, Stryker, has survived death by chocolate on two occasions.

Gerald W. Smetana, MD

Gerald W. Smetana, MD
Division of General Medicine and Primary Care, BIDMC
Professor of Medicine, Harvard Medical School

Gerald W. Smetana, MD, is a general internist in the Division of General Medicine and Primary Care at BIDMC and Professor of Medicine at Harvard Medical School. He received his medical degree at the University of California, San Francisco and completed his medical internship and residency at Beth Israel Hospital in Boston. Dr. Smetana plays a central role in the teaching of medical students, housestaff, and faculty while maintaining a large primary care practice. He has directed continuing education programs both in the U.S. and internationally. He is a section editor for the Beyond the Guidelines series in Annals of Internal Medicine. He received the Society of General Internal Medicine national award for scholarship in medical education. His clinical and research interests lie in perioperative care, hypertension, and evidence based history taking. Additionally, Dr. Smetana has recently established a fellowship for junior BIDMC faculty on the art and science of writing systematic reviews.

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