Tips: Leading From the Middle of an Organization.

The vast majority of medical officers and physicians are called upon to lead from the middle of the organization. To be effective, one must understand the different approaches needed to exert positive influence up, down, and across the chain of command while delineating the overlapping relationship between leadership and management.

Rectal Bleeding in the Clinic.

Anal cancer is a rare malignancy with an estimated 8,580 new cases each year in the USA where hematochezia, a common condition, is often the initial presenting sign. We describe a 51-year-old woman who presented with painful hematochezia, with a delayed diagnosis of anal cancer in the setting of missed and misdiagnosed digital rectal exams in an otherwise low-risk patient. This case highlights the importance of maintaining a broad differential diagnosis for hematochezia and the utility of thorough physical exams.