Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative



When a clinical visit begins to feel like being lost at sea, a simple inquiry about what a patient would most like to accomplish during their visit may help guide the encounter. 

What can you do when a clinical encounter is getting more complex by the minute, with no sense of direction or clear pathway to resolution and wrap-up? This was our situation when my longtime patient, a 70-year-old woman, was in for health maintenance and to follow up on recent gastrointestinal testing. She was upset and unfocused as she tried to explain her uncertainty about test results, difficulty sleeping, and need to update her vaccination status. Agenda setting, active listening, summarizing, and some redirecting helped, but our patient still seemed unsettled. The student interviewer paused, and then pivoted successfully with the following question:  


What do you most hope to accomplish during your visit today? 

Our patient said she wanted help tracking down her colonoscopy biopsy report, clarification of the labs she needed, and a flu shot. When we reassured her that we would get all of these things done, she was visibly relieved and expressed gratitude. A short interval follow-up was also scheduled 


It can be difficult to stop oneself from trying to track every detail in a patient’s story; but sometimes that’s not what’s needed. When caught in the chaos of a challenging patient encounter, it’s helpful to focus on the patient’s main goals. When a clinical visit begins to feel like being lost at sea, consider the following ways to regroup:  


1. Take a mindful pause. 


2. Zoom out. Get out of the weeds and look for areas of greatest concern. 


3. Ask the patient what a successful visit would look like. 






This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.