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

3 lessons on clinical excellence from the oncology clinic


While shadowing clinicians in cancer care, I learned the importance of spending time to gather the family history, building trusting relationships, and balancing treatment plans with quality-of-life considerations.

Cancer. A word that inspires fear not only in patients and their loved ones, but also for those working in healthcare. One of the oldest diseases known to humanity yet despite our best efforts, it continues to frustrate scientists and clinicians with its evasive and unrelenting nature. Even with promising advances in immunotherapy, treatment for many cancers is often life-prolonging rather than curative.


These were the thoughts in my head when I first entered the oncology clinic as a third-year medical student. I was taking an elective through the Miller-Coulson Academy of Clinical Excellence, an opportunity to learn from exceptional physicians at Johns Hopkins. My prior experience as a scribe led me to develop an interest in oncology, and I was placed with several different oncologists throughout the elective.


From that glimpse into the world of those who care for cancer patients, I took away three lessons that I will carry forward as I begin the clinical portion of my training. These strategies transcend specialties and will serve as an reminder to me of the most important aspects of patient care.


1. Learn from the medical history of your patient’s family.

We’re taught in medical school to take a patient’s family history as a routine part of the interview, but it can sometimes be overlooked when addressing more acute concerns. As we identify more genetic and epigenetic links with disease, particularly in cancer, it’s imperative to spend time identifying clues in the family history that may help direct a patient’s treatment, influence further screening, and identify other family members who may be at risk.


2. Build trust.

In oncology, establishing an effective partnership between a clinician and a patient must be done during a distressing and vulnerable period in that person’s life. A calm and confident presence is essential as the patient navigates through their journey with illness.


3. Balance treatment with quality of life.

The toll of ongoing treatment can markedly decrease a the ability of a patient with cancer to do what they enjoy. While it may seem desirable to offer the most aggressive approach, this may not be the patient’s preference. At each visit, I observed how the patient and their physician discussed and arrived at a treatment plan that balanced effectively reducing disease burden with the patients’ own goals for their quality of life.


The oncology clinic is a special place. There, news is delivered that changes the course of a person’s life. Treatment is provided that offers hope. Decisions are made that force someone to reflect on their true values. Stories are exchanged, laughter is heard, and tears are shed. Fear is often present at the start and throughout, but I also found a level of hope and comfort that was fostered by physicians using exemplary clinical skills.




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