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

Dropping my Pen


Excellent clinicians implement colleagues’ feedback to improve their care of patients and offer guidance to support the growth of others. 

“That was a great patient presentation, but I want to challenge you next time to not read from your notes,” my attending said. 


As a third-year medical student still learning the basics of clinical decision-making, I shuddered at the thought of presenting a patient without reading from my precious pocket notebooks. I’d completed three vastly different clerkship experiences—medicine, surgery, and pediatrics—and if there was one tool that enabled me to succeed in all of them, it was taking hundreds of pages of notes during my interactions with patients. Whenever I presented to attendings, my notes were to me like a teddy bear to a crying child—a source of comfort and security, something I could always lean on whenever I was nervous, forgetful, or uncertain. 


My attending’s feedback was exactly what I needed at the time for my growth as a clinician. I presented the next several patients without notes. Even though I remembered fewer details, my presentations gradually became less fluffy and more focused. Most importantly, I realized that without my notebook, I listened more intently to patients while they were sharing their stories. Since they had my full attention, I remembered more about them as a person. I made eye contact and was more present. 


As trivial as this may sound to the experienced physician, learning to surrender my habit of excessive notetaking has been a critical step in my development as a patient-centered clinician. In challenging myself to approach patient care the way a seasoned physician might, I’ve reflected on a few clinical excellence practices modeled by my colleagues: 


1. Listen. 

The fundamental skill of listening is sometimes the most challenging. I’ve seen how the pressures of electronic medical documentation can distract from the willingness to simply sit with patients and make eye contact. While it’s sometimes necessary to document in a patient’s chart during the encounter, there’s something irreplaceable about pulling up a chair next to the patient’s bedside and listening as they entrust you with things they’ve never told anyone else. 


2. Implement others’ constructive feedback. 

Although a part of me desperately wanted to stay in my comfort zone, I knew that implementing my attending’s advice would make me a better clinician. I’ve followed the example of my intern and resident colleagues who are continually executing feedback from their attendings. They admit what they don’t know and choose to learn and grow. They’ve shown me that clinical excellence requires humbly addressing one’s own weaknesses. 


3. Offer constructive feedback.

Had my attending not been interested in my professional development, he wouldn’t have taken the time to give helpful feedback. Far from being critical, he commended me for what I did well and offered encouragement for how I could do better. It was the type of feedback that made me want to improve. Excellent clinicians care deeply about teaching trainees, and in doing so, extend their care to all the patients who will someday be helped by a trainee’s care. 





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