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

12 Things I Wish I’d Known 50 Years Ago


Twelve things I would tell my younger self—all the things I didn’t know then, but wish I had.

I spent my entire career at Baltimore City Hospital (now called Johns Hopkins Bayview Medical Center), as a general internist focused on training tomorrow’s primary care internists. Here’s what I know now that I wish I’d known then:


1.) Know that almost all of my patients will come to me with expectant hope.


2.) Illnesses are full of mystery for patients, and my words and actions risk adding to the mystery. Try to demystify all the time—never add to the mystery.


3.)  Be patient-centered in all of my communication with patients. This includes the following:


Allow my patient to finish what he or she is saying.

When emotions are present, let or invite my patient to show and name them. Don’t try to switch the focus to my questions, explanations, or plans, until the patient has emoted and I’ve acknowledged his or her feelings.

Begin patient education by asking my patient what he or she already knows and thinks about their illness before I begin to tell or explain; after I have provided information, check the patient’s comprehension of it; provide written or published information on what is most  important for the patient to know.


4.) Get to know my patient’s world, enough so I can imagine him or her in that world, beginning with who is at home.


5.) Remember that my patient’s illness is probably affecting one or more others—spouse, adult children, others—and that, with the patient’s permission, I should include that other person in part or all of the encounter.


6.) When my patient has symptoms that I can’t account for, ask what he or she thinks is the problem or the cause.


7.) When I’m presenting my patient to an attending physician, offer or ask to do this in the presence of the patient, knowing that this is respectful of the patient and that the patient may contribute to the story in important ways.


8.)  Never refer to a patient as a “case.”


9.)  Walk with my patient when he or she is describing symptoms related to mobility.


10.) Find occasions to share with trusted colleagues joys, dilemmas, distresses, missteps, and regrets that have been part of my day.


11.) When I present my patient or document my patient’s care, be sure to state what my thinking is, not just my findings and plan.


12.) Have and cherish life away from my professional work, share what this is like with my colleagues, and ask them about their own life away from their professional work.