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C L O S L E R
Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative
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Connecting with Patients
Clinical Reasoning
Passion in the Medical Profession
Lifelong Learning in Clinical Excellence
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October 27, 2021 | 4 min read

Digital Media Addiction: It’s Complicated

By Natalie Gukasyan, MD, Johns Hopkins Medicine

It’s tempting to resort to simple explanations for complex behaviors like digital media use. Deep relationships with patients can help you understand what’s behind the behavior. 

April 6, 2020 | 1 min read

Addiction Recovery During the Pandemic

By Mike Fingerhood, MD, Johns Hopkins Medicine

We are all stressed by the great uncertainty related to COVID-19, but for our patients with addiction, it is much greater. Check in with your patients and support them in finding healthy ways to cope.

December 14, 2021 | 1 min read

Supporting Loved Ones of People With Addictions

By Angela Orozco, MD, Johns Hopkins Medicine

The impact of addiction extends beyond the individual. We can offer and introduce resources like Al-Anon to both patients and their loved ones. 

August 26, 2021 | 1 min read

Destigmatizing Addiction: The Power of Words

By Namrata Walia, MD, Baylor College of Medicine

Please use the term 'person with substance use disorder’ instead of ‘addict’!

May 17, 2022 | 1 min read

Word Choice Related to Substance Use Disorders

By Beth McGinty, PhD, Johns Hopkins Medicine

Words matter; calling patients with a substance use disorder an “addict” defines them by their addiction. We need to ensure that our patients feel comfortable and supported so that they will engage in treatment.  

"Macy uses personal stories to follow the threads of the opioid crisis that has blanketed Appalachia."

April 29, 2021 | 2 min read

Book Review of “Dopesick”

By Suchita Sata, MD, Duke University

Treatment for opioid use disorder is often inaccessible and unaffordable. Nevertheless, clinicians must connect patients to available services while advocating for improved systems of care.

February 22, 2018 | 3 min read

Family History and Addiction Risk

By Margaret Chisolm, MD, Johns Hopkins Medicine

For some patients the risk of becoming addicted to prescription opioids is extraordinarily high and may outweigh any pain control benefit.

September 28, 2021 | 1 min read

Considerations When Talking With Patients About Cannabis

By Mike Fingerhood, MD, Johns Hopkins Medicine

The medical literature on cannabis use is not clear, making it difficult to know what to tell patients. Share both positives and negatives about using marijuana, and help your patient make the best care plan for them.

June 16, 2021 | 1 min read

Why we Must Talk About E-cigarettes with Teen Patients

By Mike Fingerhood, MD, Johns Hopkins Medicine

Proactively counseling adolescents about the risks of e-cigarette use is essential. The message should acknowledge both the health implications and the pressures that they may feel from their peers.

December 11, 2019 | <1 min read

Medication for Opioid Use Disorder

By Mike Fingerhood, MD, Johns Hopkins Medicine

Building a therapeutic relationship with people with substance use disorders is critical when supporting them on their journey to health.

April 6, 2018 | 1 min read

The Human Tragedy of the Opioid Crisis

By Margaret Chisolm, MD, Johns Hopkins Medicine

Addiction impacts more than just my patient, but their entire family. And our job as doctors is—in some way—to care for all of them, to bring them in close, and to try to relieve their suffering in some way.

February 13, 2020 | 2 min read

“Long Walk out of the Woods”

By Shannon Scott-Vernaglia, MD, Mass General

Sometimes sharing our own struggles with patients can highlight our shared humanity and provide them with hope.

April 14, 2022 | 3 min read

Afraid to Tell The Truth

By Kirsten Elin Smith, PhD, National Institute on Drug Abuse

When I shared with my clinician that I had previously been a heroin user, she made me feel ashamed. This taught me the importance of listening to patients with nonjudgmental curiosity. 

May 29, 2018 | 2 min read

Love At First Sight

By Margaret Chisolm, MD, Johns Hopkins Medicine

A clinically excellent physician always takes the time to ask his/her patient about the history of substance use in their parents and siblings, as well as aunts, uncles, grandparents, and cousins; and always asks about adoption.

April 3, 2018 | 1 min read

Ten Tips to Support Your Patient With A Substance Use Disorder

By Mike Fingerhood, MD, Johns Hopkins Medicine

I’ve devoted my entire career to supporting patients with Substance Use Disorders (SUD). Here are the top ten tips that I’ve learned over the past few decades.

Employers must cultivate a nurturing culture that supports the emotional and physical needs of their employees.

February 9, 2021 | 3 min read

How to Support Patients With Chronic Pain and Substance Use Disorder

By Juliette Perzhinsky, MD, MSc, Central Michigan University

All patients must be treated with empathy. Those suffering with chronic pain and addiction may be especially deserving of compassion.

March 13, 2018 | 2 min read

Reading Your Patient and Changing Your Plan

By Mike Fingerhood, MD, Johns Hopkins Medicine

We usually already have an agenda set when we see patients. However, we have to be ready to improvise by reading the patient, and be open to changing our plan.

November 19, 2020 | <1 min read

Quitting Smoking During The Pandemic

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

Remind patients that quitting smoking is hard and takes time. This will help them take a first step toward better health.

September 24, 2019 | 1 min read

Counseling Patients on the Dangers of E-cigarettes

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

E-cigarettes pose unique health risks. Screening and informing our patients of these concerns is imperative.

May 28, 2019 | 3 min read

Supporting my Patients who Smoke

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

It's important to make sure that the responsibility for addressing tobacco dependence is placed on the shoulders of clinicians, and off of the shoulders of the afflicted.

October 3, 2018 | <1 min read

Dr. Mike Fingerhood: A CLOSLER Look

By Gretchen Miller, Managing Editor

Every time I see a patient I ask them about their home environment, and what the main stressors in their life are right now.

August 21, 2018 | 1 min read

Talking With Young Adult Patients About Alcohol

By Mike Fingerhood, MD, Johns Hopkins Medicine

Clinicians need to be vigilant to discuss alcohol use with patients and remember that the legal drug, alcohol, causes more morbidity and mortality than opioids.

August 1, 2018 | <1 min read

Introducing “A CLOSLER Look”

By Gretchen Miller, Managing Editor

Check out the first video our new weekly series, “A CLOSLER Look,” featuring short and sweet interviews with clinically excellent physicians. On tap today - psychiatrist Dr. Margaret Chisolm.

April 14, 2022 | 1 min read

Supporting Young Adults Who Use E-Cigarettes

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

When talking with young patients about tobacco dependence, first create a judgment-free zone and ask open-ended questions to understand why they use the product. 

June 4, 2018 | 2 min read

Half Baked

By Wilma Ferthler, MD, Rural Country Doctor, Northeast Kingdom, Vermont

Your monthly dose of comic relief from William Osler's long lost cousin Wilma Ferthler.

April 23, 2020 | 1 min read

Bibliotherapy

By Scott Wright, MD, Johns Hopkins Medicine

Happy World Book Day! Read more fiction to broaden your perspectives. If you've never listened to an audiobook, try it! It might just change your life!

July 9, 2019 | 5 min read

Pain, Opioids, and the Constant Shadow of Stigma

By Travis Rieder, PhD, Johns Hopkins Berman Institute of Bioethics

When a patient reports pain, their words need to be met with listening, compassion, and a discussion of how best to address the pain.

September 23, 2019 | 3 min read

How to Manage Chronic Pain and Opioids

By Ryan Graddy, MD, AbsoluteCARE Medical Center, Atlanta, Georgia

Safe opioid stewardship is a key objective when managing chronic pain. Combining evidence-based strategies and compassionate care can help you to realize these goals.

September 5, 2019 | 2 min read

Book Review of “In Pain”

By Traci Speed, MD, PhD, Johns Hopkins University School of Medicine

Clinicians need to understand that patients' pain is real to build rapport and reassurance, which will help patients be open to the full range of treatment options.

May 31, 2018 | 6 min read

Tips for Taking Care of Patients, From a Physician Who’s Been One

By Scott Vasher, MD, Johns Hopkins University School of Medicine

The lessons I learned from being hospitalized have stuck with me and guided me in all of my practice.

October 26, 2021 | 3 min read

What is The Scope of a Clinician’s Work?

By Margaret Chisolm, MD, Johns Hopkins Medicine

We must help our patients achieve a state where body, mind, and spirit are working as a whole. We can help them do more than survive. Let’s help them thrive!

May 16, 2018 | 2 min read

The Stigma of Opioid Use Disorder

By Margaret Chisolm, MD, Johns Hopkins Medicine

Building a strong therapeutic alliance between patient and clinician—via open communication, mutual respect, and trust—is a lifeline for the individual patient with an Opioid Use Disorder.

June 29, 2020 | 2 min read

Lessons From the AIDS Epidemic

By Melinda Kantsiper, MD, Johns Hopkins Medicine

In times of crisis, it can be helpful to listen and learn from the stories of those who have come before us.

"My patient dreamed of walking with me at the seashore and staying up late chatting. That dream was an escape, a mental vacation, and a balm for her wounds."

April 19, 2021 | 2 min read

Let Your Patient Dream

By Zeina Moukarzel, MD, MPH, Beirut, Lebanon

From my young patient about to have all of her limbs amputated, I learned about compassion and courage.

"Heart Meditation," original painting by the author. Copyright by the author.

March 19, 2020 | 3 min read

Returning to Medicine of the Heart During a Pandemic

By David Kopacz, MD, University of Washington

How can we practice the kind of medicine that we so desperately need right now? Perhaps it is time to return to a medicine of the heart and of the soul.

December 7, 2020 | 3 min read

Flipping the Switch

By Swathi Raman, MD, MPH, LifeBridge Health, Maryland

Shifting away from needing external validation can promote wellness. Self-reflection and awareness of our internal monologue may help with internal validation and improve feelings of self-worth.

Artwork by Megan Gerber. Copyright by Megan Gerber.

February 3, 2020 | 5 min read

Joyful Deficiencies

By Megan Gerber, MD, MPH, Boston University School of Medicine

Creative expression can provide needed counterbalance to the outcomes-driven world of medicine.

February 6, 2020 | 2 min read

Navigating Masculinity in Medicine

By Kultaj Kaleka, MD, RN, Central Michigan University

The clinically excellent physician understands that male patients may need support sharing their perspectives.

One way to fight ableism it to ensure that all conferences and events are wheelchair accessible.

October 14, 2020 | 2 min read

How Language Can Fight Ableism

By Harry Paul (he/him), MD/PhD student, Johns Hopkins Medicine

The first step to being an ally for the disabled community is to educate yourself about the meaning of your word choice.

"Odysseus in front of Scylla and Charybdis." Henry Fuseli. 1794-1796. Public domain.

November 7, 2019 | 4 min read

Responsible Opioid Prescribing

By Travis Rieder, PhD, Johns Hopkins Berman Institute of Bioethics

Responsible opioid prescribing requires navigating between the Scylla of over-prescribing and the Charybdis of under-prescribing. Clinicians can work toward this goal by initiating prescriptions when (and only when) appropriate, managing them over the long-term, and knowing how to compassionately deprescribe when the time comes.

October 17, 2019 | 1 min read

Highs and Lows

By Kimberly Turner, MD, Johns Hopkins Community Physicians

The clinically excellent physician is always fully present with their patients. Sometimes there is the joy of a healthy new baby, and other times there is despair.

September 3, 2019 | 2 min read

“Hand-holding”

By Colleen Leavitt, MD, Johns Hopkins Community Physicians

Personalized care softens the edges of a one-size-fits-all medical system that perpetuates inequities. For some, clinicians and the healthcare system need to be able to step-up and take actions that support their patients' health.

August 29, 2019 | 2 min read

Mindful Doctoring in the EHR Era

By Irene Estores, MD, University of Florida College of Medicine

Mindfulness is essential in clinical excellence. Consider these five tips while working with the EHR.

The author having fun ice skating with colleagues at Patterson Park, Baltimore, Maryland.

February 25, 2019 | 5 min read

General Internal Medicine: An Opportunity to Engage Holistically

By Paul O'Rourke, MD, MPH, Johns Hopkins University School of Medicine

General internal medicine focuses on the importance of knowing and treating the whole patient. The entire patient, in their biopsychosocial context, must always be considered to provide high-quality, patient-centered care.

July 25, 2018 | 2 min read

The Joy of Realizing You Were Wrong and the Importance of Believing in Recovery for All

By Angela Guarda, MD, Johns Hopkins Medicine

Helping patients change unhealthy behaviors can feel challenging, but what feels like today’s failure can be tomorrow’s story of recovery.

June 26, 2018 | 1 min read

Harnessing Digital Technology for Clinical Excellence

By Margaret Chisolm, MD, Johns Hopkins Medicine

Digital technology can be leveraged for the greater good of clinically excellent patient care. Social media tools like Twitter enable you to connect with healthcare stakeholders from around the world.

May 3, 2022 | 5 min read

10 Pearls From Clinician Exemplars

By Ralph Hruban, MD, Johns Hopkins Medicine

We have much to learn from those who came before us. One example is working toward equity in healthcare, including fighting sexism and racism. 

April 27, 2022 | 2 min read

Listening to Your Patient’s Grief

By Avani Prabhakar, MBBS, MPH, Johns Hopkins Medicine

By listening to a patient’s story of loss, we bear witness and affirm their experience. 

November 24, 2021 | 4 min read

What I Learned When I Deleted my Social Media

By Tyler Mains, MD, University of California, San Francisco

When I stopped checking Twitter, Instagram, and Facebook, I created a boundary between myself and the never-ending stream of noise and emotion. I now have more bandwidth to empathize with my patients’ feelings.

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