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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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Creative Arts in Medicine
Connecting with Patients
Passion in the Medical Profession
Lifelong Learning in Clinical Excellence
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February 25, 2018 | 1 min read

Diagnostic Excellence Starts With an Incessant Watch

By Reza Manesh, MD, Johns Hopkins University School of Medicine

Feedback is the key to improvement of any craft. No one is born an expert. It is earned through deliberate practice and an incessant thirst for progress.

Anchoring bias occurs when we rely too heavily on information received up front and too little on information received later when making a judgement about the most likely diagnosis. 

November 26, 2024 | 4 min read

Lessening the chances of making diagnostic errors 

By Elizabeth Fracica, MD, MPH, Johns Hopkins Medicine

To minimize common mistakes in diagnoses, clinicians must be mindful of cognitive and anchoring biases. Regularly seeking alternative explanations is one way to accomplish this. 

July 23, 2020 | 3 min read

Stepping Back Before Moving Forward

By Moises Auron, MD, Cleveland Clinic

Considering multiple diagnostic possibilities and not anchoring on the incoming diagnosis may increase the chance of getting it right.

August 7, 2024 | 1 min read

The rat

Soliciting diverse perspectives and considering unexpected etiologies can improve diagnostic accuracy. Answers to clinical puzzles may be rooted in cultural and geographic specificities. 

August 7, 2024 | 2 min read

Wait! Is that a zebra?

Common things are common, but occasionally unusual conditions are seen. To improve diagnostic accuracy, clinicians should consider alternative explanations and challenge their own assumptions.

December 5, 2023 | 3 min read

Museums make me a better clinician 

By Johannes Thorman, MD, Scania University Hospital, Malmo, Sweden

Museum-based health professions education is an emerging field. Studying visual art can help healthcare professionals become more patient, collaborative, rigorous, and appreciative of their colleagues.  

Three common zebras (Equus quagga), Kruger National Park, South Africa.

August 18, 2020 | 2 min read

Zebras Are Out There

By Eric Last, DO, Northwell Health, Wantagh, New York

Looking at the big picture and verifying details will help you consider diagnoses that may be unlikely, but still possible.

February 5, 2025 | 1 min read

Pathological hiccups

Sometimes benign symptoms can herald more serious problems. Being ready and willing to reconsider initial impressions is crucial for accurately discovering the underlying etiology.

January 15, 2025 | 2 min read

A spray away from the answer 

This clinical conundrum, related to hypoxia, underscores the importance of meticulous history-taking and the potential for unexpected complications with seemingly benign medications. 

April 25, 2019 | 3 min read

Diagnostic Humility

By Nathan Douthit, MD, Brookwood Baptist Health, Birmingham, Alabama

Self-awareness is critical in making accurate diagnoses.

June 25, 2018 | 2 min read

Trust The Diagnostic Process

By Michael Crocetti, MD, MPH, Johns Hopkins Community Physicians

Clinicians use a diagnostic process to guide their actions when faced with a medical problem. Hypothesis generation provides an efficient reliable framework to focus the clinical workup and come to the correct diagnosis and treatment plan.

March 4, 2024 | 2 min read

Getting the diagnosis right 

By Colleen Christmas, MD, Johns Hopkins Medicine

After arriving at what you think is the diagnosis, pause and consider alternative explanations. For patient populations at high risk for misdiagnosis (women and historically marginalized groups), examine how biases might be influencing your conclusions. 

September 7, 2022 | 2 min read

“Hysteria”

By Tina Zhang, MD, Johns Hopkins Medicine

We need to be aware of our own gender biases that could adversely affect women. To combat this, engage in shared decision-making with patients and be a lifelong learner of female health topics.   

February 23, 2018 | 2 min read

Mindfulness and Diagnostic Acumen: Inversely Related?

By Sharon Solomon, MD, Johns Hopkins Medicine

Far from being inversely related, physician mindfulness provides the foundation upon which diagnostic acumen is built.

November 22, 2021 | 4 min read

Noticing What We’ve Seen Without Seeing

By Ekene Ojukwu, MD, Johns Hopkins Medicine

Carefully observing our patients can lead to clinically relevant insights. Sometimes what seems inconsequential at first glance may be surprisingly significant.

November 18, 2024 | 3 min read

Starting from scratch  

By Erica Richards, MD, Johns Hopkins Medicine

Eliciting detailed stories about patients’ experiences is invaluable in healthcare. Approaching history-taking in a thorough manner allowed me to discover that a brain tumor was causing a patient’s psychiatric symptoms. 

July 22, 2024 | 1 min read

The third guest—ambiguity

By Javier Rascon, MD, Mallorca, Spain

Before a specific diagnosis has been established, clear communication is paramount. Use of metaphors, reviewing what is known so far, and encouraging questions builds trust and reduces patient fear. 

November 29, 2018 | 2 min read

Management Reasoning: Diagnostic Reasoning’s Underappreciated Sibling

By David Cook, MD, MHPE

Management reasoning is primarily a task of shared decision-making and monitoring, and is inherently more complex than diagnostic reasoning. A better understanding of management reasoning will offer insights into the causes and avoidance of medical error, clinical practice quality improvement, and training and assessment of health professionals.

January 10, 2019 | 3 min read

How to Improve Your Physical Diagnostic Skills With a Digital Database

By Samuel Durso, MD, Johns Hopkins Medicine

To sharpen diagnostic skill, take a minute to cross check the physical exam against images and lab results in the electronic record - if not congruent, then why?

The new 2018 members of the Gold Humanism Honor Society chapter at Georgetown University School of Medicine.

June 12, 2018 | 6 min read

Transcending Quality In Pursuit of Clinical Excellence

By Jack Penner, MD

This is an excerpt of the keynote speech given by Jack Penner at the 2018 induction ceremony for the Gold Humanism Honor Society chapter at Georgetown University School of Medicine. Dr. Penner will be entering residency in Internal Medicine at UCSF as a member of the UCPC Primary Care Track.

April 17, 2018 | 5 min read

Knowing Your Patient

By Khalil Ghanem, MD, PhD, Johns Hopkins University School of Medicine

Diagnostic excellence begins and ends with knowing your patient.

February 24, 2018 | 1 min read

Battling The System in Defense of Diagnosis

By Souvik Chatterjee, MD, Johns Hopkins Medicine

Healthcare delivery is at odds with a fundamental aspect of being a physician—strategic curriculum interventions are necessary to preserve the art of diagnosis.

October 14, 2019 | 4 min read

The Struggle Between Occam’s Razor and Hickam’s Dictum

By Kittane "Vishnu" Vishnupriya, MBBS, Johns Hopkins Medicine

Occam's razor and Hickam's dictum are both helpful tools when engaging in diagnostic reasoning.

February 24, 2025 | 2 min read

Listening to find answers 

By Michael Albert, MD, Johns Hopkins Medicine

To more accurately arrive at the diagnosis, it is generally wise to believe patients’ recounting of their symptoms and experiences. This can result in uncovering medical conditions that are sometimes labeled as being more generalized—like anxiety—and lead to improved patient outcomes.

October 9, 2019 | 3 min read

Return to Play

By John Wilckens, MD, Johns Hopkins Medicine

While research findings are critical for clinical decisions, they only support the human art of empathizing with and understanding your patients.

August 1, 2019 | 3 min read

Mindset and the Power of Yet: A Conversation With Dr. Gurpreet Dhaliwal

By Sam Kant, MD, Johns Hopkins University School of Medicine

Excellent clinicians are also thoughtful mentors. Mentors are like beacons as we navigate our path forward.

May 17, 2018 | 2 min read

How To Avoid Complacency in Diagnosis

By Michael Crocetti, MD, MPH, Johns Hopkins Community Physicians

Top tips to avoid complacency when faced with a common clinical presentation that may have an uncommon medical diagnosis.

April 29, 2019 | 1 min read

Drop the Story

By Neda Gould, PhD, Johns Hopkins Medicine

When faced with a stressful event, state the facts in one sentence. Anything beyond these facts is a story that the mind creates. Return to the facts - the only thing that is true in this moment.

Dr. Eric Howell sharing and communicating about patient care with a colleague.

May 22, 2018 | 1 min read

What My Patients Taught Me About Leadership

By Eric Howell, MD, Johns Hopkins University School of Medicine

A veteran hospitalists highlights four areas where patients have helped him become a more thoughtful leader.

The author, far right, with colleagues.

October 23, 2018 | 2 min read

Master Clinicians – The Early Years

By Vivek Murthy, MD, Johns Hopkins University School of Medicine

It’s no surprise that it takes hard work to become a great clinician. This is a glimpse of what the first steps on that road might look like.

"Sunflowers," Vincent van Gogh, 1889. Philadelphia Museum of Art.

May 2, 2019 | 4 min read

Grieving Unexpected Patient Outcomes

By Stacia Dearmin, MD, Akron Children\'s Hospital

Acknowledging and processing grief can bring healing to the clinician.

November 21, 2023 | 2 min read

“You’ll need someone to drive you home”

By Megan Murphy, MD, Johns Hopkins Medicine

Transportation may be a barrier to healthcare, especially for procedures requiring sedation. Sometimes we need to think creatively and partner with others in order to find solutions.  

September 13, 2021 | 4 min read

Only Connect

By Susrutha “Sus” Kotwal, MBBS, MD, Johns Hopkins Medicine

Missing a diagnosis made me realize the value of a thorough physical exam. It can often illuminate the cause of the illness.

June 3, 2019 | 1 min read

Every Piece of Data Matters

By Rabih Geha, MD, University of California San Francisco

Bolded, flagged, or typed in a different color, an abnormal result demands the mind’s eye in many modern EMRs, but it is equally important to direct our gaze to the quietly normal labs; not uncommonly, they may be screaming a powerful clue.

April 2, 2019 | 5 min read

Connecting to Historical Roots

By Lee Akst, MD, Johns Hopkins University School of Medicine

There are a number of important physicians in history, and an appreciation of our past can further our quest for clinical excellence in the present.

September 23, 2024 | 3 min read

The rabbit hole 

By Eric Last, DO, Northwell Health, Wantagh, New York

Through my own experience as a patient, I was reminded that ordering diagnostic tests should be approached with caution and careful consideration of the potential implications. These include the likelihood of additional testing and increased anxiety. 

December 17, 2019 | 4 min read

Stop, Look, and Listen

By Chase Webber, DO, Vanderbilt University Medical Center

From a young age, children learn to “Stop, Look, and Listen” when crossing the street. Clinicians would do well to live by these words in the realm of clinical reasoning.

Treponema pallidum Syphilis bacterium, the bacterium responsible for the dangerous sexually transmitted infection, syphilis.

January 8, 2024 | 3 min read

Combatting the syphilis epidemic 

By Zach Lorenz, MD, Johns Hopkins Medicine

Rates of syphilis and other sexually transmitted infections are skyrocketing. It’s imperative that we have candid conversations with patients about their sexual behaviors. 

May 12, 2021 | 2 min read

“To Comfort Always”

By Anna Berry, MS4, Baylor College of Medicine

When curing the disease is not possible, showing compassion for the patient is especially important.

November 12, 2019 | 2 min read

The Early Bird Special

By Rebecca Hamburger, Medical Student, Central Michgan University College of Medicine

Timing is everything. Doing our best to optimize access to healthcare is a first step to serving our patients.

Gardening creates an opportunity to take a mini-rest from the world, connect with nature, and experience the healing power of plants.

April 12, 2021 | 4 min read

Making the Most of Your Daily “Nervous Breakdown”

By David Kopacz, MD, University of Washington

A century ago, a “nervous breakdown” was a socially acceptable way to just take a break and recharge. Now, it’s not. In order to refresh yourself and mitigate burnout, consider scheduling regular time off.

November 5, 2019 | 3 min read

A Series of Biases: Murphy’s Law at Play

By Sonal Gandhi, MBBS, MD, Johns Hopkins Medicine

Biases get in the way of our clinical reasoning. When the data doesn't fit, clinically excellent providers re-examine their assumptions.

December 4, 2023 | 2 min read

More than a “picture” 

By Kittane "Vishnu" Vishnupriya, MBBS, Johns Hopkins Medicine

When explaining medical procedures to patients, use straightforward terms. Also, be mindful to maintain accuracy and clearly outline any risks. 

February 26, 2019 | 4 min read

On “Great” Diagnoses

By Nathan Douthit, MD, Brookwood Baptist Health, Birmingham, Alabama

Making an accurate diagnosis and giving a name to our patient's illness is a crucial component of acceptance and healing for the patient and their family.

September 10, 2020 | 2 min read

Collaborating With Physical Therapists

By John Corsino, PT, Cape Cod Hospital

Better collaboration between clinicians and PT colleagues can improve the health outcomes of our patients.

February 15, 2022 | 1 min read

The Free Throw Line and Mindful Practice

By Richard Schaefer, MD, MPH, Johns Hopkins Medicine

Basketball players have a ritual followed by a pause before shooting a free throw. Clinicians can do likewise to be fully present for their next patient.     

December 16, 2019 | 4 min read

Top 10 Tips to be a Great Consultant

By Aline Charabaty, MD, Johns Hopkins Medicine

Read these 10 tips so that next time your pager goes off, you can be an outstanding consultant!

November 27, 2019 | 3 min read

Clouds and Codes Aren’t Care

By Gisele Waters, PhD, Founder and President of Symbiotica Consulting

The promise of artificial intelligence is that it gives healthcare professionals the opportunity to improve the quality of care by allowing humans to focus on humans.

October 2, 2024 | 1 min read

Pain management: a perspective from a doctor in Kuwait 

Pain and suffering are ubiquitous. Observing approaches and practices in the U.S. highlighted for me the importance of open dialogue, patient empowerment, and multimodal approaches.   

May 3, 2018 | 5 min read

Challenges, Choices, and Changes

By Catherine Parrish, MD, Johns Hopkins Community Physicians

CHALLENGE yourself to be a lifelong learner—make CHOICES in your career that make you HAPPY, and use the CHANGES in your personal life to inform and enrich your work.

Our Mission

Stimulating healthcare professionals and trainees to reflect on giving exceptional care to every patient.

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