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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.

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.

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.

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.

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.

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.   

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.     

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.

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.

July 10, 2018 | 1 min read

Pause Before Hospitalizing the Elderly

By Samuel Durso, MD, Johns Hopkins Medicine

Confusion among hospitalized older adults is common and dangerous. The hospital environment should be avoided if at all possible, with a goal of managing acutely ill older adults at home.

August 15, 2023 | 2 min read

The Importance of Humanities in Medicine

By Mike McCarthy, MD, Johns Hopkins Medicine

Engaging with and studying the humanities can help us give better patient care. Literature, art, and history remind us that patients are whole persons with lives that exist beyond medical problems. 

The Bluebird Cafe, Nashville, Tennessee. Copyright by the author.

May 11, 2020 | 3 min read

Redefining Rounds—Will The Circle be Unbroken?

By Chase Webber, DO, Vanderbilt University Medical Center

A patient care team performs best when all voices harmonize and creative approaches are applauded.

March 12, 2020 | 4 min read

What I Learned From my Primary Care Mentors

By Colleen Farrell, MD, New York University

All of us can learn from primary care clinicians, who know that listening, compassion, and connection are the foundations of clinical excellence.

May 30, 2023 | 2 min read

Artificial Intelligence: Artificial? Intelligent? Neither or Both?

By Matthew Peters, MD, Johns Hopkins Medicine

AI can complement the work of mental health professionals, in addition to performing clerical tasks and analyzing big data for insightful trends.

February 2, 2023 | 2 min read

We Just Disagree

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

When colleagues offer a conflicting opinion, remember to always put the patient first, check your facts, and be open to learning.  

November 29, 2022 | 2 min read

A Weighty Matter

By Colleen Schreyer, PhD, Johns Hopkins Medicine

Weight bias is common, harms patients, and may contribute to poor health outcomes.  

September 13, 2022 | 2 min read

Psychedelics and Health

By Mary Yaden, MD, Johns Hopkins Medicine

Psychedelic therapies have long been feared and avoided. We must acknowledge that there are clinical indications where these treatments are profoundly beneficial.   

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. 

March 10, 2022 | 1 min read

Balanced Conversations About Weight

By Colleen Schreyer, PhD, Johns Hopkins Medicine

Clinicians can treat weight as simply one more piece of health information that they incorporate into a holistic care plans. This can mitigate stigma and foster empathy. 

July 1, 2019 | 1 min read

Looking Under the Hood

By Daniel Minter, MD, University of California, San Francisco

Promoting a culture of thinking out loud can demystify the process of clinical reasoning and make it accessible to all learners.

June 18, 2019 | 2 min read

Navigating the Uncertain: A Book Review of “The Laws of Medicine”

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

Siddhartha Mukherjee, MD, provides a framework to reconcile the uncertainties we constantly experience in our practice of medicine in his book, "The Laws of Medicine."

September 1, 2021 | 2 min read

What’s The Problem?

By Ben Roberts, NP, Johns Hopkins Medicine

Systematically formulating a clear statement of the patient’s problem can be incredibly helpful. This may improve your diagnostic reasoning and ability to formulate more effective therapeutic plans.

August 16, 2021 | 3 min read

The Heart of Clinical Reasoning

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

Making a diagnostic error reminded me that connecting with patients on a personal level is necessary for optimal clinical reasoning.

March 20, 2019 | 4 min read

Social History as Story

By Colleen Farrell, MD, New York University

We cannot understand our patients’ bodies if we do not understand something about who they are as human beings,

June 7, 2021 | 2 min read

It’s Not About Weight

By Nicole Cifra, MD, MPH, University of Rochester

Approaches employed by eating disorder specialists can be applied to support all patients. This includes emphasizing healthy behaviors and acknowledging your own assumptions about weight.

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