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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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March 8, 2022 | 3 min read

Tips For Assessing The Intensity of Pain

By Brian Lee, MD, PhD, Johns Hopkins Medicine, David Madder, DO, Johns Hopkins Medicine

When assessing pain, we often ask patients to assign it a number between 0 and 10. Asking about the effect of pain on behavior and functional status can often give us a more meaningful understanding. 

November 3, 2021 | 2 min read

Diagnosing And Treating Pain

By Rebekah Fenton, MD, Northwestern University

Always listen to your patients and make sure that they understand that you believe their experience of pain.

January 12, 2023 | 1 min read

Pain Talk

By Will Frye, MD, Johns Hopkins All Childrens, St. Petersburg, Florida

Chronic pain is sometimes a challenging topic to discuss with patients. I’ve learned that the most important thing is to validate my patients’ experience of suffering. 

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.

August 24, 2018 | 1 min read

Understanding How Your Patient Perceives Their Pain

By Erica Leonard, MD, Johns Hopkins University School of Medicine

By asking these seven assessment questions, you can better understand your patient’s pain in order to build a plan of care together.

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.

March 29, 2021 | 2 min read

Validating Your Patient’s Experience of Chronic Pain

By Jocelyn Fitzgerald, MD, University of Pittsburgh

We must empathize with our patients who are suffering from chronic pain. Working with them to achieve a better quality of life may be a reasonable shared goal.

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.

April 21, 2021 | 2 min read

Opioid Monitoring in Primary Care

By Jeffrey Millstein, MD, Penn Medicine

Discussions about opioid use with patients must be approached with curiosity and concern, rather than suspicion. Implemented with sensitivity, opioid monitoring programs can strengthen the clinician-patient relationship.

April 4, 2018 | 3 min read

Race, Funding, and Access to High Quality Care

By Sophie Lanzkron, MD, MDH, Johns Hopkins University School of Medicine

Sophie Lanzkron, MD, MHS, advocates for systemic change to increase access to high quality sickle cell care for all patients.

"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.

March 17, 2021 | 3 min read

Making Unconscious Bias Training Work

By Verna Monson, PhD, Minneapolis, Minnesota

To be an antiracist, you must be aware of your own biases and learn from your missteps. And remember that unconscious bias training is only a starting point for dismantling discrimination.

April 26, 2021 | 2 min read

Embrace Your Vulnerability

By Jennifer Huang, MD, Oregon Health & Science University

Sometimes sharing personal details about yourself helps forge a deeper connection with your patient.

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.

"When a patient is riding the wave of anger, instead of defensively explaining your kind intention and clinical justification for decisions, validate their experience."

March 3, 2022 | 1 min read

Listening to my Patient’s Anger

By Avani Prabhakar, MBBS, MPH, Johns Hopkins Medicine

When encountering an angry patient, validate feelings rather than becoming defensive.  

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.

October 19, 2021 | 2 min read

Asking About Your Patient’s Pet

By Elizabeth Steuber, MD, Johns Hopkins Medicine, Todd Brenner, MD, Johns Hopkins Medicine

Ask patients about their pets. This can build a bridge to talking about topics like functional status, home life, and family dynamics.

"Abstract Painting (726)" 1990, Gerhard Richter, Tate Museum.

December 6, 2018 | 5 min read

Lines Blurred

By Ekene Ojukwu, MD, Johns Hopkins Medicine

Really taking care of a patient means making hard choices, saying things people don’t want to hear, and letting them decide if they will engage in their own care. At the same time, it means learning different ways of listening, looking for opportunities and strategies to trust our patients, believing their stories, and seeing them as full individuals

February 21, 2019 | 1 min read

Substance Use Disorders in Later Life

By Mike Fingerhood, MD, Johns Hopkins Medicine

Substance use disorders in older adults often go undiagnosed because screening is frequently overlooked. Key to supporting patients to make a change is developing rapport and trust.

January 21, 2021 | 1 min read

Lost in Translation

By Sonal Gandhi, MBBS, MD, Johns Hopkins Medicine

When you and your patient don’t speak the same language, clear communication is critical. When an interpreter is unavailable, reach out to staff and others for help.

August 11, 2022 | 2 min read

A Mother’s Death

By Avani Prabhakar, MBBS, MPH, Johns Hopkins Medicine

Including a patient’s words in your empathic response is affirming and creates connection.

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.

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 12, 2020 | 2 min read

Chief Complaint: Racism

By Syeachia Dennis, MD, University of Oklahoma

Patients are increasingly recognizing the impact of racism on their health. We should be prepared to help patients confront this and consider this core to our work to systemically address this public health crisis.

July 8, 2021 | 1 min read

Reaching Out to Your Patient’s Family When Death is Imminent

By Jeffrey Millstein, MD, Penn Medicine

When my friend died of pancreatic cancer recently, I saw how valuable it was for her family to hear from the treating physician. Going forward, I will emulate this inspiring practice.

August 14, 2019 | 3 min read

What Physics Taught me About Patient Stories

By Jeffrey Millstein, MD, Penn Medicine

As in physics, the answers are usually in plain sight. Listening to our patients with curiosity and humility will usually lead to understanding.

May 10, 2018 | 3 min read

Truly Listen: Clinical Excellence in Nephrology

By Edward Kraus, MD, Johns Hopkins University School of Medicine

Listen to your patient, try to understand what they're saying, and think beyond policies and protocols to be the best advocate possible.

December 19, 2022 | 2 min read

Dismantling Ableism in Medicine

By Kerry Devlin, MMT, LPMT, MT-BC (she/her), Johns Hopkins Medicine

What does it mean to co-construct a plan of care with disabled patients? Their desires may not be what you expect.

February 22, 2021 | 3 min read

Giving Respectful Care to All

By Danielle Prentice, DO, Penn State

Respecting patients' stories, leaving preconceived notions at the door, and avoiding insensitive comments are expected professional norms in healthcare.

January 19, 2021 | 2 min read

How to Mitigate Compassion Fatigue

By Dimitrios Tsatiris, MD, Cleveland, Ohio

Prioritizing self-care and making an effort to connect with others may prevent burnout and allow us to continue to give clinically excellent care to patients.

October 16, 2019 | 2 min read

How to Show Empathy When Patients Express Anger

By Zainab Obaidi, MBBS, Johns Hopkins Medicine

There are strategies that can be used effectively when patients express anger.

November 9, 2021 | 3 min read

Giving Exceptional Care Without Exception

A one-liner works in comedy but leads to biases in medicine. Listening, getting to know, and learning from each patient will allow you to serve them best.

August 6, 2019 | 2 min read

3 Lessons From Your Patient’s Impatience

By Iro Filippaki, PhD, Johns Hopkins University School of Medicine

The excellent clinician acknowledges their patient's impatience and frustration. In doing so, relationships with patients and clinical outcomes may be improved.

November 17, 2020 | 4 min read

Allyship and Upstanding

By Geoff Stetson, MD, UCSF

It’s critical to promote a culture of emotional safety in your clinical setting. Offer support and speak up when you witness hurtful incidents.

March 1, 2018 | 2 min read

Individualized Medicine Calls Me Back to Patient Stories

By Tom Laskow, MD, Johns Hopkins University School of Medicine

New thinking mirrors old wisdom: to understand this manifestation of disease, understand this patient.

"Our medical training leaves us ill-equipped to manage feelings associated with this uncertainty, especially the shame that often accompanies a medical error."

April 15, 2021 | 3 min read

To Err is Human

By Linda Lee, MD, Johns Hopkins Medicine

Being honest with patients about errors can help ease their pain and preserve the patient-clini​cian relationship.

February 10, 2022 | 1 min read

How to Express Empathy With Humility

By Rebekah Fenton, MD, Northwestern University

To show we care, we can simply say something like, “I can’t imagine how hard this must be.”

March 11, 2021 | 1 min read

How to Create Sanctuaries for Patients

By Michelle Ogunwole, MD, Johns Hopkins Medicine

To create safe spaces for historically marginalized patients, slow down and gather more information when conflicts arise. Be aware of your biases and give patients the benefit of the doubt.

April 6, 2021 | 2 min read

How to Respond to Unexpected Things Your Patient Tells You

By Shireen Heidari, MD, Stanford University

When a patient shares something that really catches you by surprise, listen closely and ask open-ended questions to fully understand their perspectives.

December 20, 2021 | 1 min read

What Patients With Serious Illness Want to Know Most

By Avani Prabhakar, MBBS, MPH, Johns Hopkins Medicine

After receiving a terminal diagnosis, many patients especially want to know how long they have to live, what symptoms to expect, and how to cope with impending decline.  

February 4, 2021 | 2 min read

The Clinician as Patient

By Neha Pidatala, MD, New York, New York

When you’re a patient, use your medical knowledge to clearly communicate your goals of care. When treating a patient who works in healthcare, consider their unique perspective to facilitate meaningful discussions.

November 19, 2019 | 2 min read

Aging Isn’t a Dirty Word

By Sharon Inouye, MD, MPH, Encore Public Voices Fellowship, and Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School

To many, "aging" and "old" are considered dirty words. Clinicians should fight ageism.

February 13, 2019 | 2 min read

Disparities in New Treatments

By Utibe Essien, MD, MPH, University of Pittsburgh School of Medicine

When beginning new treatments, it's important to ask patients what they understand about the medication, what their expectations are, what barriers might exist to remaining on this agent, and what they value most out of their treatment plan.

October 13, 2022 | 1 min read

Asking Hard Questions

By Thuy Ngo, DO, MEd, Johns Hopkins Medicine

In the ED, my adolescent patient shared that she was being sexually abused. It reminded me of the importance of creating a safe space for courageous conversations. 

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.   

March 31, 2022 | 2 min read

A Lesson in Cultural Humility

By Mengyi "Zed" Zha, MD, Othello, Washington

Working at a community health clinic serving migrant workers from Mexico, I was confronted with a pervasive stereotype that the female patients were “dramatic.” I learned how important it was for patients’ concerns to be taken seriously.   

"Planting The Seed of The Heart," by David Kopacz.

September 21, 2021 | 7 min read

How are you . . . really?

By David Kopacz, MD, University of Washington

A helpful practice to connect and understand your patient is to ask, "How are you doing . . . really?” If they’re hesitant to respond, consider sharing something you’ve found stressful lately to open the conversation.

"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.

July 16, 2019 | 3 min read

3 Lessons in Hospitality From my Patient

By Loveleena Virk, MD, Kaiser Permanente, Oakland Medical Center, California.

Hospitality is a human connection through the gift of attention and care. When hospitality becomes our modus operandi, care is transformed from transactional to sacred.

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