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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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April 15, 2019 | 1 min read

7 Things I’ve Learned About Mentoring in 51 Years

By David Levine, MD, MPH, Johns Hopkins University School of Medicine

Helping others to achieve their full potential is the most incredible, wonderful, and exhilarating role one can undertake.

August 9, 2021 | 4 min read

Hiding in Plain Sight: Just Ask, or You’ll Miss Most Eating Disorders

By Angela Guarda, MD, Johns Hopkins Medicine

Although five percent of the population has a clinically significant eating disorder, most aren't detected because clinicians don’t ask. Simply asking,“What is the MOST you would be comfortable weighing?” can help identify a restrictive eating disorder.

"When the hospital is suspiciously quick to sweep everything about the error and suicide under the rug, Noah turns for guidance to the journal of his late father, a respected surgeon."

January 31, 2024 | 1 min read

Book review of “The committee will kill you now” 

By Joan Naidorf, DO

This novel reminded me that even in a complex healthcare system, individual clinicians can make a substantial contribution to the ethical treatment of their patients.  

October 28, 2025 | 2 min read

Far from routine  

What feels run of the mill to clinicians can be life-changing for patients. A focused moment of empathic presence may alter the course of their life. 

Aiden Crowley said that “a hug can be medicine” and that simple “presence and accompaniment” provides more for the patient and family than we might think.

November 23, 2022 | 1 min read

Using CLOSLER For Grand Rounds

By Richard Schaefer, MD, MPH, Johns Hopkins Medicine

CLOSLER has a wealth of material that can be leveraged to enhance teaching in a variety of settings, including lectures, bedside, and small group discussions. 

This is from "The Spirit Catches You and You Fall Down," written by Anne Fadiman. The art copyright is believed to belong to the publisher, Farrar, Straus and Giroux, or the artist. Public domain from wikipedia.org.

November 20, 2019 | 2 min read

“The Spirit Catches You and You Fall Down”

By Laura Pugh, Medical Student, Johns Hopkins Medicine

The gap between cultural systems can be wide. Openness, curiosity, and humility will improve cross-cultural care.

January 25, 2022 | 1 min read

Beware The Ladder of Inference

By Jeffrey Millstein, MD, Penn Medicine

Sometimes in the care of patients, we jump to conclusions. Questioning our assumptions can improve relationships and help us make better decisions.   

August 21, 2024 | 2 min read

Confessions of a non-flosser 

By Kyra Reu, medical student, University of Pennsylvania

When I told my dentist I didn’t floss regularly, it reminded me of a patient who shared she was not taking her medication as directed. Careful questioning of how the patient is actually taking their medication should be done before modifying the treatment. 

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.

February 23, 2021 | 3 min read

Tips For Giving Medical Updates to Families

By Joshua Budhu, MD, Mass General

A physician’s disappointment in hearing surprises about his loved one’s condition sparked new insights on the value of regularly updating families about the patient.

Role playing "Dungeons and Dragons."

July 31, 2023 | 3 min read

Dungeons and Dragons and Medicine

By Lillian Houston, MD, Southern Illinois University

D&D teaches us that the team is our most important asset. Interdisciplinary and diverse teams that communicate openly are most successful. 

Kau Sai Chau Public Golf Club, Hong Kong.

July 21, 2020 | 1 min read

Medicine is Like Golf

By Barry Bryant, MD, Johns Hopkins Medicine

In both medicine and golf, it's helpful to accept that much is beyond our control. Trusting our ability —grounded in thousands of hours of focused practice—may allow us to have the confidence that our best efforts will usually translate into favorable results.

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.

January 23, 2024 | 1 min read

Book review of “The algorithm will see you now”

By Joan Naidorf, DO

In this medical thriller set in the not-too-distant future, diagnosis and treatment are performed entirely by AI. The novel serves as a reminder that AI must be used thoughtfully and responsibly.  

October 22, 2025 | 3 min read

Coordination with compassion 

To build an exceptional care team: foster psychological safety, model humility, and solicit input from every person. Daily rituals of respect can sustain excellent patient care. 

November 17, 2022 | 2 min read

Personalized Clinical Quality Improvement

By Jeffrey Krimmel-Morrison, MD, University of Washington

Use evidence-informed practices in your self-directed learning—build a case tracking system, work simulated cases, use quizzing, and seek new evidence efficiently. 

November 19, 2019 | 2 min read

Aging isn’t a dirty word

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

January 12, 2022 | 2 min read

The Comfort of Death Rituals

By Jennifer Eitingon, MD, Johns Hopkins Medicine

In the past, I questioned the value of certain rituals. A woman from Panama showed me how these may provide comfort to those who have lost a loved one.  

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.

November 12, 2018 | 3 min read

Insights From “A Whole New Mind”

Daniel Pink's "A Whole New Mind" highlights the importance of cultivating empathy, humor, and the ability to create meaning.

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.

July 24, 2023 | 2 min read

Prince of Yonkers

By Carey Roesler, PA-C, Johns Hopkins Medicine

When my car broke down, a mechanic went above and beyond to make sure I made it to my aunt’s funeral. This reminded me of how lucky I am to be able to help my patients through challenging times. 

June 27, 2022 | 3 min read

Caring for people and their gender stories

By Hailey Haffey, PhD, University of Utah

To care for people is to care for the stories that shape them. Clinicians can enhance patients’ confidence in the healthcare system by skillfully engaging with their stories of gender and sexual orientation.

April 1, 2019 | 3 min read

Practicing Medicine and Having a Ball

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

Hope our 2019 April Fool's piece makes you chuckle!

July 28, 2021 | 2 min read

4 Things You Can do to Support Patients Facing Hard News

By Rebekah Fenton, MD, Northwestern University

In medicine, we sometimes have to share horrible news. When doing so, hold the conversations in a private space, make sure the patient and family understand what you’re saying, acknowledge emotions, and answer questions.

January 17, 2024 | 1 min read

“I’m not comfortable”

By Jeffrey Millstein, MD, Penn Medicine

Patients sometimes ask for interventions that conflict with clinical best practice. The most effective responses are ones that focus on patients’ needs and level of understanding rather than on the clinician’s discomfort with their requests. 

October 21, 2025 | 2 min read

Stroke, breath, care

Swimming taught me the importance of rhythm and breath. During difficult conversations with patients and families, I make room for quiet pauses to give them time to process.

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.

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.

February 17, 2021 | 1 min read

How to Talk to Patients About Unnecessary Antibiotics

By Benjamin Miller, Johns Hopkins University, Sara Keller, MD, MPH, MSPH, Johns Hopkins Medicine

When talking with patients about antibiotics that are not indicated, emphasize personal potential side effects such as yeast infections and diarrhea.

July 10, 2018 | <1 min read

Better Dementia Care Through Music

By Michele Bellantoni, MD, Johns Hopkins University School of Medicine

Having your older patients listen to music can be an effective way to reduce dementia-related behavioral disturbances.

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.

June 23, 2022 | 2 min read

Reflections at The End of a Busy Clinical Year

By Madeline Rodriguez, MD, Johns Hopkins University School of Medicine

Outstanding clinicians are humble, curious, and nonjudgmental. 

March 13, 2019 | <1 min read

Dr. Elliot Fishman, A CLOSLER Look

By Gretchen Miller, Managing Editor

Artificial intelligence (AI) will drastically alter all of medicine, with the potential to enhance patient care through improved diagnoses.

July 19, 2021 | 3 min read

Diversifying the clinician workforce (archives 2021)

By Pringl Miller, MD, San Francisco, California

Diversifying the clinician workforce is associated with improved patient satisfaction and outcomes. So, what are we waiting for?

January 11, 2024 | 2 min read

Book review of “Changing how we think about ‘difficult’ patients”  

By Jennifer Lycette, MD, rural oncologist in the Pacific Northwest

When caring for a patient whom I found challenging, I reminded myself that my negative reaction had less to do with the patient and more to do with me.  

October 16, 2025 | 4 min read

Prescribing humility 

Standard of care is provisional—reassess therapies as evidence evolves. Be open to changing your thinking and practice as new data emerge. 

June 25, 2018 | 2 min read

On The Professional Formation of Doctors

By Margaret Chisolm, MD, Johns Hopkins Medicine

By getting out of the business of knowledge and skills and returning to the work of professional formation, not only will medical schools and their patients win, but doctors—and the profession of medicine as a whole—will too.

October 10, 2019 | 2 min read

Our Greatest Teachers

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

To find meaning in your clinical work, search for the words and moments that affirm your shared humanity with patients.

January 5, 2022 | 1 min read

Bringing my nursing pearls to my doctoring (archives, 2022)

By Nina Wagner-Johnston, MD, Johns Hopkins Medicine

From my experience as a nurse, I always remember the importance of engaging the whole team. Each team member provides unique insights that can optimize the care of the patient. 

July 26, 2018 | 1 min read

A Taste of Their Own Medicine

By Scott Wright, MD, Johns Hopkins Medicine

Videos spreading misinformation to patients, promoting unproven therapies, can spread like wildfire on social media. We are sharing another video to fight fire with fire.

"The Persistence of Memory," Salvador Dali, 1931, The Museum of Modern Art.

November 19, 2018 | 2 min read

Learning from Learners

By Margaret Chisolm, MD, Johns Hopkins Medicine

Teaching is the best way to learn. In the end, I am not only a teacher and my residents are not only learners, but we are both a little of each.

February 3, 2021 | 3 min read

How to Cultivate a “Friendtorship”

By Jared Rubenstein, MD, Baylor College of Medicine, Liz Salmi, OpenNotes Communications, Beth Israel Deaconess Medical Center

A “friendtorship” is an informal peer-mentor relationship between two people with shared interests but different careers. “Friendtorships” can help you develop new perspectives and ideas about your own field.

July 18, 2023 | 1 min read

Can a chatbot be a clinician’s friend?

By Adam Poliak, PhD, Bryn Mawr College, Eric Leas, PhD, Mark Dredze, PhD, Johns Hopkins University

ChatGPT can draft seemingly empathic answers to patient questions on medical portals. This may help clinicians respond more efficiently to their patients’ concerns. 

May 26, 2020 | 1 min read

Accelerating Adaptation in Healthcare

By Lia Logio, MD, Drexel University College of Medicine

Efficiency erodes our ability to respond to the uncertainty of life. The messy world of clinical care requires time, patience, and creative experimentation.

June 22, 2022 | 1 min read

Explaining The Risks of Vaping

Prioritize discussions about the long-term consequences of smoking. Be aware that just because someone has quit doesn’t mean that they won’t relapse.

March 28, 2019 | 6 min read

Integrating Psychology and Primary Care

By Benjamin Bensadon, PhD, University of Florida College of Medicine

Person-centeredness holds great potential to maximize healing in the way Osler envisioned more than a century ago. But to translate this concept clinically, psychology and medicine must come closer together. The closer we can come together, the closer we can come to Osler.  

July 21, 2021 | 2 min read

Talking With Patients About Safe Summer Swimming

By Jade Cobern, MD, Johns Hopkins Bloomberg School of Public Health

Swimming is a summertime joy, but it is not without risk. Before patients take the plunge, they should be reminded to always swim with a buddy (never alone) and to apply sunscreen.

January 9, 2024 | 3 min read

Dust and distrust

By Matthew Kelly, PhD, MPH, Johns Hopkins Medicine

Infection-related epidemics, like AIDS and COVID, teach us much about caring. To provide humanistic care, clinicians must continuously endeavor to assess and build trust with patients. 

October 13, 2025 | 2 min read

The word “want” may leave patients wanting 

When prior notes document that a patient doesn’t “want” a specific intervention, elicit the patient’s desired outcome and acceptable trade-offs. Then determine whether “I don’t want X” is absolute or conditional and align the care plan accordingly. 

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