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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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Canadian Pacific Railway in Banff National Park,Canada

February 5, 2026 | 2 min read

Stop, look, and listen 

I find the railroad crossing rule helpful when caring for patients. I stop to consider how best to help the patient reach their health goals, truly see the person before me, and listen to their story. 

August 26, 2024 | 1 min read

The medical Tower of Babel  

Immigrant patients often face challenges when accessing healthcare because of language and cultural barriers. Certified medical interpreters can help reduce the likelihood of inequities in care. 

February 24, 2022 | 3 min read

New dad and healthcare professional

By Ben Roberts, CRNP, AGACNP-BC, ACHPN, Johns Hopkins Medicine

Placing my child’s and my patients’ needs before my own gives me purpose. These responsibilities help mitigate burnout and allow me to give excellent care.

February 25, 2020 | 2 min read

5 Things Clinicians can do to Reduce Drug Prices

By Justin McArthur, MBBS, MPH, Johns Hopkins Medicine

Excellent clinicians prescribe thoughtfully—pruning medication lists, advising patients on how to save money, and advocating for change.

August 1, 2023 | 2 min read

Psychological First Aid

By Albert Wu, MD, MPH, Johns Hopkins Medicine, Matt Norvell, DMin, Johns Hopkins Medicine

Healthcare professionals experience traumatic events that may exceed their ability to cope. Timely emotional support can help maintain their well-being. 

A shire in Shropshire. Author's photo.

January 29, 2019 | 7 min read

“Good Doctoring”

By Taylor Purvis, MD, St. Vincent Medical Center, Bridgeport, CT

Reflections from a medical student on the practice of medicine as captured in the novels "The Bad Doctor," by Ian Williams, and "A Fortunate Man," by John Berger & Jean Mohr.

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.

July 17, 2025 | 3 min read

Cricket and the cadence of care  

Like playing cricket, the art of medicine demands patience, teamwork, and a willingness to redefine victory—not every win is a cure. Sometimes success is helping a patient find comfort and dignity. 

"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.  

September 9, 2021 | 2 min read

Advising Patients About Heat-Related Illness

By Shaista Ahmed, MBBS, MPH, Johns Hopkins Medicine

Many heat-related illnesses are preventable. Advise patients to avoid going outdoors in peak heat hours, drink plenty of fluids, and know where cooling centers are in their community.

June 20, 2019 | 2 min read

Be Brave Enough to Start Conversations That Matter

By Manasa Ayyala, MD, Rutgers New Jersey Medical School

"Between the World and Me" is a must read. At 152 pages, it's a small investment of time that leaves a large impact. I invite you to read this book with the intent to ask curious questions, to be ok feeling uncomfortable, and to continue this important dialogue.

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. 

Encourage parents to support their teens in connecting with friends safely.

October 7, 2020 | 1 min read

CLOSLER Together

By Scott Wright, MD, Johns Hopkins Medicine

Discussing CLOSLER pieces in groups may yield more insights than simply reading on your own. Consider adding a discussion of a piece to your next staff, practice, or division meeting.

Bronze sculpture of Emmanuel Kant, by sculptor Daniel Rauch, 1857.

January 29, 2026 | 3 min read

Lessons from philosophy on facing uncertainty  

Giving exceptional care requires us to be open to other perspectives, recognize the limits of medical knowledge, and respect the patient’s lived experience. 

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. 

March 22, 2018 | 7 min read

Fundamentals for Caring for Transgender Patients

By Paula Neira, JD, MSN, RN, CEN, FAAN, Johns Hopkins Medicine

Improve your skills as you work to support your transgender patients and interact with your transgender colleagues.

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. 

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.

January 14, 2019 | 2 min read

We’re Getting CLOSLER to the Super Bowl!

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

Football-inspired clinical pearls from Vermont family physician Dr. Wilma Ferthler teach us how to be better clinicians.

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.

August 17, 2020 | 1 min read

Top Tips For Starting a New Phase in Your Career

By Christle Nwora, MD, Johns Hopkins Medicine

Making time to care for yourself, asking questions, and letting go of perfection can help you successfully navigate a new chapter in your life.

The autism ribbon.

June 12, 2025 | 2 min read

The strengths of neurodiverse healthcare professionals 

Neurodivergent healthcare professionals bring unique attributes to a medical team that can enhance patient care. We can foster inclusive environments that actively support these diverse ways of thinking and working.

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.  

“Imagine your baby’s lungs are a tree,” she said. “A pleural effusion would be a puddle around the tree while pulmonary edema is water on the leaves.” The mother seemed to follow along, nodding her head. I was grateful to hear this metaphor that inspired me to utilize pictorial representations more.

August 19, 2021 | 2 min read

The Power of Pictures

By Rebekah Fenton, MD, Northwestern University

When educating patients about their illness, it’s often helpful to include pictures and visual descriptions to improve understanding.

June 18, 2019 | 2 min read

Navigating the Uncertain: A Book Review of “The Laws 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."

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. 

January 28, 2026 | 4 min read

A model mentor 

Effective clinical teaching pairs rigor with kindness. Building psychological safety can accelerate learning, reduce burnout, and improve patient care. 

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.

Reverse Waterfall, Nasik, Maharashtra, India.

February 16, 2022 | 1 min read

Mentorship in Reverse

By Rayah Sawaya, MD, American University of Beirut

If you find a mentor who’s helpful and generous, consider reciprocating with “reverse mentoring.”

March 27, 2018 | 2 min read

12 Things I Wish I’d Known 50 Years Ago

By Randy Barker, MD, Johns Hopkins Medicine, retired

Twelve things I would tell my younger self—all the things I didn’t know then, but wish I had.

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. 

May 9, 2018 | 2 min read

Applying the Coaching Model to Medical Education

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

Coaching—direct observation of learners with feedback geared toward skills development—is an important way to teach individualized medical education. Outstanding coaches across disciplines share characteristics that can be applied in clinical coaching encounters.

March 18, 2019 | 2 min read

The Truth About Sex

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

How you phrase questions when obtaining a sexual history can mitigate the impact of social desirability bias and enhance the accuracy of the information that is obtained.

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. 

August 10, 2020 | 2 min read

Debriefing after death (archives, 2020)

By Christopher Bennett, MD, Stanford University

Reflecting on a patient's death as a team provides an opportunity to process emotions and strengthen team dynamics.

June 9, 2025 | 3 min read

When care hurts 

Patients’ past healthcare experiences influence their ability to engage in care. Taking time to learn about their life stories builds trust and empowers them to participate in their healing. 

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. 

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’!

Ruth and Carl J. Shapiro Gallery (Gallery 232), Museum of Fine Arts, Boston, featuring "Daughters of Edward Darley Boit," by John Singer Sargent (American, 1856–1925). Photograph by Flora Smyth Zahra.

June 6, 2019 | 7 min read

May Art Museum Challenge

By Flora Smyth Zahra, MA Clin Ed, DRestDent RCS, FHEA, Kings College London, Margaret Chisolm, MD, Johns Hopkins Medicine

The art museum is a space that has lessons to teach about clinical excellence, and fosters both the personal development and professional identity formation of clinicians.

January 27, 2026 | 3 min read

Mindset matters 

Adopt a growth mindset—treat setbacks and mistakes as data for learning. Ask “What can we learn?” rather than “Who failed?” to help build psychological safety within your healthcare team.

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.     

An example of a trompe l’oeil in a geriatric hospital setting. Copyright by the author.

January 27, 2020 | 3 min read

Ethical Dilemmas in Dementia Care Design

By Diana Anderson, MD, MArch, Clincial Geriatrics Fellow, University of California, San Francisco

Innovative dementia care designs raise moral questions about whether deception of patients is ever ethical. The clinically excellent physician tries to avoid deception at all costs.

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.

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.

August 3, 2020 | 1 min read

Book Review of “Elderhood”

By Michelle Gyenes, MS, Columbia Mailman School of Public Health

Ageism is a form of discrimination that contributes to poor health outcomes. To mitigate its effects, we must enact policies that address biases in ourselves, our workplaces, and our communities.

May 27, 2025 | 2 min read

Whose knowledge counts?  

Listening closely builds patient trust, which is fundamental to effective care. Dismissing a patient's self-reported observations, even unintentionally, erodes this trust and can prevent you from truly understanding their concerns. 

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.  

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.

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 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.

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