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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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May 10, 2021 | 2 min read

Bearing Witness

By Jennifer Caputo-Seidler, MD, University of South Florida

During the pandemic healthcare professionals have often been the only ones present with patients at the end of life. It’s ok if you struggle to find the right words—sitting with a patient so they're not alone is enough.

December 5, 2022 | 2 min read

The “List”

By Jeffrey Millstein, MD, Penn Medicine

Reviewing patients’ lists of concerns is an opportunity to build trust and partnership. It may also make visits more productive and satisfying for both patients and clinicians. 

December 10, 2025 | 2 min read

Beyond the signature 

Informed consent includes a patient-centered conversation grounded in their goals, not just a list of risks. Ask what matters most and address any concerns that arise. 

September 26, 2023 | 2 min read

Talk Less, Listen More

By Aurora Grutman, medical student, Johns Hopkins Medicine

A conversation with a fentanyl overdose survivor taught me to listen with humble curiosity, and talk to patients thoughtfully with respect and sensitivity.

March 21, 2019 | 3 min read

Sitting with suffering

By Margaret "Molly" Hayes, MD, Harvard Medical School

Sometimes just our presence is all we can do to comfort a grieving family. It never feels like enough and it never will be, but it is something. Silence is powerful and doesn’t need to be filled with empty words. Sit with suffering and silence.

February 8, 2022 | 2 min read

How to Improve Patient-Clinician Connections, Part 3

By Christine Ko, MD, Yale University

Starting each visit with a centering exercise focused on the patient may allow one to be fully present.    

October 22, 2024 | 4 min read

Note to self: “Sit down and shut up” 

By William Ravekes, MD, Johns Hopkins Medicine

Sitting down demonstrates presence and creates a sense of equality in the interaction. Together with active listening and avoiding interruptions, this fosters trust and rapport. 

February 5, 2020 | 2 min read

A Picture’s Worth a Thousand Words

By Rafael Llinas, MD, Johns Hopkins Medicine

The clinically excellent physician knows that sometimes talking isn't enough. When possible, sharing information with patients visually can enhance their understanding.

May 5, 2021 | 2 min read

Empathy Instead of Judgment

By Isaiah Crum, MD, University of Pittsburgh

Through the death of an infant patient, I was reminded of how integral being compassionate and non-judgmental is to clinical care.

November 15, 2022 | 1 min read

Will I lose my hair? (from the 2022 archives)

By Lauren Rissman, MD, Advocate Childrens Hospital

Talking with my young patient about his cancer, he shared being most afraid of going bald. I learned that it’s important to acknowledge and validate all worries, including those that are not life-threatening.

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.

September 7, 2023 | 2 min read

“That Guy”

By Maureen Flood, NP, Johns Hopkins Medicine

When caring for a patient that pushes my buttons, I remind myself that they were once an innocent baby who was loved by someone. 

January 9, 2019 | 1 min read

The Disease of Loneliness

By Shannon Scott-Vernaglia, MD, Mass General

In an environment pushing us ever faster, making the time to listen will often lead to better patient outcomes and greater clinician fulfillment.

February 7, 2022 | 2 min read

How to Improve Clinician-Patient Connections, Part 2

By Christine Ko, MD, Yale University

I almost always run late in clinic. By having a growth mindset, I’ve reframed this as an opportunity to improve.  

October 9, 2024 | 2 min read

Softening the “SPIKES” 

When delivering challenging news, it is crucial to tailor the communication to the patient's preferences. Break down the message into small, spaced-out segments to allow for gradual processing. 

February 6, 2020 | 2 min read

Navigating Masculinity in Medicine

By Kultaj Kaleka, MD, RN, Central Michigan University

The clinically excellent physician understands that male patients may need support sharing their perspectives.

May 3, 2021 | 6 min read

Why we Must Learn About Our Patients’ Communities

By Daniel Thomas, MD, Johns Hopkins Medicine

Make time to learn about and invest in the community you serve to deepen your connection with patients.

November 9, 2022 | 2 min read

Trust

By Joanne Shay, MD, Johns Hopkins Medicine

While caring for a four-year-old girl diagnosed with lymphoma, I learned that acknowledging and validating patient and family fears strengthens relationships.

September 6, 2023 | 3 min read

Getting Older in Medicine

By Joanne Shay, MD, Johns Hopkins Medicine

Both of my knees need to be replaced—I already can’t wait to get back to playing pickleball. I now have renewed empathy in the OR and remind patients: “Recovery will take time. Try to be patient.” 

December 19, 2018 | <1 min read

Dr. Michael Carducci, A CLOSLER Look

By Gretchen Miller, Managing Editor

Patients with cancer are vulnerable. There are a lot of emotions associated with this diagnosis, and I want to make patients feel that they are not the disease.

"Deliberate practice is needed."

January 19, 2022 | 2 min read

Cognitive Psychology And Patient-Clinician Connections

By Christine Ko, MD, Yale University

To foster warmth toward patients, first be aware of how you’re feeling. If you're feeling burned out, you can intentionally practice cultivating a more caring attitude. 

September 12, 2024 | 2 min read

Validating feelings 

I cared for a patient who had been rejected from a rehab facility because of her weight. I was reminded of the importance of acknowledging the patient’s emotions as part of the care plan. 

January 29, 2020 | 2 min read

How to Give Patients Presence

By Aidan Crowley, Medical Student, University of Pennsylvania

Leaving your own worries at the door, sitting at eye level, and listening attentively are three important ways to connect meaningfully with your patients.

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.

November 2, 2022 | 2 min read

The Last Choice

By Ivy Akid, MD, Johns Hopkins Medicine

Caring for a man dying of cancer reminded me to always guide patients toward decisions that best align with their goals of care. 

August 21, 2023 | 2 min read

DO you see me? CAN you see me? 

By Mandy Hill, DrPH, MPH, UTHealth Houston, McGovern Medical School

As a part of every patient encounter, I ask myself how I can ensure that they have a positive experience. This begins with recognizing the patient as a person. 

December 20, 2018 | 9 min read

You’re not getting my f-ing box cutter: paradoxical ways kids ask for limits

By Hal Kronsberg, MD, Johns Hopkins University School of Medicine

The most important lesson I’ve learned as a child psychiatrist is how badly kids want limits when they’re struggling, even when they keep that wish to themselves. Kids are smart, and when we catch them breaking a rule, we need to be curious about why it happened.

January 10, 2022 | 2 min read

Being Present During The Dying Process

By Shireen Heidari, MD, Stanford University

It’s the job of all clinicians to guide patients and their loved ones through the experience of death. Offering support and being present can help them navigate the end of life. 

September 11, 2024 | 1 min read

Would you like to share a photo?  

By Jeffrey Millstein, MD, Penn Medicine

Asking patients to show photos of family, pets, or other meaningful things can help them feel more thoroughly known and cared for. This can sometimes make a visit more productive and meaningful for everyone. 

January 13, 2020 | 4 min read

You are my Sunshine

By Lingsheng Li, MD, MHS, University of California, San Franscisco

The clinically excellent clinician understands that what we say and do may matter more than what we know.

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.

October 24, 2022 | 1 min read

Wayfinding

By Jeffrey Millstein, MD, Penn Medicine, William Cohen, medical student, Penn Medicine

When a clinical visit begins to feel like being lost at sea, a simple inquiry about what a patient would most like to accomplish during their visit may help guide the encounter. 

September 4, 2018 | 1 min read

7 Tips for Working With an Interpreter

By Stephanie Nothelle, MD, Johns Hopkins University School of Medicine

Pause often, ask one question at a time, and avoid idioms when speaking through an interpreter.

July 10, 2023 | 3 min read

Dying With Peace And Joy 

By Lillie Shockney, RN, MS, Johns Hopkins Medicine

Empowering your patient to be the ultimate decision maker about all things related to the end of their life is fulfilling and meaningful for both of you. 

Infectious disease physician Amash Adalja, MD, often uses car analogies to concretize abstract concepts for his patients.

December 17, 2018 | 1 min read

How to Make Abstract Concepts Concrete

By Amesh Adalja, MD, Johns Hopkins Bloomberg School of Public Health

To explain complex subjects to patients, you take an abstract concept and concretize it. This is important for patient counseling, and as a method to check your own knowledge.

January 6, 2022 | 1 min read

Celebrating The Wonderful Throughout The Year

By Susan Lehmann, MD, Johns Hopkins Medicine

Reinforcing our ties with family and friends (including coworkers) is more important than ever. These connections can be an antidote to despair and anxiety. 

August 8, 2024 | 2 min read

Unspoken  

From my experience working on an inpatient psychiatry unit, I learned to look for hidden messages in the patient’s story and explore these with curiosity. Sometimes a patient’s cry for help is cloaked in other behaviors.  

January 14, 2020 | 3 min read

A Relationship Between Equals

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

The clinically excellent practice is centered on core humanistic values rather than on efficiency or productivity.

Humility—a graceful bridge over the abyss of self-doubt.

April 7, 2021 | 3 min read

Humility

By Steve Bierman, MD, Del Mar, California

In medicine, all too often the optimal approach for diagnosis or therapy is not entirely clear. Acknowledging uncertainty with your patient is a sign of a humility that can strengthen the connection.

October 20, 2022 | 2 min read

How I Comfort Patients

By Joanne Shay, MD, Johns Hopkins Medicine

We are sometimes unable to cure our patients. We can still make them feel heard and understood, and consider what it might be like to walk in their shoes.

October 31, 2025 | 2 min read

Starting over 

Approach each patient encounter with humility and curiosity. If you misstep, apologize and invite a reset to restore trust. 

July 9, 2018 | <1 min read

On Clipping Nails

By William Greenough, MD, Johns Hopkins University School of Medicine

Making a moment for foot care creates an opportunity to bond with my patient and strengthen our relationship.

December 15, 2021 | 1 min read

The Power of Humor

By Jennifer Eitingon, MD, Johns Hopkins Medicine

My dying patient taught me that laughter can sometimes normalize difficult situations. Finding humor in the problem lightened the mood and allowed us to devise a care plan that preserved her dignity.  

August 7, 2024 | 2 min read

Listen, understand, empower 

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

December 12, 2019 | 2 min read

When to Consider Making a House Call

By Mattan Schuchman, MD, Johns Hopkins University School of Medicine

House calls can offer insights and create opportunities that are not possible in the office. Go for it when you can!

March 15, 2021 | 1 min read

How to talk with patients who are vaccine-hesitant (archives, 2021)

When speaking with patients reluctant to get vaccinated, listen to their concerns, and convey respect and empathy.

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. 

October 29, 2025 | 2 min read

The long way home 

As my patient’s symptoms eased, our conversations evolved from medical check-ins to life planning. Including patient-defined milestones—like “safe to fly”—in the treatment plan makes healthcare more meaningful for both patients and clinicians. 

June 5, 2023 | 1 min read

Saying No With Compassion And Curiosity

By Jeffrey Millstein, MD, Penn Medicine

When patients request something that is unsafe, be curious and explore their perspective before declining. This approach is collaborative and less stressful for both clinician and patient. 

December 1, 2021 | 1 min read

Building Bridges Between Visits

By Jeffrey Millstein, MD, Penn Medicine

Telling patients how to contact me with questions or concerns between visits improves communication and can positively impact health outcomes. 

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