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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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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 1, 2020 | 4 min read

When Patients Trust Only You

By Howard Chang, Medical Student, Johns Hopkins Medicine

Through empathic listening, all members of the healthcare team can build rapport with patients in their most vulnerable moments.

December 16, 2025 | 1 min read

Check box vs. check-in  

Medical visits today often involve care gap inquiries. The way we ask patients about them can help transform a rote task into a curious and satisfying conversation. 

October 2, 2023 | 4 min read

Exclamation Points And Exhalations

By Ajibike Lapite, MD, MPHTM, Texas Childrens Hospital

Even when lab results are normal, some patients may still have concerns. Take time to address their fears and worries.

July 22, 2019 | 5 min read

5 Lessons From Visible Ink

By Anoushka Sinha, MD, Columbia University

It is humbling to remember we are merely characters in our patients' stories. We are neither the author nor the narrator, and certainly not the lead.

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.    

November 21, 2024 | 2 min read

Building bridges with patients through writing

By Roshni Beeharry, MBBS, University College London

Reflective journaling can be used to help us step into our patient’s shoes to understand their unique challenges. Consider experimenting with this and other forms of writing.

April 30, 2020 | 4 min read

Letting go of Your Agenda

By Allison Chrestensen, MPH, OTR/L

Compassionate care requires that we trust our patients to guide us.

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.

November 25, 2020 | 2 min read

Naming Chickens

By Claire Crawford, MSW, PhD, Texas Childrens

Incorporate laughter and joy where you can, giving yourself, your patients, and their families, moments of respite.

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 28, 2023 | 1 min read

Out of Body 

By Jeffrey Millstein, MD, Penn Medicine

Even when clear and without excessive jargon, explanations of body processes can be confusing for some patients. Real world, non-medical analogies may be enlightening. 

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.

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 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. 

April 29, 2020 | 3 min read

Connecting Through Shared Vulnerabilities

By Jeffrey Millstein, MD, Penn Medicine

Talking about shared COVID-19 worries allows you to connect more deeply 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.

November 18, 2020 | 1 min read

She’s Only 24

By Rakesh Patel, MD, University of Nottingham

Listening to patients’ fears and concerns builds understanding about the potential impact of disease on their long term goals. This may be especially important for younger patients.

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 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.

May 28, 2019 | 3 min read

Supporting my Patients who Smoke

It's important to make sure that the responsibility for addressing tobacco dependence is placed on the shoulders of clinicians, and off of the shoulders of the afflicted.

"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. 

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. 

March 29, 2018 | 1 min read

Top Five Tips For Successful Community Engagement

Part II of II: Five specific strategies to gain the trust of your patient’s community, agree on health goals, and together define what success looks like.

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. 

Maintain eye contact with your patient if and when you're typing in the electronic medical record (EMR).

December 15, 2020 | 1 min read

Embracing the EMR

By Alice Rothchild, MD, Seattle, WA

The best gift we can give our patients is our undivided attention. Maintain eye contact with your patient if and when you’re typing in the electronic medical record during the encounter.

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. 

May 21, 2019 | 3 min read

Telling People Terrible Things

By Amy Caruso Brown, MD, SUNY Upstate Medical University

Learning to break bad news gently takes time and practice, with the goal of telling the most terrible things to our patients a little bit less terrible.

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 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. 

April 15, 2020 | 2 min read

Keeping Older Adults Connected

By Susan Lehmann, MD, Johns Hopkins Medicine

Social distancing can increase loneliness, especially among older adults. Finding ways to stay connected through phone and virtual visits can combat social isolation.

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. 

November 4, 2020 | 3 min read

It’s All Relative

By Elisabeth Marsh, MD, Johns Hopkins Medicine

It's essential that we approach each patient with a fresh outlook. Bringing emotions, positive or negative, from a previous clinical interaction can adversely affect the next patient.

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.” 

The author enjoying time with her beautiful family. Photo credit to the author, and used with permission.

April 18, 2019 | 1 min read

Patients Are Partners, Not Consumers

By Hala Durrah, MTA, Patient Family Engagement Advocate & Consultant, Washington, DC

My hope is that physicians, patients, and families, consider each other as partners, with mutual respect, trust, compassion, understanding, and empathy guiding and facilitating interactions and relationships.

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. 

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. 

March 28, 2018 | 2 min read

The Physician-Citizen—Making Health Accessible to All

Part I of II: Why being “bedside” in our patients’ communities matters.

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.

September 30, 2020 | 2 min read

Perspective-taking Through Poetry

By Howard Chang, Medical Student, Johns Hopkins Medicine

Creative writing may enhance our ability to recognize and understand conflicting perspectives in order to better empathize with our patients.

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.

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. 

May 6, 2019 | 3 min read

When I Could not Hear my Patient

By Erin Snyder, MD, University of Alabama School of Medicine

Listening and understanding is what leads to true patient partnership, which is what is going to lead to true health.

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 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.  

March 10, 2020 | 1 min read

Observing and Acknowledging Family Dynamics

By Kimberly Zeren, NP, Johns Hopkins Community Physicians

During your next patient encounter, take the time to observe the family dynamics. Don't be afraid to ask the difficult questions.

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 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 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. 

April 3, 2019 | <1 min read

Dr. Lee Akst: A CLOSLER Look

By Gretchen Miller, Managing Editor

When meeting a new patient, Dr. Akst asks himself, "How can I educate and empower my patient to work with me as a team?"

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