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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 12, 2020 | 4 min read

What I learned from my primary care mentors

By Colleen Farrell, MD, New York University

All of us can learn from primary care clinicians, who know that listening, compassion, and connection are the foundations of clinical excellence.

"Critical care unit," drawing by the author.

October 29, 2024 | 1 min read

“Critical care unit”—a visual reflection

By Sujal Manohar, medical student, Baylor College of Medicine

In the face of devastating diagnoses and uncertain prognoses, pediatric patients and their loved ones need to feel heard and understood. 

July 23, 2019 | 3 min read

Engaging Care Partners in Communication

By Antonio Wolff, MD, Johns Hopkins University School of Medicine, Jennifer Aufill, BA, Johns Hopkins Bloomberg School of Public Health, Jennifer Wolff, PhD, Johns Hopkins Bloomberg School of Public Health

Families and friends are valuable resources. These partners in care can help clinicians improve quality of care and patient outcomes.

October 23, 2024 | 2 min read

Educated lucky: Making critical decisions without all the answers 

By Edana Mann, MD, Johns Hopkins Medicine

In critical care, we often make life-saving decisions with incomplete information. Teamwork is essential, and sometimes acting on our best-educated guess is the only option. These moments remind us of life’s fragility and the importance of trusting our instincts and each other. 

January 11, 2023 | 3 min read

Joy in Primary Care 

By Jane Abernethy, MD, MBE, Johns Hopkins Medicine

Meaningful longitudinal primary care relationships with patients are fulfilling and rewarding. Modeling for trainees that this career path can be gratifying and fun is vital. 

December 11, 2024 | 2 min read

Taking the call 

By Stasia Reynolds, MD, Johns Hopkins Medicine

It is a privilege to bear witness to the suffering our patients endure and to share in the joy that comes in honoring a dying wish.   

January 30, 2019 | <1 min read

Dr. David Wu, A CLOSLER Look

By Gretchen Miller, Managing Editor

Palliative care is an approach to medicine that focuses on quality of life. My hope is that every clinician learns basic palliative skills to lead family conversations when there is a critically ill patient. It's a precious privilege to be able to enter people's lives at their most vulnerable time, and help them find some kind of peace.

April 24, 2018 | 2 min read

Equality v. Equity

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

Working towards giving equitable care, not equal care, should be our focus, especially if we’re aiming to shrink the health disparities gap.

October 10, 2018 | <1 min read

Engaging With Patients’ Communities

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

Making time to engage with my patients' community has made all the difference in giving clinically excellent care. Enjoy my recent TED Talk, where I tell the story of my journey to connect with my patients' community in Baltimore, Maryland.

April 30, 2018 | 4 min read

The 15 Values of a Pediatric Anesthesiologist

By Ivor Berkowitz, MBBCh, MBA, Johns Hopkins Medicine

A pediatric anesthesiologist shares the 15 values that have guided his career.

June 25, 2018 | 2 min read

The Mission of a Clinician-Educator

By Leah Wolfe, MD, Johns Hopkins University School of Medicine

As a clinician-educator, my mission is to help train and inspire a new generation of internists who are passionate about patient care, are outstanding clinicians, and can provide the leadership needed to change our existing healthcare system into one that better serves the needs of individuals and society.

November 27, 2019 | 3 min read

Clouds and Codes Aren’t Care

By Gisele Waters, PhD, Founder and President of Symbiotica Consulting

The promise of artificial intelligence is that it gives healthcare professionals the opportunity to improve the quality of care by allowing humans to focus on humans.

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.

April 20, 2020 | 3 min read

Gender-Affirming Care During the Pandemic

By Carl G. Streed Jr., MD, MPH, Boston Medical Center, Liam Hein, PhD, RN, University of South Carolina, College of Nursing, Paula Neira, JD, MSN, RN, CEN, FAAN, Johns Hopkins Medicine

Postponing procedures safeguards public health but can be distressing, particularly for transgender patients. Be proactive and transparent about access limitations during the pandemic.

March 26, 2018 | 1 min read

Knowing and Caring For The Patient As A Person

By Kimberly Peairs, MD, Johns Hopkins University School of Medicine

Medical care extends far beyond simply treating a disease—it involves forging a relationship and offering trust, support, and wisdom. 

February 5, 2019 | 2 min read

Creating a Clear Care Map for Patients

By Chris Myers

Showing patients and their families a clear map of their care plan can help bring awareness and healing to patients and families alike.

February 10, 2020 | 2 min read

Engendering Trust in the Care Team

By Jeffrey Millstein, MD, Penn Medicine

Excellent clinicians help patients expand their circle of trust, beyond their favorite physician, to include more members of the healthcare team.

September 26, 2024 | 3 min read

Under the influencers 

By Adam Schiavi, MD, PhD, Johns Hopkins Medicine

The social media "Black out challenge" promotes asphyxia that can result in irreversible brain damage or death. Healthcare professionals should warn patients and caregivers to be cautious about social media trends and provocations. 

"Blue Rider," Franz Marc, 1911.

May 14, 2019 | 4 min read

Review of “Critical Crash”

By Andre Lijoi, MD, York, Pennsylvania

We all have our woundedness, and our own story is important in the context of caring for our patients. These stories and wounds operate in the background of our consciousness and we must recognize and manage them.

November 15, 2018 | 3 min read

You’re Always a Provider, Even in the Coffee Line

By Ishwaria Subbiah, MD, MS, The University of Texas MD Anderson Cancer Center

Opportunities to ease distress extend beyond the bedside and outside of the clinic to every interaction with our patients and also their caregivers.

How can we make hospital care even more patient-centered?

March 2, 2021 | 2 min read

Patient-Centeredness in The Hospital

By Patrick McMurray, RN, North Carolina

One way to demonstrate patient-centered care is creating spaces in which patients feel less vulnerable. A space that is safe, calm, and private is ideal for healing.

October 16, 2018 | 3 min read

The Heart of Trauma-Informed Care

By Cooper Lloyd, MD, MPH, Johns Hopkins University School of Medicine

Trauma-informed care is care in which we recognize trauma’s prevalence and long-term effects; understand trauma’s effects on patient behavior and engagement in care; prioritize patient choice and collaboration while building trust; and offer education and resources to promote healing.

November 10, 2021 | 5 min read

Reading Between The Lines

We don’t always say what we’re thinking, particularly in difficult conversations. Sharing and exploring unspoken thoughts can lead to stronger connections with our patients and better care.

November 2, 2021 | 2 min read

What All Clinicians Must Know About End-of-Life Care

By Pringl Miller, MD, San Francisco, California

Initiating and withdrawing life-sustaining medical treatment is the patient’s or their surrogate's decision, not ours. We must always honor their wishes.

June 26, 2019 | <1 min read

Dr. Panagis Galiatsatos, A CLOSLER Look

By Gretchen Miller, Managing Editor

We need to think of ourselves as community members who happen to be clinicians.

June 12, 2024 | 3 min read

Getting serious about citrus 

By Maureen Flood, NP, Johns Hopkins Medicine

In patients with chronic conditions and socially determined health risks, remember to consider vitamin C deficiency. 

"If I die, tell my mother I love her. If I get better, I'm going to visit her in Tennessee. She has ten acres and a farmhouse."

May 11, 2021 | 1 min read

Empathy at The End of Life

By Avani Prabhakar, MBBS, MPH, Johns Hopkins Medicine

At the end of life, clinicians who are present and listen compassionately may be entrusted with patients’ final wishes. Attempting to honor these requests is one way to serve.

August 30, 2019 | 1 min read

The Gatekeepers of “Fairness”

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

Excellent clinicians spend time listening to patients, acknowledging concerns, and empathizing with feelings that life is not fair.

Clouds at sunset, Paliambella, Greece. Photo by the author.

November 6, 2018 | 1 min read

Lessons From Paliambella, Greece

By Panagis Galiatsatos, MD, Johns Hopkins Medicine

Working to cultivate community cohesiveness in the neighborhoods where we work and where our patients live could help community health achieve its fullest potential. Here are a few simple ways to get started.

November 5, 2020 | 3 min read

Cultivating Compassion

By Aidan Crowley, Medical Student, University of Pennsylvania

Compassion—acting on the desire to relieve suffering—is central to giving clinically excellent care to those in need.

May 7, 2024 | 3 min read

“My patient is dying”

By Nakiya Showell, MD, MPH, MHS, Johns Hopkins Medicine

Excellent patient care goes beyond medical expertise. Building relationships, clear communication, and emotional intelligence are crucial for compassionate care, especially in the face of critical illness. 

July 16, 2018 | 2 min read

Commitment, Integrity, and Humility

By Luca Vricella, MD, Johns Hopkins University School of Medicine

Humility is what allows us to approach clinical challenges. Thus we should behave with humility to all of those around us: patients, families, and co-workers.

February 28, 2018 | 3 min read

Sacred or Stigma? A New Realm of Expression

By David Efron, MD, Johns Hopkins University School of Medicine

In 2018, do not resuscitate options are broad—distillation of the letters DNR do not provide enough guidance, and tattoos have yet to be validated as a definitive expression of this wish.

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.

June 23, 2021 | 6 min read

Aducanumab: The Clinical Wisdom of Being Conservative, Careful, And Transparent

By Constantine Lyketsos, MD, Johns Hopkins Medicine

Clinicians frequently face thorny ethical dilemmas when caring for patients. Take time to reflect on all components of these issues before discussions with patients.

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.

October 20, 2021 | 3 min read

Rethinking the Routine in the Pursuit of Inclusion

Interprofessional team members bring a rich variety of perspectives about patients that can lead to better whole person care. Using first names among our team helps minimize power differentials.

January 7, 2019 | 2 min read

Helping Your Patient Get Better Sleep During Hospital Stays

By Rachel Salas, MD, Johns Hopkins Medicine

Sleep is important during hospitalization, and we need to maximize quality and quantity the best we can for our patients. Asking about your patient’s sleep and identifying ways to improve it when possible is one way to start.

May 6, 2025 | 2 min read

Healing from the emotional toll of a medical error  

Mistakes in patient care are not uncommon. Clinicians can lean on their support systems to recover from stressful events at work. Taking care of yourself enables you to continue giving compassionate care. 

July 9, 2018 | 2 min read

Educator, Advocate, Surgeon, and Caregiver for Life

By Matthew Weiss, MD, Johns Hopkins University School of Medicine

As a cancer surgeon, my approach to care focuses heavily on communication with patients and their loved ones. Quite simply, I treat patients as I would want to be treated myself as a patient. 

April 11, 2019 | 2 min read

A Band of Sisters and Brothers

By Ivor Berkowitz, MBBCh, MBA, Johns Hopkins Medicine

It is difficult for new members to join an established tightly-knit team that has shared intense, life-altering, emotionally charged experiences with each other for many years.

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.

July 15, 2021 | 1 min read

Honoring Patients’ and Families’ Goals of Care

By Shireen Heidari, MD, Stanford University

When supporting critically ill or dying patients, keep their care goals at the forefront of conversations and planning.

August 1, 2022 | 1 min read

Keeping Children Safe

By Katherine Hoops, MD, Johns Hopkins Medicine, Monique Burke, MD, President, MD Chapter of the AAP

The new Safer Communities Act helps clinicians connect patients to mental healthcare. Hopefully, this will reduce youth gun violence, including suicide. 

July 19, 2018 | 1 min read

Reflections on “Will You Forgive Me for Saving You?”

By Ivor Berkowitz, MBBCh, MBA, Johns Hopkins Medicine

A pediatric intensivist offers reflections on a moving piece from the NEJM.

Evelyn in her nursing uniform.

December 18, 2018 | 4 min read

Evelyn’s Story

By Mariah Robertson, MD, Johns Hopkins Medicine

Keeping in touch with patients and their families in the days, weeks, and months following an encounter makes the practice of medicine meaningful and rewarding.

May 7, 2024 | 2 min read

Kids in tow 

By Martina Anto-Ocrah, PhD, MPH, University of Pittsburgh

I once had to bring my four children with me to an OB-GYN appointment. It reminded me that it’s important to recognize that patients may have challenges getting to clinic, and to work with them to find solutions. 

May 27, 2021 | 2 min read

How to Support Asian American and Pacific Islander (AAPI) Patients

By James Wu, MD, Medical College of Wisconsin, Neurofourier, MD, New York, New York, Yuemei Zhang, MD, University of Washington

Currently, AAPI people are facing a wave of discrimination. Clinicians need to be sensitive to patients’ experience of racism and educate themselves on how to best offer support.

April 14, 2022 | 1 min read

“Don’t Worry”

By Jeffrey Millstein, MD, Penn Medicine

General reassurances are often ineffective when they don’t address patients’ true concerns.

July 18, 2022 | 2 min read

How to have effective discussions about alcohol 

By Beth McGinty, PhD, Johns Hopkins Medicine, Mike Fingerhood, MD, Johns Hopkins Medicine

Talking with patients about the risks of heavy alcohol consumption and the benefits of change can have a positive impact on their health. 

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