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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 18, 2022 | 3 min read

A Matter of Interpretation

By Kathleen Page, MD, Johns Hopkins Medicine

Practice, preparation, and intentionality are essential to mastering medical skills, including how to communicate effectively with an interpreter. 

May 9, 2023 | 3 min read

Interpreting Patients’ Goals

By Adela Wu, MD, Stanford Medicine

While caring for a patient who spoke a different language than I, the medical interpreter translated more than words. She also explained cultural differences that proved invaluable.

February 28, 2022 | 4 min read

To Our Interpreters: Gracias, Shukriyah, Todah, Danyavad, Merci, Danke

By Cecilia Murach, Medical Interpreter, Johns Hopkins Medicine, Kamna Balhara, MD, Johns Hopkins Medicine, Nathan Irvin, MD, Johns Hopkins Medicine

When working with an interpreter, remember that they’re a person, not a machine. Saying “thank you” makes them feel like a valued member of the healthcare team. 

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.

September 23, 2021 | 2 min read

Best Practices for Cross-Cultural Communication

By Rebekah Fenton, MD, Northwestern University

When caring for patients with limited English proficiency, always use a licensed interpreter. Remember to direct your speech and body language to the patient. 

April 11, 2022 | 6 min read

Effective Partnering With Medical Interpreters

By Cecilia Murach, Medical Interpreter, Johns Hopkins Medicine

A medical interpreter can support successful communication between limited English proficiency patients and the other clinical team members. This collaboration helps build cross-cultural connections with patients and improve care. 

August 4, 2021 | 1 min read

Best Practices When Working With an Interpreter

When caring for a patient with limited English proficiency, understand that you’ll need to collaborate effectively with an interpreter. Speak naturally in the first person and maintain eye contact with your patient, not the interpreter.

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. 

October 1, 2019 | 4 min read

Developing a Complete Culture of Interpretation

By April Lugo, Program Coordinator, Johns Hopkins Medicine Office of Diversity and Inclusion

The clinically excellent clinician prioritizes training for themselves and their staff on the proper role of an interpreter. They work to empower interpreters to translate not only the patient's words, but also the patient's tone, cadence, and meaning.

August 12, 2021 | 1 min read

Beyond Language—Closing the Gaps 

By Vivian Altiery De Jesus, MD, MBE, Johns Hopkins Medicine

Caring for a patient who didn’t speak English showed me that all patients can benefit from a compassionate facial expression, eye contact, and a soothing tone.

November 27, 2023 | 2 min read

When the truth (literally) hurts

By Eric Last, DO, Northwell Health, Wantagh, New York

When our patients are facing surgery or other procedures, thoughtful questions can help allay their worries.  

March 14, 2019 | 4 min read

How to Help Your Patient Understand Genetic Testing Results

By Leslie Ordal, MSc, CGC

To help your patient with their direct-to-consumer genetic testing results, use skills that apply for any sensitive clinical encounter: listen, acknowledge, and reassure of your presence in the process. Then connect your patient with a genetic counsellor for follow-up as needed.

September 19, 2022 | 1 min read

What I’ve Learned as an ESL Physician

By Ming-Hsien Wang, MD, Johns Hopkins Medicine

Growing up with non-English speaking parents, I know first-hand the challenges that these patients face. Being able to communicate is imperative for connecting and creating effective treatment plans. 

May 20, 2025 | 1 min read

Lessons from the Dizi 

Playing the Chinese bamboo flute has enhanced my ability to listen deeply and enriched my understanding of patients. 

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.

October 4, 2021 | 1 min read

Words Matter

By Leslie Miller, MD, Johns Hopkins Medicine

When serving as an advocate for a family member, I noted judgmental language in the EHR. This reminds me as a clinician to consider how patients (and their families) will feel when they read my notes.

January 21, 2021 | 1 min read

Lost in Translation

By Sonal Gandhi, MBBS, MD, Johns Hopkins Medicine

When you and your patient don’t speak the same language, clear communication is critical. When an interpreter is unavailable, reach out to staff and others for help.

Édouard Manet: "A Bar at the Folies-Bergère," 1881-1882. This is a faithful photographic reproduction of a two-dimensional, public domain work of art. The work of art itself is in the public domain for the following reason: Public domain This work is in the public domain in its country of origin and other countries and areas where the copyright term is the author's life plus 100 years or less.

August 6, 2019 | 7 min read

July Art Museum Challenge

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

The skills required in the clinic are the same as those in the art gallery: to examine, investigate, embrace ambiguity, consider multiple interpretations, reflect, collaborate, and learn.

October 11, 2022 | 6 min read

Learning About Your Patients And Their Communities

By Hailey Haffey, PhD, University of Utah

Receiving patient and community stories with thoughtful attention can help serve the aims of equity in healthcare. 

Dr. Margaret Chisolm captures a photograph of the painting, "John, 1st Baron Byron," 2013, Kehinde Wiley (American, born in 1977), at the Museum of Fine Arts, Boston.

April 8, 2019 | 5 min read

On Looking: March Museum Visit

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

Visual Thinking Strategies and the Personal Response Tour are two examples of museum-based pedagogical practice that build critical thinking skills, foster empathy, and allow for reflective space away from the clinic.

January 10, 2019 | 3 min read

How to Improve Your Physical Diagnostic Skills With a Digital Database

By Samuel Durso, MD, Johns Hopkins Medicine

To sharpen diagnostic skill, take a minute to cross check the physical exam against images and lab results in the electronic record - if not congruent, then why?

June 18, 2019 | 2 min read

Navigating the Uncertain: A Book Review of “The Laws of Medicine”

By Sam Kant, MD, Johns Hopkins University School 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."

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.

March 8, 2022 | 3 min read

Tips For Assessing The Intensity of Pain

By Brian Lee, MD, PhD, Johns Hopkins Medicine, David Madder, DO, Johns Hopkins Medicine

When assessing pain, we often ask patients to assign it a number between 0 and 10. Asking about the effect of pain on behavior and functional status can often give us a more meaningful understanding. 

"An Infinity Room Installation," Yayoi Kusama. Wikivisually.com. Public Domain.

December 19, 2019 | 5 min read

November Art Museum Challenge

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

The reality of clinical practice can be complex and uncertain and these sessions away from the clinics in and around the art museum space allow students through haptic exploration to become more comfortable with ambiguity.

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.

May 19, 2021 | 3 min read

Clinical Training Translating to Clinical Excellence

By Jennifer Spicer, MD, MPH, Emory University

Bias awareness achieved in teaching/learning can transfer to the clinic. Thus learners can help clinicians become aware of bias toward patients.

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.

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.

May 18, 2023 | 2 min read

Ballet And Medicine

By Maria Guinle, medical student, Stanford Medicine

Medicine is similar to dancing. Learning from mistakes and working as part of a team are necessary for success. 

August 6, 2019 | 2 min read

3 Lessons From Your Patient’s Impatience

By Iro Filippaki, PhD, Johns Hopkins University School of Medicine

The excellent clinician acknowledges their patient's impatience and frustration. In doing so, relationships with patients and clinical outcomes may be improved.

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 2, 2023 | 2 min read

We Just Disagree

By Eric Last, DO, Northwell Health, Wantagh, New York

When colleagues offer a conflicting opinion, remember to always put the patient first, check your facts, and be open to learning.  

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.

Boundary Waters Wilderness, Minnesota.

October 3, 2022 | 4 min read

Setting Boundaries in Medicine

By Laura Hanyok, MD, Johns Hopkins Medicine

Key to mitigating burnout is managing expectations of yourself and others, while still fulfilling our duties to patients. 

September 27, 2022 | 2 min read

When?

By Shreya Srivastava, medical student, Albany Medical College

When my friend was struggling with her mother’s new diagnosis, she listened to the popular French song about cancer entitled, “Quand c’est?” It gave her a sense of support, empathy, and solidarity with others.

Guanyin, Bodhisattva of Compassion, Honolulu Museum of Art. Photo by Margaret Chisolm, MD.

March 7, 2019 | 5 min read

On Looking: February Museum Visit

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

The more lessons on clinical excellence we look for in art, the more we find.

September 21, 2022 | 1 min read

Helping Patients Navigate Risk in The New Normal

By David Hurwitz, MD, MBA, Johns Hopkins Medicine

Using empathic listening to give COVID-related advice will help your patients balance the risks of the pandemic with enjoying the activities in their lives that matter most. 

The author's drawing of her heart utilizing the technique of defamiliarization.

February 14, 2019 | 3 min read

Defamiliarization

By Sarah Walser, , Penn State College of Medicine

Incorporating defamiliarization into practice builds empathy and broadens our worldview. It challenges us to expand and find confluence between different frameworks through which an experience, such as a disease, can be interpreted.

Natya Dhrami Foundation for Performing Arts. Copyright with Eswar Avidi.

August 10, 2022 | 3 min read

Storytelling With Hands

By Shreya Srivastava, medical student, Albany Medical College

Exploring Non-Western art forms–like Indian classical dance–can diversify our understanding of the cultural and spiritual roles that body parts can play in healing.

January 28, 2019 | 3 min read

Reflections on “Healing Alone”

By Helen Bradshaw, MD, Johns Hopkins University School of Medicine

In defense of the practice of pimping, though the term is a regrettable word choice, I learned from having questions directed at me. And my frequently incorrect responses were usually met with thoughtful explanations.

July 11, 2022 | 5 min read

Navigating Power Relations in Healthcare

By Hailey Haffey, PhD, University of Utah

We must be aware of the power we have in relation to our patients. This imbalance must only be used in the service of care.   

A crowd organized by the Student Non-Violent Coordinating Committee sang “We Shall Overcome” in Farmville, Virginia, in 1966, after a speech by Stokely Carmichael.

January 18, 2019 | 9 min read

From Clinic to Senate

By Kali Cyrus, MD, MPH, Johns Hopkins Medicine

Advocacy does not have to mean changing legal precedents; it can also be taking a mentee out for coffee, giving feedback about your colleague’s stereotyping of a patient, or not patronizing restaurants with unfair wage practices.

July 6, 2022 | 1 min read

Any Side Effects?

By Jeffrey Millstein, MD, Penn Medicine

Teaching my patients to ask questions helps address their worries about medications. 

April 14, 2022 | 3 min read

Equity and Ethical Considerations With The Use of Psychedelics

By Ian Pocock, LICSW, Washington

Psychedelic medicines may help patients suffering with PTSD and treatment-resistant depression. As with many new therapies, ethical considerations and ensuring equal access for everyone are works in progress.

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.

October 16, 2018 | 3 min read

The heart of trauma-informed care (archives, 2018)

Trauma-informed care means recognizing trauma’s prevalence and long-term effects; understanding its effects on patient behavior and engagement in care; prioritizing patient choice and collaboration while building trust; and offering education and resources to promote healing.

March 31, 2022 | 2 min read

A Lesson in Cultural Humility

By Mengyi "Zed" Zha, MD, Othello, Washington

Working at a community health clinic serving migrant workers from Mexico, I was confronted with a pervasive stereotype that the female patients were “dramatic.” I learned how important it was for patients’ concerns to be taken seriously.   

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.

April 8, 2022 | 1 min read

“Better”

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

Using precise language can help us partner with patients in hoping for the best, without causing confusion. 

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