Moments in Medicine at Michigan

David Miller, M.D., from Midland, is a fourth-year resident in urology who is also pursuing a Masters of Public Health degree in the U-M School of Public Health.

“Public health is focused at the level of populations, while clinical medicine is focused on one-on-one interaction — what can I best do for this one individual that I’m talking to at this point in time? There’s the potential for those two ideals to be at odds, but I think that both disciplines working together can accomplish so much more than having isolated interests that come together less frequently.

David Miller, M.D. Photo: J. Adrian Wylie

“Since I started to have involvement and responsibility in patient care as a resident, I’ve come to recognize that taking a critical look at what we do is essential. We’re coming to understand that there are measures of health and disease beyond morbidity and mortality, which is historically how we as a profession — and perhaps a society — have measured how we’re doing as physicians. In many ways, those are really crude measures because they don’t take into account a lot of what patients feel about their condition, or a lot of the suffering that’s associated with disease.

“One of my goals is to move beyond the traditional measures of quality in medical care. Skills like biostatistics and epidemiology, and other traditional public health disciplines, are helping me accomplish that. Among my greatest interests right now are urological cancers — prostate cancer, bladder cancer, testicular cancer ... they all can have a dramatic impact on people’s lives.

“There’s a difference between disease and illness. Illness is more of a human phenomenon: someone has a disease, but how does that impact that person’s life? Beyond the surgery, beyond the time when the disease may or may not be cured, it’s important for physicians to recognize that the illness can persist.”