Miller School Student Writes Essay in New England Journal of Medicine

How many refrigerators must a repairman fix to be able to afford his coronary-artery bypass surgery?

That question, which came out of a discussion Nicholas Rohrhoff had with the man who came to fix his fridge the summer before he began studying at the Miller School, is part of an inspirational essay the fourth-year medical student wrote for the ‘Perspective’ section of the February 23 issue of the prestigious New England Journal of Medicine, a significant accomplishment for a medical student.

Moved by his encounter with the repairman, as well as the patients he came across while working at the medical school’s Mitchell Wolfson Sr. Department of Community Service free health fairs, and even the plight of his parents after his father lost his job and health insurance, Rohrhoff stresses the importance of physicians not only treating their patients’ maladies, but caring about their lives.

In the essay, titled “What Life Is Like,” Rohrhoff says it wasn’t until he heard University of Miami President Donna E. Shalala, the former Secretary of the U.S. Department of Health and Human Services, urge physicians and medical students to always ask people “what their lives are like” that he realized conversations like the one he had with the repairman are crucial for improving the delivery of health care. The repairman imagined he would have to fix an infinite number of refrigerators to get the heart surgery he needed.

“President Shalala reminded us that, although medical education is rightly focused on everything we need to remember, there’s another aspect of health care we can’t afford to forget. Digging deeper into our conversations with patients to find out who they are is as essential to the development of an effective care plan as diagnosing an illness,” said Rohrhoff, who spent a year between his third and fourth year of medical school in Washington, D.C., as the government relations fellow at the American Medical Association.

Rohrhoff was selected last year for the program from a competitive pool of the nation’s medical students who are members of the AMA Medical Student Section. In Washington, the fellow becomes part of the AMA’s dynamic advocacy team that seeks to improve health care by advancing the medical group’s legislative agenda, all for the benefit of physicians, medical students and patients.

In giving examples of why physicians need to care about how their patients live, Rohrhoff notes that homeless patients with diabetes usually don’t receive insulin because of an important, but sometimes overlooked, detail: They don’t have refrigerators. Other patients have poor diets resulting from little work or unemployment and a lack of fresh food grocery stores in their neighborhoods. And some uninsured patients simply don’t realize that there are federal or state assistance programs for which they or their children qualify.

As such, Rohrhoff writes, while the fate of the Patient Protection and Affordable Care Act of 2010 rests with the courts, “the impetus for it remains: a lower-cost, higher-quality health care system accessible to the handyman, my patients, my parents, and every other American who needs it. Tomorrow’s physicians must lead us from the system that we have to the system that we need.”

Alex J. Mechaber, M.D., senior associate dean for undergraduate medical education and associate professor of medicine at the Miller School, said Rohrhoff’s essay “embodies what the influential Dr. Francis W. Peabody famously told his Harvard students in 1925 about ‘the secret of the care of the patient is in caring for the patient.’ Nick has personalized what we teach at the Miller School. The future of health care, indeed, is much brighter with future physicians like Nick.”

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