“For Good”

By Sharon Tregaskis

Performing a pediatric physical exam can be a terrifying rite of passage for a medical student. Will you inadvertently harm the infant? What about the caregiver—will they trust you? What are the tricks to putting a toddler or preschooler at ease during an exam? How do you wield a tongue blade to see a youngster’s tonsils without distressing everyone in the room? And, is it OK to have fun? 

Nico Miller was a student in Columbia Nursing’s master’s degree program in 2022 when he got the answers to some of those questions from his late dad, Steven Zane Miller’84, by way of a 1999 training video filmed for distribution to medical schools across the United States and Canada.

“You really always have two patients, which are the child and the parents,” Dr. Miller explains in a voiceover. In the video, the storied medical educator and then director of pediatric emergency medicine at Columbia crouches in front of a 3-year-old, stretching his mouth wide as he invites the child to do the same. “You can use the parent to also get the child to be relaxed,” Dr. Miller continues in the voiceover, as the parent holds the otoscope, opens her own mouth, then smiles encouragingly at the child. “Parents are a terrifically, even in performing part of the physical exam.”

Dr. Miller helped to craft the video at the invitation of pediatric medical educator and filmmaker Mary Ann LoFrumento, MD, assistant professor of pediatrics and a hospitalist at Morgan Stanley Children’s Hospital. The 18-minute video combines a handful of Columbia medical students on the brink of their pediatric clerkships voicing their concerns and clinicians addressing common themes. At the video’s conclusion, the pediatricians reflect on their own career paths. Dr. Miller—clad in a white coat, a button-down plaid shirt, and a necktie sporting colorful children’s drawings— offers what amounts to a benediction. “Take the opportunity to enjoy it,” he tells the students. “For me, it’s a terrific pleasure. Hopefully you’ll have a good time, too.”

Nico Miller shared the video with his entire nursing class. “It was full of clinical pearls—things that aren’t in the textbook that get passed down from provider to provider,” says Mr. Miller, who is pursuing his doctorate in Columbia’s doctor of nursing practice program and working as an RN in the emergency department at Morgan Stanley Children’s Hospital.

Nico Miller was 7 years old when his father died in October 2004 in a plane crash in northeast Missouri. Dr. Miller was en route to a conference on compassionate care in medicine. Nico Miller’s memories center on his father as family man: the budding guitarist who made up silly songs and taught his three children the lyrics to Beatles, Johnny Cash, and Bruce Springsteen classics for family singalongs. The man who ordered pizza and let the kids jump on his bed and coaxed them into home productions of his Shakespeare favorites and let them stay home from school on the rare occasions when their mom, Dodi Meyer, MD, also a faculty member in Columbia’s Department of Pediatrics, traveled for work.

Oldest son Jesse Miller recalls Mets and Knicks games, a Bruce Springsteen concert at Shea Stadium, summer with extended family at a rented house in Cold Spring Harbor, listening to his father read aloud to them at bedtime, the pre-dawn squeaking of the floor as Dr. Miller prayed each morning. “He was the most observant of all of us,” he says. “His faith informed his humanism— the ethical tenets of making sure everyone is treated with dignity, respect, seriousness comes from that idea that there’s holiness, worthiness in everyone, regardless of their background or whether they’re kids, or what religion they are, and what they believe.”

Steve Miller grew up in a working class family as the son of two Holocaust survivors; his father was a kosher butcher. He earned scholarships to pay for his undergraduate degree. Jesse Miller credits his own career—as an independent film producer in Brooklyn—to the opportunities his parents created. “Sometimes I feel that I’m getting to live out these artistic passions that he couldn’t do professionally,” he says. “I’m able to do things he wanted to do because of his choices and because of the way he and my mom raised us—hopefully he would have been proud.”

Humanism Ambassador

Dr. Miller’s trip in 2004 was part of his work in championing humanism in medical practice and medical education. His teaching was recognized in multiple ways. He was a six-time recipient of VP&S teaching awards, recipient of the Columbia University Presidential Teaching Award, and a national finalist in the Association of American Medical Colleges prize for outstanding teacher. In 1998 he launched the student clinician’s ceremony that marks the transition for medical students from classroom teaching to clinical education in hospital and ambulatory settings, and the ceremony now bears his name.

At the time of his death, 46-year-old Dr. Miller was the Arnold P. Gold Associate Professor of Clinical Pediatrics, director of pediatric medical student education, and director of pediatric emergency medicine. “I always thought of humanism in medicine as how we treat the patient, but it’s also how the staff treats each other,” says Nico Miller. “The nurses, the doctors, the techs: We work together in a team. Everyone’s teaching each other, working together, has a good sense of humor. I like to think that he had a hand in developing that culture.” 

This fall, the VP&S Department of Pediatrics will host the 15th annual Steve Miller Day, an event held each October to celebrate Dr. Miller’s legacy and champion a culture of humanism in medicine. Keynote speakers over the years have included Anna Quindlen, Andrew Solomon, Abraham Verghese, Khalid Hosseini, and Daniela Lamas’08. The event includes an educational workshop, luncheon, and presentations by winners of the prior year’s Steve Miller Fellowship in Medical Education, which supports original scholarly work by VP&S students devoted to enhancing medical education or humanism in medicine from the medical student perspective.

“The most important part of the day to me is the student presentations,” says Dr. Meyer, now professor and vice chair of community health at Columbia’s Department of Pediatrics. “I want his life to be relevant to the future, not only the past. I want to extend his legacy with students today.” Dr. Meyer sits on the committee of 12 faculty—some personal friends of the family, all dedicated proponents of medical education—that reviews proposals and selects fellows.

Rita Charon, MD, PhD, the Bernard Schoenberg Professor of Social Medicine, professor of medicine, and founding chair of the Department of Medical Humanities & Ethics, is an ex officio member of the Steve Miller Day committee. When she worked with Dr. Miller in the late 1990s, she was formulating what would become the field of narrative medicine and Dr. Miller was a newly appointed Gold Foundation emissary for humanism in medicine. “Steve Miller went from being a practitioner to a teacher to a model to an icon,” says Dr. Charon. “Steve Miller Day celebrates our commitment to person-centered care—to individually seeing, hearing, taking in what a particular patient, especially a child, might need to convey. This is something that we all agree is part of what it means to be trained at Columbia.”

Katherine Nash’15, now assistant professor of pediatrics at VP&S, a hospitalist at Morgan Stanley Children’s Hospital, and a health services researcher in the Department of Pediatrics, was a Steve Miller Fellow in 2012. She and two classmates launched a cultural and Spanish language immersion program—now known as “Digame Bienvenidos”—to introduce new VP&S and College of Dental Medicine students to Washington Heights. Dr. Nash credits her current focus on equity in health care delivery to her experience as a Fellow. “The fellowship demonstrated an institutional commitment to equity and social justice-focused programs,” says Dr. Nash, who calls it a flywheel for medical students who are curious about pursuing work related to medical education, humanism, and justice. “The program is telling young trainees that this work is possible, and that it’s possible to get support for this work.”

Michael Devlin’82, professor of psychiatry, first encountered Dr. Miller when they were both students at VP&S. “Steve had a big personality,” Dr. Devlin recalls. “He was active in the Bard Hall players—a high-energy, everybody’s friend kind of guy.” In the late ’90s, they reconnected as teachers. Dr. Devlin was exploring how to shift his own career in academic medicine from clinical research to education. Dr. Devlin joined Drs. Miller and Charon as volunteer preceptors for the course “Foundations of Clinical Medicine”—known as “Clinical Practice” at the time—in which small groups of preclinical students and faculty mentors meet to discuss topics including the doctor-patient relationship, medical interviewing, ethics, health promotion, narrative medicine, and evidence-based medicine/epidemiology.

"Miller Time"

When Dr. Devlin set out to craft a program of conversation and reflection for students in their third year, he met with each of the clerkship directors for their input. “Steve, of course, was basically already doing this in the pediatrics clerkship,” says Dr. Devlin, who audited the gatherings at Dr. Miller’s invitation.

Those Friday afternoon sessions, known as “Miller Time,” unspooled gently as Dr. Miller inquired about how things were going for the students, what movies they had seen recently, what they thought of his latest haircut, who had the best new restaurant recommendation for Dr. Miller’s next date night with Dr. Meyer. The conversation put students at ease and built trust, as Dr. Miller modeled the skills his students would need to establish rapport with patients and their parents. The conversations also made Dr. Miller a stronger mentor.

“He was invested in getting to know each and every student—our essence, our career trajectory, and how he could get us where we were going,” says Liat Simkhay Snyder’05, now a pediatrician at Montefiore Medical Center. As a first-generation medical student, Dr. Snyder didn’t have doctors in her own family to advise her on work-life balance, especially as she embarked simultaneously on marriage and residency. She turned to Dr. Miller. “He helped us think through details of what do you want your residency, your training, your career, your early marriage to look like? He was really good at reflecting back and helping us figure out what would work for us.”

Dr. Miller also showed by example that it was possible as a pediatrician, a unit director, and a busy academic to have a rich family life. If he was having a meeting in his office on the fifth floor of the hospital and his computer alerted him to an incoming message from one of his children, he would pause to tap out a response—his two index fingers flying across the keyboard. Artwork by Nico, Maya, and Jesse adorned the door, while family photographs and more artwork covered the wall above his desk.

During “Miller Time” sessions, students could count on their preceptor ultimately steering the conversation to clinical challenges and inviting them to grapple with conflict and its resolution, whether their own internal insecurities or challenging encounters with patients or colleagues. Dr. Devlin has kept pages on which he scrawled principles gleaned from those conversations: Develop respectful disengagement technique. Anticipate communication concerns. Stay in the room, keep company. Establish trust. Recognize self-interest. The one that echoes most resoundingly in his own practice, says Dr. Devlin, is the imperative to strive for real partnership with patients. “It’s kind of a radical concept in medicine,” he says, “to really meet people where they are, on their terms and not ours.”

On Sept. 14, 2001, Dr. Devlin and Dr. Miller crossed paths as each made his way to small group sessions with students, their first after the 9/11 terror attacks. “We were going into separate rooms,” Dr. Devlin recalls. “Neither of us had the slightest idea what we were going to do.” Dr. Devlin opted to ask his students whether they wanted to focus on the previously scheduled standardized patient encounter or broaden the conversation to their reflections on the week’s events. “It was a Steve kind of thing to do, to open it up to the group.”

The students—just three weeks into medical school—debated whether to double down on academics, sensing that their medical training might be even more relevant in this new world order, or devote class time to the tectonic shift in geopolitical relations suddenly underway. One student invited the group to discuss what happened on 9/11. Another, a young woman from the Middle East, described her anxiety and fear at the American nationalism that had sprung up in recent days, and another mourned a loved one among the casualties. “It was so poignant,” says Dr. Devlin. “They were medical students and wanted to help but were only three weeks into medical school. Yet just being people, being open, being willing to be there for other people and for one another, they were helping. I’m not sure that would have happened had I not bumped into Steve as I was heading into class.”

Teachable Skills

In 1999, the same year the training video was made, the journal Academic Medicine published “The Habit of Humanism: A Framework for Making Humanistic Care a Reflexive Clinical Skill,” an essay co-authored by Dr. Miller. The paper distilled three principles central to Dr. Miller’s practice: identify multiple perspectives, reflect on possible conflicts, and choose altruism.

Already honored by the Ambulatory Pediatrics Association as a National Pediatric Faculty Development Scholar in recognition of his extensive curriculum development, training workshops, and faculty development efforts, Dr. Miller sought more ways to share his principles with students. “Steve was so excited about finding another way to teach medical students,” says Dr. LoFrumento of the conversations that led to the training video on pediatric physical exams. “He was very astute in figuring out that it was the students’ voices that we needed to use.”

“Both as a teacher and as a physician, taking down the barrier between people was his big message,” says Dr. Snyder, the 2005 graduate. “He was super insightful and brilliant to realize that empathy is a teachable skill.”

Roy Gulick’86, now chief of infectious diseases at Weill Cornell, sees the legacy of Dr. Miller’s love of theater—including many shared productions by what is now the Broadway Haven Players—in Dr. Miller’s techniques for teaching empathy. Dr. Miller appeared in “Company,” “Pippin,” and “Two Gentlemen of Verona.” One year he directed “Fiddler on the Roof,” casting Dr. Gulick as Perchik, and the next year the two costarred in “Cabaret.” Another year, Dr. Gulick cast Dr. Miller in “Once Upon a Mattress.” “When you play a role or you’re directing and working through scenes,” says Dr. Gulick, “you have to get into someone’s skin, learn how they think and respond to situations.”

Forensic psychiatrist Martin Epson’07 was a first-generation medical student fresh out of Harvard Divinity School, struggling with undiagnosed, untreated depression and still reeling from his mother’s terminal illness and death when he was assigned to Dr. Miller’s clinical practice group in 2002. At the end of his first year, administrators gave Dr. Epson a choice: Repeat his first year or leave Columbia. The repeat year was just as rocky and when administrators again suggested that Dr. Epson abandon his medical studies, he appealed to Dr. Miller, who drafted a letter of support. “To this day, I don’t know what he wrote,” says Dr. Epson, who also later earned a law degree. Dr. Epson describes the letter as a pebble thrown into the pond of his career. “By the time I got to third year, I knew I wanted to be a psychiatrist. Steve wasn’t a psychiatrist, but because of his deep grounding in humanism, he was teaching us some really deep psychospiritual, therapeutic concepts. Attunement affects how our minds, our brains work. There’s a lot of science that supports it, but he was approaching it from humanism.”

The month after Dr. Miller’s death, students organized a memorial gathering to honor Dr. Miller’s life and legacy. The soundtrack featured a playlist of Dr. Miller’s favorite Broadway tunes, including “For Good,” the duet sung by the main characters in “Wicked” as they reflect on the effect their friendship has had on each other. Dr. Snyder spoke. So, too, did Dr. Epson. “Now I’m a father, a married man,” says Dr. Epson. “In that moment, I had this incredible sense of Dr. Miller’s work not yet finished. I felt it was up to us to give him permission to leave those fledgling projects and roles in our hands. I spoke to him. I said, ‘We’ll carry on, we’ll miss you, and we’ll try to live out your legacy.’” 

Twenty years after her husband’s death, Dr. Meyer reflects on his legacy. “When someone is a public persona like he was, the legacy belongs to multiple people at the same time. The legacy of him in our family and as a husband belongs to us, and his legacy as a teacher and educator belongs to his students and his department. In this case, his legacy lives in the lives of the people he taught. It’s important to me that Steve Miller Day be owned by people other than me or our children—specifically by people who never met him. This way the day and his legacy at Columbia, and in the medical profession at large, stands on its own and can lead into the future.” 

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Past Winners of the Steve Miller Fellowship

2024

Harrison Fillmore and Hannah Weinstein: “Sustainable Futures through Environmental Justice: Incorporating a Climate Health Curriculum into MCY and D&I”

Joshua Dawson and Michelle Batlle: “Pick Up Sports and Health: A service-learning model to promote health literacy and health careers among school-aged children in upper Manhattan”

Paul Lewis: “Adolescents Caring for Community by Promoting Literacy on Insurance, Stroke, Health Education, Emergencies, and Dementia (ACComPLISHED): A Community Health Worker (CHW) Program”

2023

Alan Mograby and Anthony Sulvetta: “Effects of a Supplemental Oral Health MiniCourse on Columbia VP&S Students: A Pilot Study”

Omid Cohensedgh and Anne-Sophie van Wingerden: “OBGYN Care for Trans, Gender-Diverse, and Intersex Individuals”

2022

Jeremiah Douchee: “Just Care in the Justice System”

2021

Caroline Cherston: “Developing a Pilot VP&S Curriculum on Trauma-Informed Care”

Todd Jones: “Post IntensiveCare Syndrome”

2020

Zach Pitkowsky: “Using a Child Life Approach with Pediatric Patients and Families”

Teddy Goetz: “Professional Identify Formation” Amanda Wang: “Understanding Food Insecurity in Northern Manhattan: A Mixed-Methods Approach”

2019

Rebekah Boyd and Angela Chang: “Interdisciplinary Refugee Partnership in Health”

Rachel MacLean: “The Companion Project” Catherine Kernie: “Development of a Service-Learning Partnership between VP&S and Gigi’s Playhouse”

2018

Vibhu Krishna: “Humanizing the Body: Life Drawing in Preclinical Education”

Taylor Jacob: “Service-Learning in the VP&S Student Run Clinics: A Pilot”

Sarah Godfrey and Gregory Karelas: “The Public Health Commute”

2017

Stanislaw Gabryszewski: “Enhancing Nutrition Education in Medical School through Humanistic Approaches”

Dua Hassan: “Fighting for Equality in Healthcare: Addressing Health Disparities and Implicit Bias through Medical Education”

Katrina Kostro: “Meditation and Relaxation Skills Workshop for Medical Students, Patients, and Caregivers: A Shared Practice for Mindfulness, Empathy, and Mutual Healing”

Dylan Marshall: “Emotional Intelligence: Fostering Relationships Essential to Making the Practice of Medicine Sustainably Meaningful, thus Preventing Medical Student Burnout”

2016

Amulya Iyer: “Exploring the Relationship between Hospitalized Patients and their Medical Students: A Qualitative Study”

Subha Perni and Lauren Pollack: “Moral Distress in Caring for Older Adults during Early Clinical Training”

Patrick van Nieuwenhuizen: “Democratizing Medical Education: An Open Access Platform for Preclinical Sciences”

2015

Jemma Benson and Christopher Clayton: “Digame Bienvenidos: Washington Heights Pre-Orientation Program”

Erica Cao: “The Benefits of Music and Service-Learning: An Intervention Program for Medical Students and At-Risk Youth”

2014

Erin Elbel: “Development & Piloting of an Educational Module for Medical Students in Hospital-Based Interdisciplinary Communication and Quality Improvement”

Jessica Calihan: “Developing a Humanistic Cross-School Training for Examining Asylum Seekers”

2013

Zeena Audi: “Lang Scholar Community Ambassador Internship”

Hannah Roberts: “Medical Students’ Perceptions of Dementia Patients (before and after attending a non-clinical arts-centered session)”

2012

Jonathan D. Hansen: “The 21st Century Lecture Hall”

Lily Mundy, Katherine Nash, and Michael Steinhaus: “Washington Heights Immersion Program”

2011

Cecilia Fix: “Similarities and Differences between the Health Care System in New York and the Dominican Republic”

Haley Masterson: “Assessing the Effect of the VP&S Psychiatric Rotation on Student Perceptions of the Mentally Ill”

2010

Jon Hatoun and Yuna Larrabee: “Ethics: Truth-Telling & the Major Clinical Year (MCY) in Medical School”

Eliza Miller: “Narrative Medicine Curriculum”