My Kind of Medicine: Real Lives of Practicing Internists: L. Clifford McDonald, MD, FACP
Working as a “foot soldier” for the Centers for Disease Control and Prevention (CDC) has its moments, the first of which for a young L. Clifford McDonald was terrifying and thrilling all at once. Three weeks after landing the job, he found himself stepping off a plane in the Caribbean and greeting the nation’s Minister of Health. His task was to figure out why eight infants had unexpectedly passed away at a local nursery. People were watching, too. One of the infants happened to be a nephew of a major local politician. Daunting? Yes he says, but worth it. As he puts it, “It was the best job in the world.”
A Global Point of View
Ten years later as Chief of the CDC Prevention and Response Branch, Dr. McDonald has grown into his responsibility, but is every bit as challenged today as he was on that day on the Caribbean tarmac. His job and that of the branch he oversees is to study the causes of health care associated infections and ways to prevent them. This includes overseeing investigations of outbreaks in hospitals and the use of science to guide national policy on prevention. He loves the job and says his decision to pursue internal medicine made it possible. “When I look back I can see how my training has contributed to where I am now—without it I would not have had the opportunity to subspecialize in infectious diseases,” he says. And although his father was a physician, Dr. McDonald attributes his passion for medicine to an inner awareness he discovered in high school. “I enjoyed science a lot but I wanted to help people, too,” he explains. “And I am so glad I chose internal medicine because it has opened up so many different opportunities and has been a platform for so many things for me in public health.”
After finishing medical school at Northwestern University’s Feinberg School of Medicine, Dr. McDonald began his career as a hospitalist at Blodgett Hospital, near Grand Rapids, Michigan. A short stint as a missionary physician followed in Taiwan, and then work as an infectious disease fellow at the University of South Alabama and a microbiology fellow at Duke University. Upon completing his fellowships, Dr. McDonald was accepted into CDC’s elite Epidemic Intelligence Service (EIS), which he says provides the ‘foot soldiers’ for CDC. It would take him to four continents and far-reaching parts of the world—South America, the Caribbean, Thailand and Africa—in two years. “It was exciting and challenging,” he says, but adds that it was not all fun and games. “It could be anxiety provoking. For example, my first investigation in the Caribbean when I was thrust into being the sole investigator of a high profile outbreak—the pressure was definitely on.”
L. Clifford McDonald, MD, FACP with his family.
He says working in public health has been the opportunity of a lifetime. “For me it has been an opportunity to understand how to control the spread of disease and also how policies can have a major impact on making patients safer,” he says. His work overseas has also given him the perspective to appreciate what our own health care system offers in comparison to those abroad. “Working overseas I have realized how glad I am to live in a place where information is shared freely across various levels of experience,” he says. “I think the way we share information here with students is really beneficial, as well as the ways in which teachers can learn from students. The fact is sometimes we don’t have all the answers. Sometimes the patient has the answer and we need to take on the role of directing the traffic as we lead teams of other professionals.”
A Sensitive Soul
Working with a team is something Dr. McDonald has come to value more and more, having weathered a handful of difficult situations alone, as he did one evening while working his evening shift at Blodgett Hospital. A man in his 60s with apparent pancreatitis and evidence of a large myocardial infarction had come under Dr. McDonald’s care from the day shift. When the man’s condition started to decline, Dr. McDonald started to struggle. “Despite my best efforts to keep him alive and to keep him supported, he was deteriorating rapidly,” he remembers. “Despite intensive support, the patient died that evening. The particularly hard part was interacting with a family I did not know; the patient and his family had recently moved to the area and did not have a local physician to consult, so it came as a shock to the family. What I learned from it was how to not be afraid to ask for help. I faced the care of that patient largely alone, thus I appreciate having a team to work with now.”
The experience touched him as it would have any physician, but for Dr. McDonald the incident resonated deeply. “I could see and hear their anguish. I had been through residency and all that by this point, and there had been other times I had gone through a similar process with other patients, but in this situation I was very much alone. I cried with them.” Empathetic would be the word to describe people like Dr. McDonald, but the 45-year-old also seems to have an extra layer of sensitivity built in. It is apparent when he talks of his wife and his experience coping with Hodgkin’s disease since the age of 17.
“Having been diagnosed with Hodgkin’s at a young age, I’ve experienced medicine from the other side,” he explains. “It’s been intense at times. I underwent chemo and radiation therapy as an undergrad and since then I’ve been having little complications here and there. Recently I had to have a pacemaker put in.” But the difficulties of his disease are minimized by the joys in his life—his wife Lisa, a nurse, and six children. Dr. McDonald met Lisa at a Christian clinic for the poor in Chicago. She clearly has an enormous impact on him. “She keeps me young in more than one way,” he says. “She keeps me very active and she’s just very positive. Her faith in God inspires those around her; she is not someone who sits around feeling sorry for herself.”
Dr. McDonald knows a thing or two about life as well. He says students need to consider the long term when making a career choice. “Don’t let temporary situations dictate your future—consider both lifestyle and the purpose you want to have in life that extends beyond the material,” he says. “In hindsight I know that some of the other careers I was considering I wouldn’t be satisfied with now. I also feel like internal medicine has altruism at its very core and that is something to be proud of. Yes we do get to do science, but we also have the chance to help people. We don’t know the future of health care, but it’s why I went into medicine in the first place. People always respect that and they’ll always come back to it.”
Match Day 2012: An Exciting Experience
Go behind the scenes at Match Day 2012 at The Perelman School of Medicine at the University of Pennsylvania and hear Dr. Katrina Armstrong, Chief of the Internal Medicine Division at Penn Medicine describe being part of the Match Day experience.
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