A new approach to caring for the elderly

Dr. McCloud's senior photo gallery © UC Regents
Dr. McCloud and his gallery of senior portraits.

By David Eastis

Posted Oct. 13, 2010

Physician Michael K. McCloud recalls the incident fondly. On one typical Saturday evening about two years ago, he received a telephone call. A woman who recently had moved to a retirement community began experiencing painful symptoms of a urinary infection. Because she recently relocated, she had no local physician in the area yet. A friend who is a patient of McCloud’s encouraged the ailing woman to call him for assistance.

McCloud, a UC Davis clinical professor of medicine, readily agreed to see the woman – at her home. After stopping by his office to pick up urine testing equipment, he arrived at her seniors’ complex within the hour. On the stairs to her third-floor apartment, a passing resident spotted the well-worn black medical bag in McCloud’s hand. The woman stopped him to comment, “That looks just like one of those old-fashioned bags doctors used to take on house calls.”

This year McCloud marked his 10th anniversary as a clinician educator on the faculty of the UC Davis Department of Medicine, in the Division of General Medicine. And while he still makes numerous evening and weekend patient calls, not just his black bag but also a medical student is likely to be in tow.

Medical student Mamta Parikh and Dr. McCloud © UC Regents
"His empathy for his patients gave me a bar that I can only hope to keep reaching," medical student Mamta Parikh says of her training with McCloud.

“We have a critical shortage of physicians and nurses with training in the special needs of the elderly,” notes McCloud. With the shortage projected to even worsen, McCloud has shifted the focus of his work to encouraging and teaching the next generation of physicians and physician extenders the skills and sensitivity necessary to treat our most vulnerable adult population.

Medical students who have spent a one-month clerkship rounding with McCloud are unanimous in their laudatory evaluations of the rotation.

“Dr. McCloud is an exceptional physician as both a teacher and a role model,” says fourth-year UC Davis medical student Mamta Parikh, who completed a clerkship with McCloud. “His medical acumen coupled with his empathy for his patients gave me a bar that I can only hope to keep reaching as I go through my training. His enthusiasm and passion for what he does is an asset to his patients. It is so important for medical students to be exposed to physicians like Dr. McCloud. In addition to serving as an excellent role model, his love of what he does is infectious and encourages students to look within themselves to find their own calling.”

McCloud’s other great passion is educating the community to prepare for aging, and to help them learn about the diseases associated with aging. He is well known for his acclaimed program, “Aging and Medical Science: A Mini Medical School to Prepare for Life’s Second Half.” The program, which McCloud has presented annually since 2002, consists of classes taught by UC Davis faculty members and clinicians with expertise in nutrition, cardiovascular health, hearing, vision, bone and joint problems, cardiovascular health, and other topics.

Fred Harrold and Dr. McCloud © UC Regents
Fred Harrold, a graduate and now advisor of the "Mini Medical School," discusses the program with McCloud

Prominent Sacramento businessman and avid community volunteer Fred “Fritz” Harrold of the Harrold Ford dealership is a 2009 graduate of the UC Davis Mini Medical School and now is a member of the program’s community advisory board. Harrold marvels at McCloud’s spirit and diligence in balancing a heavy patient caseload, teaching responsibilities and commitment to the community.

“Dr. McCloud’s dedication and passion for medicine are obvious. He is the constant inspiration for the Mini Medical School, which has achieved fame for its method of teaching the over-50 crowd by mixing humor with an intensive and condensed medical curriculum of issues facing our older population,” says Harrold. “Many myths and misleading medical advertisements are refuted in layman’s terms. I learned information vital to maintaining optimal health.”

McCloud’s passion for educating community members to prepare for aging, and to learn about the diseases associated with aging, originated years ago. He conducted scores of community workshops and lectures before devising the Mini Medical School concept.

He remembers one instance in 1995, while he was on a three-year sabbatical from practice that included study and research at Duke and Yale universities. He was invited to a church in Knoxville, Tenn., to give a morning talk on Alzheimer’s disease. To his great surprise, 500 individuals had packed the church sanctuary, hoping to understand this peculiar new disease which their own doctors did not seem to fully grasp. He realized that he could make a difference by making complex and at times frightening medical information understandable to the lay public.

Assemblymember Mariko Yamada“Dr. McCloud is an extraordinary physician-educator, practicing and teaching in that all-too-rare medical specialty of geriatrics. His scientific and instructional skills are surpassed only by his unique talent in engaging students of all ages through his innovative approach to healthy aging.”
— Assembly member Mariko Yamada

Since that time, McCloud has given approximately 150 invited lectures and workshops to the community, as well as to physician groups, elder law attorneys, government groups and industry. His community outreach has been the subject of several magazine and newspaper articles. His discussion with writer Gitta Morris about “practical geriatrics for an aging nation” was the subject of a Sunday New York Times half-page feature story. McCloud also appeared recently on CBS evening news in a segment on “Geriatricians: Preserving Life.”

McCloud has been honored by the Alzheimer’s Association for his board work and other contributions. The California State Senate presented him with a commendation for service to the community and for innovative program development.

Assembly member Mariko Yamada, chair of the California Assembly Committee on Aging and Long-Term Care, praises McCloud’s dedication to the health care of older populations.

“Dr. McCloud is an extraordinary physician-educator, practicing and teaching in that all-too-rare medical specialty of geriatrics. His scientific and instructional skills are surpassed only by his unique talent in engaging students of all ages through his innovative approach to healthy aging,” Yamada said. “His ability to combine health and humor has changed the course of many lives in the Sacramento region, including mine, and for that I will be eternally grateful.”

McCloud, while on the go and carrying his black bag, cheerfully answers a few questions.

Q.  Your old-fashioned black medical bag is a distinguishing characteristic. When did you begin using it?

A.  I get a lot of comments about the black bag. It has been my portable medical office for more than three decades, since I opened a private internal medicine and geriatric practice in San Francisco in 1979. It has seen me through several hundred home and convalescent hospital visits, and has been misplaced only a couple of times. I keep planning to put an identification tag on the bag, but people pretty much know it’s mine.

Q.  Isn’t longevity mostly a function of heredity?

A.  Heredity does play a role, and I advise you to be born into the right family. If you have a parent who lived beyond 90 years of age, it does add longevity. Otherwise, parental longevity is a poor predictor of your remaining years. In actuality, our lifestyle choices are a better predictor of our “health span,” or years of life free of disability and chronic illness. I’m less interested in hearing your answer to the question “Did your parents live to an old age?” than your answer to the question “Do you want French fries with that order?”

Q.  How important are diet and exercise in attaining healthy aging? How often do we need to exercise?

A.  In every laboratory animal studied, caloric restriction and increased activity added longevity. I recommend exercise and physical activity at least on the days that you eat.

Q.  Do you practice what you teach? We are walking during this conversation, aren’t we? Some of your students and residents have elected to specialize in geriatrics. How do you get them excited about caring for older adults?

A.  I let my patients do the job. They are certainly what sold me on the specialty.

Q.  Your “humor with a message” has you in demand as a speaker. Is there one take-home message you like to give?

A.  Yes. I encourage individuals to become more informed about the aging process, preventive measures and, especially, the medications they take. I know people who will pore over consumer magazines before purchasing a small appliance, but will take Mighty Mango Liver Cleanser because their daughter recommended it.

The medical bag carries on a long tradition

Dr. McCloud's medical bag © UC RegentsThe accoutrements of medical doctors these days include electronic pagers, lab coats and digital instruments. In years past, however, physicians were most readily identified by the medical bags they carried. When doctors made “house calls” to the homes of patients, they toted a medical bag to carry medical equipment and supplies. In the 19th century, physicians traveled with their leather medical bag by horse and buggy, or on horseback using medical saddlebags.

A physician’s bag typically might contain a stethoscope, blood pressure cuff, glucometer, tongue depressors, a reflex hammer, syringes, tourniquet, forceps, scalpel, scissors, cotton balls and bandages; hand cleanser and antibiotic and antibacterial drugs; and medications to treat asthma, dehydration or other potential medical emergencies.

House calls remained common through the 1950s, when the Pressman Toy Co. introduced a popular toy “doctor’s bag” containing simulated medical gear to help children feel more at ease when the family physician came calling.

Antique medical bags are highly prized among collectors. Manufacturers continue to produce medical bags made of various synthetic materials. They’re used most commonly today in rural settings and by physicians who cater to specialized needs, as Michael McCloud does.

Q.  How can people sort out reliable health information from advertising and hucksterism?

A.  There are some terrific sources of reliable and unbiased information on aging and health. The UC Berkeley Wellness Letter and the Johns Hopkins Health After 50 newsletter are two of my favorites. Three overlooked and excellent online resources are the Department of Health and Human Services’ healthfinder.gov, the National Library of Medicine’s medlineplus.gov and the American College of Physicians’ acponline.org/ patients_families websites.

Q.  Your small consultation office in the Ellison Ambulatory Care Center is well known. It is a gallery of floor-to-ceiling photographic portraits of culturally diverse elderly people. Did you photograph them yourself?

A.  All but one. The woman skydiving to celebrate her 80th birthday gave me the photo when she returned the hip protectors I lent her for the event. She signed the photograph with “I did it! Lois.”

Q. When you created the UC Davis “Mini Medical School to Prepare for Life’s Second Half,” did you anticipate such a popular program? Over the years, more than 3,000 people have enrolled.

A.  I did not anticipate such demand. In 2002, we expected about 75 attendees to a onetime series of classes and had to move to a larger venue after the first 200 individuals called for admission. For whatever reason, it struck a respondent chord. The other surprise has been the multigenerational appeal, with students ranging from their 20s to 90s.

Q.  How has the Mini Medical School program become so successful?

A.  Truthfully, it has been the commitment and passion of our extraordinary faculty, along with a team of tireless volunteers. The energy of these “true believers” brings me back every year.

Q.  How many Mini Medical School classes have you attended yourself?

A.  All 54. And I still learn something from each. The classes are too good to miss one.

Q.  You give an inspiring toast to your Mini Medical School graduates each year. How did you toast the Class of 2010?

A.  My toast was “May each of you one day reminisce about old age.”

Michael McCloud says he plans to carry that black bag for another three decades.

Learn more about the UC Davis Mini Medical School.