George W. Bush had seasonal allergic rhinitis — hay fever. Barack Obama had tendinitis in his left knee. Bush the elder had a sebaceous cyst drained from his third finger. Jimmy Carter: severe hemorrhoids. Donald Trump? His vitamin D is a touch low.
If he were my patient — I’m a primary care physician — I might have him take a supplement. He isn’t my patient, though. So why am I musing about his vitamin D at all? Why am I spending any time thinking about this most likely minimally significant test result in someone who is not my patient?
Because reading about the president’s physical exam results feels like privileged information about a larger-than-life figure, and because I can’t help but try to read between the lines. But the memos the White House puts out after such exams don’t really give us any useful information as citizens. It’s time to stop sharing the results of the president’s annual physical.
For years, presidents and their retinues managed to keep many serious health issues secret: Woodrow Wilson’s strokes, John F. Kennedy’s Addison’s disease and amphetamine use, Franklin Roosevelt’s polio and congestive heart failure. Nowadays, the public expects more transparency. The unofficial tradition of the White House doctor providing a report on the president’s physical exam stretches back at least to Gerald Ford’s physical in 1975, and the last four presidents before Trump each underwent at least four periodic exams during their time in office.
Even as they offer tantalizing bits of information, though, the content of these presidential health reports leaves a lot to be desired. After last year’s presidential health memo was released by Trump’s then-White House personal physician, Dr. Ronny L. Jackson, cardiologists and other doctors pounced on Trump’s LDL cholesterol (over goal) and coronary calcium scores (moderately elevated but of unclear significance), kicking up a flurry of debate about what might be concluded, or not, about Trump’s heart health. Trump’s physical this year is scheduled for Friday.
Is the purpose of releasing these reports simply a means to placate a public with a deep interest in their leader’s health, some of whom may be hoping for intimate or even salacious details? Or is it that the reports might provide an insight into the president’s mind and actions?
I’ve performed a lot of annual physicals over the last 20 years. Primary care doctors cover every aspect of a person’s health, from top to toe. We measure, among other things, height and weight and blood pressure; we review medications, check in about smoking, drinking, and recreational drugs; carry out a thorough physical exam; schedule appropriate screening tests; discuss healthy behaviors; and more. The process is a mechanism to assess health risks and how to lessen them.
But while it’s all well and good to play medical detective with tidbits from the president’s annual physical exam report, it’s highly unlikely that some critical detail will just happen to be slipped in. That’s because what I’m reading is at least two degrees removed from the actual patient-doctor encounter. It’s been filtered by the White House doctor and, I assume, combed through by the boss himself. A president’s medical record is not public information, so each chief executive gets to decide which details and how much (if any) he is going to reveal.
And thus the memo, more than likely, is a watered-down summary with a strong infusion of medical jargon. As seems to be the case with other presidential health memos, there’s the inevitable highlighting of mild conditions that are part and parcel of comprehensive physical examinations: for instance, Carter’s hemorrhoids. Presumably, every word has been carefully reviewed by doctor and patient, if not by a few other staff from the White House Medical Unit.
That’s why I’d like to see an end to the public release of the president’s periodic health report.
To be sure, any medical condition that would preclude the president from fulfilling his duty is a news story. A news release about such a diagnosis would be appropriate in the case of an acute and serious illness or injury, or if the president is about to undergo surgery or a procedure that involves some sedation. Any of those could interfere with his ability to govern.
Still, that’s not the type of information that’s revealed in a periodic health exam report. And while it’s understandably reassuring to the public to have an annual exam detail a picture of rosy health, that report can ultimately only provide a false reassurance, because we just don’t know the whole story.
Is it better to have something revealed than nothing? No — both because there may be an inaccurate expectation that such reports are full and complete, and also because citizens and journalists alike inevitably make assumptions and draw conclusions from incomplete information.
Of course, if the president has a major health issue, we all must know. But let’s leave the vitamin D, hemorrhoids and cholesterol out of the picture. The general public needs to check out from the president’s checkup.