President Donald Trump is fit for duty - medically, mentally, cognitively, psychologically, emotionally, physically and otherwise. In quite frankly the most transparent briefing on presidential health in recent memory, White House physician Rear Adm. Ronny Jackson confirmed this at a press conference yesterday whose Q&A portion lasted nearly an hour when he released a verbal and formally written medical assessment that reflects a thorough, comprehensive evaluation.
Dressed in his official U.S. Navy military uniform, Jackson made clear the President insisted on full disclosure, "He said, 'I want you to get out there and I want you to talk to them and I want you to answer every single question they have.' " He was told Press Secretary Sarah Sanders was to give him the podium for however long it took. His earnest manner and matter-of-fact, honorable nature was quite the match for a relentless press. Fixated on the fodder that has overtaken media coverage on the issue, attendees asked repeatedly and in every permutation many of the same questions with a skew and emphasis on the following topics: mental fitness, cognitive function, weight, diet and exercise. Jackson, who has provided care for administrations of each political party over many years, responded clearly, openly, decisively and in exhaustive depth and detail.
What does the report tell us
The report tells us that the President received a thorough overall assessment of health and each organ system, which I will momentarily discuss. It affirms that the experienced Dr. Jackson has, based on this week's evaluation, no concerns over this president's capacity to perform his current job now and for the remainder of his tenure in the role. The latter portion of that statement is a natural extension for inclusion when formally assessing medical fitness for president. As is also customary, it is written in a consistent manner to Dr. Jackson's language used in prior statements, like this one he released addressing President Barack Obama's 2016 health: click here. All standard stuff in the field of medical practice.
The exam involved proper and pertinent physical evaluation, diagnostic testing and consultations based on age-appropriate protocols, the personal and family history of the patient and investigation of the faculties necessary to perform the role of President.
On review of the physical exam by systems which included results of studies performed, we learned the following pertinent positives and negatives:
- Low risk for stroke, heart attacks, cardiovascular events: normal blood pressure/heart rate, auscultation of carotid arteries normal, no abdominal masses, normal heart rhythm on electrocardiogram (EKG), had favorable Transthoracic Echocardiogram, Exercise Stress Test showed "above average exercise capacity," no signs of heart failure
- No signs of cancer: no anemia, normal complete blood count (no signs of blood cancers), no enlarged lymph nodes found, no blood in urine (normal urinalysis), normal thyroid, "genitourinary exam normal" implies no testicular/prostate findings (low PSA and has many years of comparison data), no skin findings, no signs of lung nodules or masses, normal liver (normal colonoscopy 2013, not indicated this year - due at next year's exam), normal ear/nose throat
- No focal neurological exam deficits or global findings, normal fundoscopic exam (e.g. no signs of brain tumors, neurodegenerative disease)
- No cognitive deficits on preliminary and more comprehensive screening (see next section). No signs of dementia.
- No signs of diabetes. No signs of liver, kidney, heart, bladder, GI disease. No signs of pulmonary disease (low dose CT scan done and normal, normal exam).
- Hypercholesterolemia (on cholesterol-lowering medicine, Crestor, for his history with elevated cholesterol): Total cholesterol 223, LDL 143.
- Trump is current and up-to-date with all recommended preventive screening tests and exams, including vaccines (this includes flu shot & travel ones). He got Prevnar 13 (to prevent pneumococcal pneumonia) and Twinrix (to prevent Hepatitis A/B) on Friday.
What did the doctor's verbal statements confirm
The statements of the doctor mainly served to underscore how capable and appropriate it is that he is the one tasked to discern President Trump's fitness for duty. In addition to his four-plus hour examination on Friday, Dr. Jackson detailed how for the last year he sees the president daily, often repeatedly throughout a day (e.g. three times) and experiences significant verbal exchanges, protracted conversations and interactions. Throughout this period, he has repeatedly been available to address any concerns or manage routine viruses (e.g. colds) and jet lag preventive measures, for example. Standard stuff for this and any president. He often is the first and last person to see the President given the proximity of his office location. Dr. Jackson's encounters extend well beyond the confines of the White House. He and his team travel with the president. No matter the time zone or the hour, circumstance or stressful scenario, Dr. Jackson enjoys continuous, dynamic access to the Commander-in-Chief and is able to monitor his health and responses amidst calm and crisis. He is engaged with family members (e.g. First Lady, daughter Ivanka) to garner an even more complete picture of well-being and determine ways to improve things like diet. He stated involving the spouse of any president is pretty common-- as it is in routine medical practice.
Of the pertinent findings he addressed:
- He has no concerns with the President's cognitive abilities or mental health. His personal observations of the last year and direct evaluation of President Trump (along with lack of any familial or staff concerns and negative outcomes on screening tools and questioning) ruled out any need to proceed further in standard algorithms. His decision to perform a more extensive test of cognition for which the president received a perfect score (30/30 on Montreal Cognitive Assessment) went above and beyond what he would have done --and what was even indicated by his preliminary assessment --had the president not personally requested it be performed.
- There are no acute worries.
- Because there was a time constraint to get all the testing done, a hearing test was deferred and will be performed for completeness. This can happen any day from the office within the White House.
- He has the president's consent to become more involved in optimizing his diet and starting a routine exercise program for the goal of around a 10-15 lbs. weight loss in the next year. They discussed getting more fats and carbohydrates out of his diet.
- President Trump's overall health is excellent. His lifelong abstinence to alcohol and smoking has served him well.
- He will adjust his cholesterol medicine with a slight increase to get his LDL down to further lower his cardiac risk.
Let's debunk some narratives in the public sphere
Dr. Jackson expressly stated the President does not wear dentures, partial or otherwise. Intense internet and media speculation over this mounted after an isolated public appearance of the president showed him needing water after some apparent, but limited runs of muffled speech. Jackson attributed that one appearance to having given the president a hefty dose of Sudafed --which is a decongestant that can be overly drying.
Psychologists and psychiatrists - who have never met or treated the president - have been making spurious claims in the public sphere regarding his cognitive ability and mental fitness.
Dr. Jackson was firm that he would not engage in such "tabloid psychiatry." When asked in the press conference about a psychologist or psychiatrist's input, Dr. Jackson spoke of the extensive litany of access he has to specialists both military and civilian at Walter Reed and beyond should he deem them necessary. He firmly refutes any need. He reiterated that he, given he is the quarterback of the team and President Trump's primary care physician who sees him every single day, is more than suited for the task. This notion put out into the public sphere proclaiming that Trump won't have a specific psychiatric assessment is a misleading one. The role of the primary care physician is to be an expert diagnostician which includes the capacity to discern mental and psychological pathology and should there be any concern in this realm then such an act of consulting psychiatry would be implemented. When asked repeatedly about the topic, Dr. Jackson answered consistently and authoritatively that he has no concerns over this aspect of President Trump's health and well-being.
He is classified as being in "excellent" health despite an affinity for hamburgers and fried chicken and an apparent aversion to exercise. The weight listed is just shy of being categorized as obese, coincidence or would doctor fudge number? Why didn't he calculate BMI (body mass index) or check abdominal circumference?
Let's parse this running narrative. First, I extensively address how medical language or medical speak is different from what the public might use as a description. See In Medicine, Words Matter (And Not In The Ways You Might Think) where I go into greater detail about when a doctor concludes someone is in "excellent" health and what that means in medicine. In summary, from our perspective, which includes treating patients with life-threatening to terminal conditions, for a routine periodic examination when cancer, heart disease and the like are ruled out we use the go-to term someone's condition is "excellent" or "very good." It is standard and one doctor might have a predilection for a particular term, but their individual consistent use is what is most relevant (look no further than the public releases of this doctor to appreciate this holds true).
Second, it is not the job of a physician to pass judgment on a patient or their life choices. Our role is to facilitate their good health and well-being, empower them with helpful information while retaining their autonomy and intervene in matters with their consent to avoid progression of disease or avoidance of it. As per the president's penchant for an unhealthy diet and lack of exercise, there is certainly room for improvement. Given his expressed desire to Dr. Jackson to make some strides in this arena, the doc is involving a nutritionist, in particular to work with the White House chef on meal preparation, and will be implementing an aerobic exercise regimen that is gentle on the joints with a goal of 10-15 lbs weight loss in the next year. He has also invoked the help of the First Lady, which is pretty routine in presidential history.
Third, as per labels of "overweight" or "obese," none of that changes the clinical picture or a patient's management. The President and his physician recognize an area of improvement and are implementing a plan to change it. This notion of a "perfect" test like BMI or abdominal circumference serves nothing but political expediency which medicine should be immune to and would not alter the current plan already in place or clarify any aspect of his known evaluation. The importance of BMI has been garnering less favor in recent years anyway. But, the data is readily available in his report so anyone can calculate it. What is more meaningful is the impact of such a diet and frame on the president's actual health. To date, he has no signs of diabetes (his testing has been negative) and his cardiac health is favorable with a good family history. So, as stated by his physician, he has been blessed by good genes and a very uniquely high energy and stamina:
"It's called genetics...I told the president if he had eaten healthier over the last 25 years, he might live to be 200."
For example, some people have significant family history of heart attacks in the 20s or 30s and such a diet would be an even greater risk for those populations. Though the president's preference is for fast food, that is not what health professionals would advise him or anyone. With respect to this issue, frequency matters too with the goal being a mostly healthy diet.
Life and truly living it has risks and it comes down often to how much risk we each can tolerate. Everyone has a vice, some are healthier than others. The fact President Trump has fully abstained from alcohol and smoking (especially cigarettes) throughout his life has served him very well. Where President Obama demonstrated a healthy lifestyle with respect to routine exercise, well-balanced eating and consistent maintenance of weight, smoking posed a challenge. Throughout presidential history it is clear each leader had a unique default--some more or less healthy than others-- to manage the stress of the job. Dr. Jackson added that this president has an uncanny ability to reset each morning no matter the situation. This bodes well in coping with stress.
Fourth, the president is an avid golfer. Though not the same as being a dedicated treadmill or elliptical user, there is walking in golf which is a positive benefit (depending on how much a person uses the cart) and the activity's role in relaxation from stress.
Fifth, maligning the integrity of this doctor by putting forth the idea he would "fudge" anything is a baseless assault, in general, and given his decorated and dedicated record of service is way off the mark. In addition, Dr. Jackson went into great depth about his obligation (and the staff's) and what the trajectory would be should he ever have concerns about a President possessing the appropriate mental faculties for the job (see the video, link included at beginning of article).
As per Dr. Jackson, "All clinical data indicates that the President is very healthy and that he will remain so for the duration of his Presidency."