Donald Trump: November 2019 Physical Examination


circus-like physicals
 
For physical exams while he was a private citizen, Trump said, "Well, I try and do it every year" 1. His long-time personal physician has written: "He has had an annual physical exam in the spring of every year" 2.

As a candidate, Trump issued three statements about his medical health:

  • 2015: (December)   MORE 3 (Physician statement #1)
  • 2016: (September)  MORE 2 (Physician statement #2)
  • 2016: (September)  MORE 1 (Interviews: Dr. Oz, Fox)
Since taking office, Trump has had more-or-less yearly physical examinations at Walter Reed National Military Medical Center:
  • 2017: (January)  Takes office.
  • 2018: (January)  MORE 4 Press briefing: MORE 5
  • 2019: (February) MORE 6
  • 2019: (November) SEE BELOW 7
The main medical results from these evaluations are tabulated elsewhere MORE, and are discussed in various pages.

Comment: Incredibly, these physical examinations, which one would expect to be routine, staid affairs, took on circus-like characteristics:

  • The 2015 report had ridiculous, unprofessional hyperbole that made Trump's physician a national laughingstock. It later emerged that Trump wrote this report himself.
  • The 2018 report was delivered during a press conference in which the President's physician made good-humored and properly caveated remarks that commentators unfairly inflated to ridiculousness.
  • The first 2019 report, though more subdued (and, sadly, far less complete), still contained unsupportable prognostications from the new presidential physician.
  • The second 2019 report, for Trump's "interim checkup" if that's what it really was, is a shambles. Subtexts of the nonsensical statements from the White House and the President's physician strongly suggest it was not a routine examination at all, but a hurried, abrupt consultation at Walter Reed for undisclosed medical reasons.

Hence, three times in two years confidence in the office of the President's physician was undermined -- a low ebb in its history. Even with a perhaps unwarranted acceptance that the President's medical team has been completely and honestly forthcoming, all this sturm und drang is itself dangerous, as it can easily detract from substantive medical issues -- as it already seems to have done with Trump's sleep.



unexpected weekend hospital consultation
 
With no prior announcement, Trump was driven to Walter Reed Hospital during the afternoon of Saturday, November 16, 2019, supposedly for a routine "interim" physical examination 8. Despite reassuring statements from the White House press office and, later, from the President's physician that all was well with the President SEE BELOW, the undeniably unusual logistics of the event raised medical questions that have yet to be answered.

Here is the main problem. Officials want us to believe a series of events occurred that would have been pitched to President Trump with a conversation like this:

"Sir, we're going to take 5 hours of your day to bring you to Walter Reed for an hour of consultation, despite the fact that you'll be coming back for another multi-hour visit two months later. And, while you're at Walter Reed, we won't do any specialized evaluations, in fact we won't do anything we couldn't do at the White House. We'll even drive you so it takes longer than flying by helicopter.

"Yes, sir, we know that you really hate germs and that hospitals are filled with the worst germs there are. That's why we want to keep you there for longer than necessary, for a tour, even though discussions of medical treatments are distasteful to you and even though, if you had to make a hospital tour, you could at any time visit a military hospital overseas which is better P.R.

"Yes, sir, we know you like to play golf on weekends. But we think you'll also enjoy talking with the family of a servicemember who is physically damaged as a result of obeying orders that came from your administration. Yes, sir, we know that if the servicemember's children are there that will be a particularly difficult thing for you emotionally, but we will have plenty of Purell and hand-wipes for you after you give them an endearing touch.

"Yes, sir, we think this is the right way to handle your preventive health care. True, we are bringing you back sooner than any other President has ever been brought back for routine preventive health care, but it won't look bad and besides, you are, after all, older than all of the others were, except for that one who had Alzheimer disease. Pardon? Uh, no, sir, of course you have great genes and have nothing wrong with you like Alzheimer disease. We just think that this will keep your name in front of the public due to the fact that it won't be pre-announced and so the press will go hyper and have a reason to write stories about you on an otherwise quiet weekend. And this novel course will also give us the chance to educate the public that routine preventative care occurs continuously throughout the year, and is not just a single annual event. It's a win-win!"

So what actually did happen? Alas, we have little to go on beyond the official statement from the President's physician. This is problematic, however, because its most crucial sentences appear to be as carefully engineered as a jet engine, to sound reassuring while technically allowing great wiggle room and deniability.

From the full text of the physician's note SEE BELOW, here are the critical sentences that require careful parsing:

The President has not had any chest pain, nor was he evaluated or treated for any urgent or acute issues. Specifically, he did not undergo any specialized cardiac or neurologic evaluations.
Dr. Zebra dissects these sentences here --> SEE BELOW

The most informative question to ponder about this event is: What is available at Walter Reed that is not available at the White House medical facility?


More...
Scroll down to see the statement from the President's physician. Its two key sentences are analyzed below.

Comment: When the President's medical staff loses the confidence of the public, an analysis such as this one becomes, unfortunately, necessary. It nit-picks the statement released by the President's physician after his abrupt consultation at Walter Reed. It shows lay readers how a medically knowledgeable person could hoodwink the public while seeming to be forthcoming.
    Dr. Zebra does not accuse the physician of lying to the public. However, we should assume that the statement released by the physician is, like all White House staff releases (check out the fancy letterhead), a carefully engineered script. The statement was clearly engineered to communicate a message of "Nothing to see here, all is well, please move on." While that may indeed have been the reality of the situation, the goal on this page is to show that it need not be.
    When physicians become just another tool of the President, they damage the nation, the profession, and ultimately their patient. Physicians must have the spine to say clearly what is going on. If they are not being complete in their disclosures, then they have an obligation to say they are not being complete. The art here is to disclose enough information to the public to maintain their trust while protecting the legitimate privacy concerns of the president.

· · ·

The two key sentences of the statement are:

The President has not had any chest pain, nor was he evaluated or treated for any urgent or acute issues. Specifically, he did not undergo any specialized cardiac or neurologic evaluations.

The sentences actually do not rule out some of the most serious medical concerns if careful parsing is applied:

  • "The President has not had any chest pain"
    This is a horrible statement that attempts to say the President had no symptoms suggestive of a heart attack (myocardial infarction) or similar conditions of inadequate blood flow in the heart (cardiac ischemia):
    1. "Pain" is completely the wrong word. Few patients with cardiac ischemia complain of pain. Words like "pressure" and "squeezing" are more common. This is why physicians are taught to ask about, and report, "discomfort" rather than pain. So, the statement does not eliminate the possibility that Trump had the chest discomfort that is classic for cardiac ischemia.
    2. "Chest" is too limited. The discomfort of cardiac ischemia is not limited to the chest. People with cardiac ischemia can feel nothing in their chest but instead have discomfort in their left arm or jaw. So, the statement does not eliminate the possibility that Trump had the jaw or left arm discomfort that is classic for cardiac ischemia.
    3. The symptoms of cardiac ischemia can vary widely. For example, some people with cardiac ischemia have symptoms very similar to indigestion. As might be imagined, this is a diagnostic challenge. So, the statement does not eliminate the possibility that Trump had difficult-to-diagnose symptoms of cardiac ischemia.
  • "nor was he evaluated or treated for any urgent or acute issues"
    The words "urgent" and "acute" are slippery to the point of meaninglessness because they do not have standard definitions in the medical profession.
    1. This sadly cynical view is proven by White House comments in 2001 when then-Vice President Richard Cheney was experiencing unstable angina and underwent a coronary angioplasty -- "a non-emergency precautionary procedure" according to the White House creative writers. (Hospitals put patients with unstable angina into the coronary intensive care unit.)
    2. The phrasing also leaves open the possibility that the acute part of the illness had occurred at the White House, but had resolved before Trump arrived at Walter Reed. Examples include chest discomfort from cardiac ischemia, or a neurological deficit from a TIA, or a cardiac arrhythmia, or an acute confusional state.
    3. Though well outside common use in the medical profession, White House creative writers could take the stance that a previously diagnosed disease can never be "urgent" or "acute" because it is so long known. So a cancer diagnosed six months ago, but undisclosed to the public, could today cause a bowel obstruction or a high blood calcium level or a clot or pain or whatever, and none of this would be urgent or acute because the cancer is old news to the physicians.
  • "he did not undergo any specialized cardiac or neurologic evaluations"
    There are several slippery points here:
    1. The statement says nothing about the coronary arteries because the statement says "cardiac," not "cardiovascular." That is because, strictly speaking, "cardiac" refers to structures of the heart proper, such as valves and muscle, but not to the all-important coronary arteries located outside the heart, on its surface. Thus, the statement does not rule out the possibility of specialized testing related to the coronary arteries.
    2. The statement says nothing about the brain arteries. Similar to the "cardiovascular" note above, the statement says "neurologic," not "neurovascular" (or the more common term "cerebrovascular.")
    3. "Specialized" is not as inclusive as it seems. For example, an electrocardiogram (EKG) would not be considered specialized because they are so commonly done, even by non-cardiologists. Similarly, ultrasound examinations of any organ could be claimed as "not specialized" because many emergency room physicians now carry hand-held portable ultrasound machines to evaluate a variety of conditions. (This claim could be made even if a radiologist read the scans.) Similarly, many internists perform stress tests, so that too could be considered "non-specialized." Even consultation by a neurologist could be considered not "specialized" because all physicians learn how to perform a neurological examination on their patients.
Several other parts of the statement could be similarly analyzed (e.g. "planned interim checkup" = "Mr. President, if you develop signs of a stroke we'll plan to check up on you right away, interim most likely").


Below is the publicly-released report of President Trump's "physical examination" of November 16, 2018. Notice that the President's physician does not say that the upcoming post-New-Year's physical will disclose any more information about this event. But Dr. Zebra wearies of the chase.

Cited Sources
  1. Cillizza, Chris; Blake, Aaron. Donald Trump's interview with Dr. Oz was just as amazingly strange as we thought it would be. (Published 15 September, 2016. Downloaded on 2019-12-01.) Available on the web: https://www.washingtonpost.com/news/the-fix/wp/2016/09/15/donald-trumps-visit-with-dr-oz-was-just-as-amazing-as-you-though-it-would-be/
        

    Comment: Also includes annotations by Cillizza and Blake. Their interview transcript is archived here: MORE

  2. Bornstein, Harold N. [Public Letter]. (Published 13 Sept. 2016. Downloaded on 2019-11-30.) Available on the web: https://assets.donaldjtrump.com/DJT_Medical_Records_.pdf
        

    Comment: Dr. Bornstein became Trump's physician in 1980. Bornstein's letter is linked to by Frizell (op cit) and is archived here -->   MORE

  3. Bump, Philip. Donald Trump's doctor came down with a case of Trumpitis. (Published 26 Aug. 2016 (revision of original Dec. 2015 story). Downloaded on 2019-11-25.) Available on the web: https://www.washingtonpost.com/news/the-fix/wp/2015/12/14/donald-trumps-doctor-has-come-down-with-a-case-of-trumpitis/
        

    Comment: This articles relates to the first of Dr. Bornstein's letters, reprinted here -->   MORE

  4. Jackson, Ronny L. (M.D.). The President's Periodic Physical Exam. (Published January 16, 2018. Downloaded on 2019-11-21.) Available on the web: https://www.whitehouse.gov/wp-content/uploads/2018/01/Summary-of-Physical-Exam-for-President-Trump-12-Jan-2018.pdf
        

    Comment: The document is archived here -->   MORE. Also highly informative is the press briefing where the report was delivered: MORE.

  5. Sanders, Sarah; Jackson Ronny. Press Briefing by Press Secretary Sarah Sanders and Dr. Ronny Jackson. (Published 16 Jan. 2018. Downloaded on 2019-12-28.) Available on the web: https://www.whitehouse.gov/briefings-statements/press-briefing-by-press-secretary-sarah-sanders-and-dr-ronny-jackson-01162018/
        

    Comment: A transcript of the press briefing is archived here --> MORE

  6. Conley, Sean (D.O.). The President's Second Periodic Physical Exam. (Published February 14, 2019. Downloaded on 2019-11-25.) Available on the web: https://www.whitehouse.gov/briefings-statements/memorandum-physician-president-2/
        

    Comment: The document is archived here -->   MORE

  7. Conley, Sean (D.O.). Interim Check Up. (Published November 18, 2019. Downloaded on 2019-11-21.) Available on the web: XXXXXXXXXXXXXXXXXXXXX
        

    Comment: The document is archived here -->   MORE

  8. Olorunnipa, Toluse; Gardner, Amy. Trump's health under scrutiny again after unplanned visit to Walter Reed. (Published Nov. 18, 2019. Downloaded on 2019-12-27.) Available on the web: https://www.washingtonpost.com/politics/trumps-health-under-scrutiny-again-after-unplanned-visit-to-walter-reed/2019/11/18/f83c91a4-0a26-11ea-97ac-a7ccc8dd1ebc_story.html

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