⬅ Donald Trump: November 2019 Physical Examination

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 sham exam part 1
• 2020: (June)     MORE 8 sham exam part 2

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.
• The 2020 report was no report at all, except for confirming with painful clarity the degree to which the White House physician is a patsy of his President. Worse, with a presidential election occurring less than five months later, the results of this physical examination will be the only recent medical data available to the electorate when they vote.

Hence, four times in three years confidence in the office of the President's physician was undermined -- a low ebb in its history. Even if one credulously believes 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.

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 9. 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) and prompted much speculation (including from Dr. Zebra MORE).

Eight months later, questions about Tump's health arose after he visited West Point. In response, the White House released a summary of his physical, including a statement that the physical had been completed at the White House. Trump, however, later stated that the November visit to Walter Reed was the conclusion of his physical. 10 Specific refutations of much of the earlier medical speculation were also released 11 12.

On the heels of this, a Pulitzer Prize-winning reporter from the New York Times reported in a book 13a that

In reporting for this book, I learned that in the hours leading up to Trump’s trip to the hospital, word went out in the West Wing for the vice president to be on standby to take over the powers of the presidency temporarily if Trump had to undergo a procedure that would have required him to be anesthetized. Pence never assumed the powers of the presidency, and the reason for Trump's trip to the doctor remains a mystery.

Asked about this, Pence said he didn't recall being told to be on standby 14 -- a rather incredible statement 15.

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.