How patient confidentiality works when politicians' doctors are asked to testify

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NPR’s Ayesha Rascoe asks Dr. Jacob Appel about whether such reports are trustworthy. NPR’s Ayesha Rascoe ask Dr. Jacob Appel about whether such reports are trustworthy.

AYESHA RASCOE, HOST:



Senate Majority Leader Mitch McConnell returned from vacation last week and had a message for his colleagues and rivals.

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MITCH MCCONNELL: Now, one particular moment of my time back home has received its fair share of attention in the press over the past week. But I assure you, August was a busy and productive month for me and my staff back in the commonwealth.

RASCOE: McConnell, who’s 81, was referring to a news conference when he appeared to freeze in place and was unable to communicate. This was the second incident of this kind to occur in the summer. Dr. Brian Monahan is the attending physician for Congress. He issued a letter to the public stating that there was no proof McConnell suffered a stroke or seizure. How honestly could Dr. Monahan speak about McConnell, given the patient confidentiality? Jacob Appel, a medical history professor at Mount Sinai Medical Center in New York joins us. Welcome to the program.

JACOB APPEL: Thank you for having me.

RASCOE: So what did you think when you heard about Dr. Monahan’s letter? What level of trust should the public place in his words?

APPEL His patient is not Americans. The public often wants to hear directly from the president’s doctor. You know, for years I covered the White House. I would be there to watch former President Obama’s physical. When Trump got his physical I sat down and asked questions like, “Does Trump seem to be a bit sniffly?” How confident can I be that the answers are accurate when the doctor is speaking to the president, and not us?

APPEL : You cannot be. I’d say that, ethically speaking, most doctors also try to be as honest with the public as they can. There’s a big difference between lying and omitting facts. It also implies that knowing the health details of a senator or president is not important. It’s not useful for the public to know that Mitch McConnell didn’t have an epileptic seizure or a stroke, or that Jimmy Carter had hemorrhoids. Plenty of impaired senators have served for many years because the level of ability you need to be a senator or the president is not just different, but it’s very distinctive from the skills that the average person needs.

RASCOE: Well, talk to me about that, because you wrote an op-ed this summer in the Hill. It’s a paper that covers Congress. You said, quote: “Information about the health of our political leaders is usually of little use to the general public.” “

APPEL: Sure. It’s hard to know what to do when you have that kind of information, even if your a doctor or expert on presidential health. What the average person can do is not very helpful. For example, knowing that Barack Obama smokes a certain number of cigarettes each day is not very useful. In 1940, people who voted on the basis of health would have chosen Wendell Willkie over Franklin Roosevelt. Wendell Willkie looked as fit as a fiddle. Roosevelt had polio, severe hypertension. Franklin Roosevelt’s health was questioned in 2020 after then-President Trump contracted COVID. The fear was that he would not survive. At the time, Trump’s White House physician said that he was doing well after being admitted to hospital. Mark Meadows, Trump’s chief-of-staff, said the exact opposite shortly after. What should take precedence if the American public wants to know but it seems like it could have geopolitical implications?

APPEL: Yeah, well, I think, in real time, in the acute moment, the American people knowing really isn’t going to affect their choices or help them in any way. We all hope that our presidents live long and healthy lives, regardless of which party they are from. But if this is not the case, we have vice presidents. You can see how the country has managed to survive many peaceful transitions of power from a president to a vice-president. It’s also important to keep in mind that we might not want to be privy to the health status of our presidents and senators, because the Chinese government or the Russian Secret Service would know about it as soon as they knew. We probably don’t want to share that information with them. His wife and doctor, according to some historians, took on the role of president. Is there a point in which the public does deserve to know what is going on health-wise with the president out of the concern that who is making the actual decisions?

APPEL: Oh, yeah. It is clear that there is a tipping-point. There have been presidents in office who were incredibly impaired, and probably too impaired to perform their duties. We have, unlike back then, a precise procedure for removing a disabled president. The 25th Amendment, the Cabinet and confirmation by Congress are all part of the process. If a president reached this point today, i’d hope that the public would be informed and that appropriate action would be taken. Thank you so much. Thank you so very much.

APPEL: Thank you for having me.

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