If President Donald Trump were any other 71-year-old — covered by Medicare and having his annual wellness visit — he'd be checked on his cognitive functions and possible safety risks. But when the president goes for his physical exam Friday, the White House said his mental fitness won't be tested. And there's no guarantee that the public would find out the results of cognitive tests if Trump were to take them.
White House deputy press secretary Hogan Gidley said such tests are not part of the president’s planned physical. "He's sharp as a tack. He's a workhorse, and he demands his staff be the same way," he told reporters aboard Air Force One.
That decision concerns physicians and public health experts who say Trump should be assessed the same way as other elderly Americans, particularly given his globe-shaping job and his control of the U.S. nuclear arsenal.
"A physical tends to be exactly that — a physical," said Arthur Caplan, a bioethicist at the NYU School of Medicine. "They're not really oriented toward the big question that people want to ask about Trump: Are you mentally there? Are you cognitively able to function?"
Trump's visit to Walter Reed Medical Center, where he'll undergo his first physical as president, continues a long tradition of presidents getting semi-regular check-ups in order to reassure the public. The most recent physical exam of a president, performed in February 2016 on then-President Barack Obama, was a standard battery of measurements and blood work that revealed that Obama had "improved lean body mass" and lowered his cholesterol level since his previous exam in 2014.
But the White House is neither required to perform a regular physical exam of the president, nor required to release all of the details unless the president consents. The exam also may not include Medicare's standard battery of wellness tests, which are designed for Americans age 66 and older, and check for risks like depression and other neurological problems. When asked whether Trump would have "a psychiatric test," Gidley responded no, but declined to elaborate.
That opens a political loophole because presidents and those who seek the office have an inherent interest in keeping their most troubling medical details secret — a risk that Trump himself tried to exploit during the 2016 campaign, repeatedly questioning whether challenger Hillary Clinton had the "stamina" to serve as president. Clinton, recovering from a bout of pneumonia, had stumbled leaving a 9/11 ceremony, giving rise to conspiracy theories about her health. Presidents for decades, from Franklin D. Roosevelt to John F. Kennedy to Ronald Reagan, have hidden their own medical conditions, from partial paralysis to painkiller addiction to signs of dementia.
"The things that we'd want to know are the things, unfortunately, that people won't want to reveal," Connie Mariano, the White House physician to three presidents, told POLITICO in 2016. Mariano noted that mental illness, for instance, can be perceived as disqualifying — an issue that's emerged as lawmakers and independent psychiatrists have raised questions about Trump's mental state.
Trump is slated to be screened Friday by Ronny Jackson, the official physician to the president and Navy rear admiral who also administered physicals to Obama. Jackson, a 23-year Navy serviceman, also worked as a White House physician during the George W. Bush administration and now leads the White House Medical Unit, a round-the-clock team of specialists that are available to the president.
Trump's longtime personal doctor is Harold Bornstein, the New York City-based gastroenterologist who famously proclaimed during the 2016 presidential campaign that Trump would be "the healthiest individual ever elected to the presidency."
Caplan said that the White House's traditional decision to get screened by military personnel at Walter Reed gives a president more control than going to a private institution, such as Mayo Clinic or the Cleveland Clinic. "Remember, it's the commander in chief being examined by active military doctors. He's more in charge," Caplan said. There's also a privacy benefit with military personnel: "They know they shouldn't be blabbing to reporters" — unlike Bornstein, who's repeatedly given interviews about Trump's health.
The president's physical exam would be familiar to any American who's had an annual check-up: The physician typically measures indicators like resting heart rate and blood pressure, reviews the president's medications and draws blood for further testing. Trump's doctors have previously said that he takes a statin to control cholesterol, antibiotics for rosacea and Propecia to treat male-pattern baldness.
The presidential physical also includes a height and weight check, allowing the doctor to calculate the president's official body-mass index — an issue that could be relevant to Trump, given that his 2016 appearance on "The Dr. Oz Show" revealed he was on the verge of obesity. At 6 foot 3 inches and weighing 236 pounds, Trump had a body-mass index of 29.5 in that 2016 appearance; a measurement of 30 and over is obese.
The physical also may be tailored to a president's specific needs. Twelve specialists consulted on then-President Bill Clinton's 1999 physical, possibly given his two-year lapse since receiving a physical exam and his recovery from a 1997 knee surgery. The exam revealed that Clinton had gained eighteen pounds in two years, but remained in generally excellent health overall.
But experts have warned that the traditional physical doesn't go far enough to assess a president's mental state. Lawrence Mohr, who was a White House physician to Reagan and President George H.W. Bush, believed that presidents should be evaluated for "alertness, cognitive function, judgment, appropriate behavior, the ability to choose among options and the ability to communicate clearly," he told a researcher in 2010. That wouldn't be just a theoretical exercise; about half of all previous presidents have suffered from a known illness or injury in office.
Mohr, who died in 2013, also believed that the president should retain some right to patient privacy.
"I do feel strongly that confidentiality within the doctor-patient relationship should remain inviolate," Mohr said in a 1993 speech. "There are, however, cases of potential presidential disability in which some of that may need to be violated within the context of an established process," he added, pointing to the 25th Amendment. Under that process, a president may be formally removed from office if the vice president and a majority of the Cabinet deem him physically or mentally "unable to discharge the powers and duties of his office."
For a typical man Trump's age, any cognitive risk would likely be revealed by the Medicare annual wellness visit, which specifically screens older adults for mental impairment — although the White House said that Trump won't undergo a similar battery of tests.
At 71, Trump would be the first president to qualify for the visit — ironically, created under Obamacare in 2011 and tailored to assess Americans age 66 and older. The test is free for Medicare beneficiaries, although it's not required.
"The focus of these [Medicare] visits is thinking about what are the ways aging adults face unique risks and how we can mitigate them," said Ishani Ganguli, a Harvard Medical School primary care physician who's studied Medicare's exam and performed many herself. "In this population, I'm thinking about subtle changes in cognitive function."
For instance, physicians who treat older patients like Trump commonly administer what's called the MoCA test, which assesses an older patient's attention and concentration, executive function and other tests designed to reveal mild cognitive dysfunction. Another test known as "get up and go" measures a patient's ability to quickly stand up, sit down and walk, which can reveal possible neurological problems.
Ganguli said that regardless of what's covered in a routine presidential physical, a trained physician should tailor tests to the specific patient.
"A physical — really, any opportunity a primary care physician has to evaluate a patient — should always prompt evaluation of concerning symptoms," Ganguli said. "In Trump's case, even if the doctor wasn't doing a cognitive evaluation for routine screening, he or she would be compelled to evaluate for cognitive deficits if they had cause for concern."