By Catherine M. Mullaly
September 15, 2016
If you’re having surgery today, you’ll meet me, or one of my colleagues — an anesthesiologist in blue scrubs. I will put you to sleep, monitor your vital signs like a hawk, keep you pain-free, and, when the operation is over, return you to consciousness as if nothing had ever happened.
First, you trust me because of the credentials “MD Anesthesiologist” you see spelled out on my hospital badge. Second, you trust me because of what you don’t see. Long before we met, my health record was checked for you. Like coffee grounds in a French press, my medical history and medical record were squeezed through review boards to make sure that I am fit to safely care for you.
When I applied for a state medical license, every month of my life since medical school had to be accounted for. Hospital credentialing was equally rigorous. I answered batteries of questions about my health, including grilling on communicable diseases, drug and alcohol use, and motor vehicle violations beyond the usual parking tickets. My immunizations were confirmed with blood tests and official laboratory reports.
Certain queries became routine like, “Are you fit and able to perform the duties of your profession?” —yes — and “Is there any reason that would prohibit you from fulfilling your duties?” — no. Once in practice, random urine testing for drugs also became routine. All of this licensing and credentialing gets repeated every one to two years.
As much as I appreciate the trust you have in my health, it is in your best interest that someone else drilled deep into it for objective, independent, evidence-based truth.
Our next president and commander in chief deserves equivalent medical scrutiny. The safety of the nation will be in his or her hands.
Presidential candidates Donald Trump and Hillary Clinton are battling it out on the field of real and perceived nondisclosure of their medical records. Trump is under fire for revealing only nonspecific health commentary. And although Clinton has disclosed very specific health details, including an MRI-diagnosed blood clot (specifically a right transverse sinus venous thrombosis) after a December 2012 fall, she is being criticized for late disclosure of her current pneumonia diagnosis and treatment.
On Wednesday, Dr. Lisa Bardack, Clinton’s doctor and chair of internal medicine at CareMount Medical in New York, released a full update on her patient’s health, including objective CT data that showed a diagnosis of a “small right middle-lobe pneumonia” in Clinton’s lung, and a “coronary [heart] calcium score [that] was again zero,” indicating low cardiovascular risk.
To use a football metaphor, in this medical record disclosure contest, Clinton just scored a touchdown while Trump is still in the locker room.
Voters don’t need to know every detail about a presidential candidate’s health. But they should expect certain, specific, and objective medical record disclosures from all candidates as they march toward November’s electoral reckoning. The most important questions and disclosures relate to the brain and heart, past and present. Does the candidate have normal cognitive and executive functions? Is the candidate’s heart up to the physical demands of the job?
Ill health should by no means disqualify a candidate. But persistent nondisclosure of a presidential candidate’s medical records matters for two key reasons: uncertainty and distraction.
Uncertainty. Disclosures matter because they eliminate the uncertainty in not knowing about a candidate’s health. The president of the United States of America presides over the largest economy and military in the world. Market stability and international security depend on that predictable leadership. Uncertainty, real or perceived, in a president’s health may be seen as weakness on the international stage and an opportunity to exploit or attack.
What remains in the campaign is uncertainty over Trump’s medical record and current health. (Perhaps his appearance Thursday afternoon on “The Dr. Oz Show” will change that.) What is confirmed are daily prescriptions for aspirin and a cholesterol-reducing statin.
Does Trump have significant heart or blood vessel disease? Has he ever completed an exercise stress test or other imaging to rule out clogged arteries in his heart? Does his past medical history include outpatient angioplasties to clear out clogged vessels with daily aspirin needed thereafter for ongoing care? Without medical record disclosures, such questions and uncertainty remain.
Distraction error. Not disclosing medical records also matters because both candidates, and both campaigns, now spin in their own self-induced “distraction errors.” This important concept, taught to anesthesia residents, emerged from a horrific plane crash.
On Dec. 29, 1972, Eastern Airlines Flight 401 left John F. Kennedy International Airport in New York for Miami. It never reached its destination. Instead, the plane crashed in the Florida Everglades. During the flight, the captain and pilot fixated on a malfunctioning cockpit landing gear indicator light and failed to recognize the plane was losing altitude. They lost “situational awareness,” and 101 people died in what was surely a preventable crash.
In simulated crisis management, we teach anesthesia residents to recognize these distraction errors every day: when the most life-threatening diagnosis in a patient’s care may be delayed or missed because of a clinical distraction elsewhere.
The campaigns have lost situational awareness. Around-the-clock reporting on the candidates’ health and medical record nondisclosures has distracted attention from the substance of the presidential race. It has diverted the spotlight from pressing policy matters that truly need direction from the candidates, such as poverty in America, gendered economic inequality, the humanitarian crises inside Syria, cyber attacks on major US institutions, the ongoing nuclear ambitions of North Korea, and much more.
As individuals, our right to health privacy should be strongly protected. But it would be a mistake to project this expectation of privacy onto presidential candidates. American presidential candidates are not private citizens. They are in line to become public servants, responsible for the economic and physical well-being of over 323 million people, including you.
Looking out over the current presidential race, what I see is the equivalent of a fibrillating heart — plenty of furious but uncoordinated movement in the field but with no actual blood being pumped to the body politic.
We need to defibrillate the current national discourse. A credible, and equal, medical record disclosure from Trump would help jump-start the conversation. And then, to quote a campaign slogan from Winston Churchill, “Onward.”
Published September 15, 2016
Catherine M. Mullaly, MD, is a Massachusetts-based anesthesiologist, global health physician, writer, and journalist.
Catherine M. Mullaly can be reached at firstname.lastname@example.org
Follow Catherine on Twitter @MullalyMD