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Dr. Pate’s Prescription for Change

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Lessons Learned from Reviewing the Health Records of the Presidential Candidates

By Dr. David C. Pate, News and Community
September 20, 2016

Along with millions of Americans, I have been watching the back and forth regarding the health of the presidential candidates.

Before the dustup, I hadn’t given the matter much thought. Maybe, as a physician, I should have. After all, it’s my vote and my tax dollars, quite literally, that are on the line. It’s a more serious matter than I think most of us have believed.

Here’s why.

I. The public has a right to know.

The public has a vested interest in knowing with reasonable certainty that the candidate they wish to support is likely to be physically able to carry out the responsibilities of the office for the term of the office.

Donald Trump and Hillary Clinton would be the oldest and the second-oldest, respectively, to assume the responsibilities of the presidency if elected. Even they agree that the public has a right to know about their health. But both candidates have expressed reluctance to be fully transparent with their medical information.

II. Just how much information should be released?

If the interest is as I stated – to know with reasonable certainty that the candidate is likely to be physically able to carry out the responsibilities of the office for the term of their office – then the answer is that it is less information than is in their complete medical record.

For example, whether a candidate had an appendectomy or cholecystectomy in the past, a bout of seasonal allergies or an episode of sinusitis is not helpful in determining the likelihood that a candidate will be healthy and will survive the term of office.

On the other hand, a past history of melanoma, such as in candidate Sen. John McCain’s case, is relevant to that determination. McCain released 1,173 pages of medical records to reporters and permitted them to interview his doctors.

I think most would agree that candidates should be able to have some degree of privacy when it comes to their medical records and medical history.

Again, those items that impact future health and longevity are fair game, but do we really need to know details that are intensely personal – e.g., past weights or body mass ratios, a benign abnormality on a mammogram or information relating to sexual health or functioning? I don’t believe so.

III. How should the public come to have the pertinent medical information?

Donald Trump released his medical information on a television medical show. Hillary Clinton released a letter from her doctor following a scare during which she nearly collapsed. John McCain released more than a thousand pages of actual medical records.

None of these seem ideal. In the first case, Dr. Oz was presented with a letter from Donald Trump’s doctor on live television and had no time to prepare for a discussion. Dr. Oz did not have the benefit of seeing the actual medical records.

With Clinton, a letter from her doctor was posted on her campaign website.

But letters from doctors often put the doctor in a precarious position. We physicians are protective of our patients and their information. We are unlikely to express concerns that we may have, other than to the patient, if those concerns have not already manifested themselves.

In a public letter, we are always going to try to present our patients in the best possible light. There is much that the actual medical records would tell other physicians that would perhaps not come across in a summary letter prepared for the public’s eyes.

And in these current examples, we see variation in just what information is released in the public letters from the two candidates’ physicians. For example, Trump’s physician released his height and weight. Clinton’s doctor did not.

On the other hand, in McCain’s case, voluminous medical records were released to reporters, many of whom were not conversant in medical jargon and conventions.

So, what would be a better way? We all might be better served if the medical records of the candidates were turned over to a panel of physicians removed from the politics who could issue the relevant health information without political influence. The panel could review the medical records and distill what information would be pertinent in clear, understandable language. This would strike the proper balance of protecting the candidate’s privacy and satisfying the public’s right to know pertinent information.

IV. Both candidates are physically qualified for the job.

Based upon what we know at this point, there is no reason to disqualify either candidate for office. Neither appears to be at significantly increased risk for the two leading causes of death in this age group – cardiovascular disease and cancer.

Clinton has a history of recurrent deep venous thrombosis (blood clots) that probably does put her at somewhat increased risk for another one with prolonged flights, though I suspect that with Air Force One, she would be able to get up and stretch her legs, and she is on an anticoagulant (blood thinner).

Both candidates have had some testing done that is unexplained, but in each case, was normal. We have been told that Clinton had a breast ultrasound, even though her mammogram was reported to be normal, and that Trump had an echocardiogram, even though his physical exam and EKG were normal.

My diagnosis? Each is healthy enough, but it appears that both candidates have had low-value/no-value healthcare services such as I have written about before on this blog, services that only contribute to healthcare costs – something for each to consider as they determine where to take healthcare reform from here, should he or she be elected.

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.