\n<\/p>\n
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman.<\/p>\n
Being a doctor is challenging enough, but imagine having a patient whose health has direct implications for national security and global politics. Presidential physicians face unique medical challenges, from preparing for gunshot wounds to managing the health care of someone with a grueling schedule. And then there\u2019s the question of transparency: How much should the public know about a president\u2019s health?<\/p>\n
Jeffrey Kuhlman served as physician to the president from 2009 to 2013. He also held other medical roles at the White House, like Director of the White House Medical Unit, White House Physician and Senior Medical Officer for the Marine One squadron, for more than a decade before that. His recent book Transforming Presidential Healthcare offers a rare inside look at what it takes to keep commanders in chief healthy. He recently chatted with Scientific American associate editor Lauren Young. Here\u2019s their conversation.<\/p>\n
If you’re enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today.<\/p>\n
Lauren Young: Tell me how you became a physician to the president. How does one find themselves in such an important medical role?<\/p>\n
Jeffrey Kuhlman: Like many things in life it\u2019s being in the right place at the right time. I would say it probably started a decade earlier or two. I was a high school senior, March 30, 1981, and I heard on the radio, \u201cShots fired,\u201d for President Reagan\u2014his code sign was \u201cRawhide,\u201d so: \u201cRawhide down\u201d\u2014and they had taken him to the hospital, to George Washington [University Hospital]. And that\u2019s where they treated him like a trauma patient instead of like a VIP and saved his life.<\/p>\n
So that was that installation in the brain of, \u201cHey, there\u2019s actually doctors and nurses that take care of the president.\u201d I didn\u2019t think much of that. I went to college, went to medical school\u2014the Navy paid for my way. And I had hardship tours in Pearl Harbor and in London for Naval Forces Europe, and then I found myself being assigned to the president\u2019s helicopter squadron in Quantico, Virginia.<\/p>\n
And President [Bill] Clinton, his second term, he was in a little trouble at home, so he spent lots of time going overseas, so I did 18 foreign trips that time. We take care of everyone that\u2019s on those trips. And that\u2019s when the White House physicians at the time were just extremely glad that I was taking care of everyone and said, \u201cYou\u2019re gonna work here,\u201d so they actually sent me orders. So I was kind of in the right place at the right time with the right education, the right experience and, most importantly, a supportive family.<\/p>\n
And one of the toughest things is getting the top-secret Yankee White clearance. And so that\u2019s\u2014you have unimpeded access to the president and, with that, their schedule. You can be in a room alone with them with life-and-death medications. And getting that top-secret clearance\u2014luckily, I\u2019ve lived a pretty boring life, so I didn\u2019t get into trouble. I was privileged to take care of five and a half presidents, and about a decade later I wrote a book, recently out, Transforming Presidential Healthcare, and basically, it\u2019s ensuring continuity of the presidency to the commander in chief.<\/p>\n
Young: Wow, what a journey. You mention that you\u2019ve served five and a half\u2014I think you said, right\u2014five and a half presidents. Who\u2019s the half [laughs]?<\/p>\n
Kuhlman: If you read the book Transforming Presidential Healthcare, it goes through the five. So it goes through: President Clinton\u2014I got to the White House at the tail end of his presidency, in his last months. President Clinton, even though I just met with him a couple times for, like, a minute or two, he has a presence about him that, at that moment in time, he makes you feel like you\u2019re the most important person in the world, that he\u2019s focused on you. And then when I interacted with him 10 years later he remembers your name. He remembers what you talked about. He remembers, like, the family if you brought that up. And so he has that gift of connecting with people personally.<\/p>\n
Then I was there for President George W. Bush. So he was president for eight years, and he\u2019s the one that gave me the nickname \u201cLeno.\u201d So he just liked to give people nicknames. I don\u2019t know if it\u2019s my monologues. Some people think it might be just how I\u2019m built\u2014my white hair or my protruding jaw. And it just stuck, that a lot of people wouldn\u2019t even know my name. They would just say, you know, \u201cDoc Leno.\u201d And it continued on with President [Barack] Obama.<\/p>\n
So President George H. W. Bush, former president, he was around. I took care of him, like, at Camp David, Kennebunkport, Prairie Chapel Ranch, and he was the most gracious person I\u2019ve ever met. And at Camp David he would come play volleyball with us, which is pretty good as an 80-year-old. And took care of him for a chronic problem, and a week later a handwritten letter came to my home address. So he was the third president.<\/p>\n
President Obama, when he came into office he was 47; he was a youngster. Michelle Obama was 44. They had two school-aged kids. And President Obama kind of said, \u201cI don\u2019t really need a doctor, but Michelle and the girls do, and so I\u2019m going with you,\u201d which I thought, you know, it\u2019s probably the highest compliment a father can give you. And then during that time Vice President [Joe] Biden was around, so that\u2019s who I\u2019d call the fifth president.<\/p>\n
And then also, when Hillary Clinton was first lady, we would take care of her. And when she was senator from New York, she would be taken care of by [the] Office of [the] Attending Physician of Congress. But then when she was secretary of state, during President Obama\u2019s first term; that\u2019s when I was around. She had some medical conditions on some of the foreign trips that we went on\u2014she was often present\u2014and so I rendered help to her. So that\u2019s who I count as the half president \u2019cause she came pretty close in the historic election of 2016.<\/p>\n
Young: I was reading your book, Transforming Presidential Healthcare, and you give such a fascinating inside look at White House medicine, and you talk about, like, the costs, the considerations that go into the medical care of the president. A really interesting theme that seemed to come out of the book and, you know, your work is how the president\u2019s care is not, quote, unquote, \u201cVIP care.\u201d Can you elaborate a little bit on that?<\/p>\n
Kuhlman: So what I found in life is, often, those that you think have the best access to care\u2014Michael Jackson, Steve Jobs, you know, celebrities, rock stars, ultrahigh-net-worth individuals\u2014they have horrible access to care. They often think that they\u2019re smarter. They don\u2019t have the time in their schedule. They have barriers that they put between them and others. And then they tend to be surrounded by sycophant doctors that just wanna please them. So I, I would say I would run away from VIP care, but the care that we tried to provide the president and the first family and the senior staff and, actually, anyone that works on the 18 acres is private, secure, that meets their schedule.<\/p>\n
So the doctor\u2019s office has been there since about the early 1900s. The first full-time doctor was a Navy doctor, Presley Rixey, and he had taken care of the McKinley family. And he actually wasn\u2019t at Buffalo when a president was fatally shot there; he was tending to Mrs. [Ida] McKinley, who was invalid from a seizure disorder. So when Teddy Roosevelt came in he actually made Dr. Rixey full time: \u201cYou\u2019re gonna be the White House doctor.\u201d And that\u2019s when they started calling it the White House, \u2019cause before that it was the Executive Mansion.<\/p>\n
So that\u2019s basically what we try to do, is private, secure, and what I told each president is: \u201cFor me, no politics, no policy, just trusted medical advice. Luckily, if you are red or blue as a president, luckily, you\u2019re all the same inside, so I could take care of the biology.\u201d<\/p>\n
Young: So then what would you say are the major differences in serving the general public medically versus serving the president of the U.S.?<\/p>\n
Kuhlman: So the major difference is the logistics around it. You know, the number-one threat to an adult is a out-of-hospital cardiac arrest; we know every day in the U.S. [roughly] 1,000 Americans drop dead. So if we can get an AED [automated external defibrillator] on them\u2014it helps to have a trained individual but, more importantly, start defibrillating with equipment that works and that you\u2019ve trained with. And so that\u2019s the number-one threat to a president of the U.S., so that\u2019s why the doctor is within two minutes at all times: every minute that you wait their survival drops by 10 percent. The second set of hands is a critical care nurse and he or she with equipment that, like, compliments the AED.<\/p>\n
And then the other occupational hazard is gunshot wounds, knife stabbings. So in our history, if we\u2019ve had, you know, 47 presidents, maybe there\u2019s 45 individuals of that 47, but four of them have been assassinated. So we are prepared anywhere in the world\u2014the doctor and the nurse and a tactical medical officer\u2014to basically do what I coined \u201ccare under fire,\u201d and so it\u2019s: keep the blood in the body, and get to definitive care. So get to that level-one trauma center. Know where it is. Get there by any means possible. And then knowing, with Secret Service, they\u2019re gonna get us there, but we\u2019re gonna keep the blood in the body, we\u2019re gonna get to that trauma center, and then they\u2019re gonna save the president\u2019s life.<\/p>\n
The other big difference: if you\u2019re not the president, you just call 911 …<\/p>\n
Young: Right.<\/p>\n
Kuhlman: But 911 doesn\u2019t really work when you\u2019re traveling with the president.<\/p>\n
The other thing that we are prepared for is\u2014what I laid out in Transforming Presidential Healthcare is asymmetrical threats, so think about chemical, biologic attacks. So knowing how to prevent them, knowing how to diagnose them, knowing how to treat them.<\/p>\n
And then if you get to the kind of the more routine: you know, they\u2019re human, so they\u2019re gonna have upset stomach or different basketball injuries that\u2014maybe they get their lip cracked open or teeth broken or something.<\/p>\n
Young: I know, too\u2014and I\u2019ll just chime in for the audience\u2014I know that you mentioned that basketball injury to the lip. I think that was President Obama. Is that right [laughs]?<\/p>\n
Kuhlman: That was …<\/p>\n
Young: Yeah [laughs].<\/p>\n
Kuhlman: So it was, actually, on Black Friday, the day after Thanksgiving, and I actually happened to be at the White House evaluating other family members of the first family. And at the time the Air Force doctor, Dr. [Jeffrey] Kueter, he was over covering President Obama, and he called me, and he had never called me from a site before, and I said, \u201cOkay, what you got? What\u2019s the injury?\u201d And so he told me a, a lacerated lip and wanted to know what he should do with him. And I said, \u201cBring him back here to the White House.\u201d<\/p>\n
And so they came back to the White House. He came right in. We evaluated the injuries and sewed \u2019em up and gave him the typical ice pack and anti-inflammatory pain medication. And I probably had 100 people contact me that day telling me why they were the experts in the world to sew up somebody\u2019s lip.<\/p>\n
Young: [Laughs.]<\/p>\n
Kuhlman: And luckily, we did it right; he later took his daughters to, I think, a Georgetown basketball game.<\/p>\n
Young: I feel like you have to be ready for absolutely anything that gets thrown at you in this position. One thing you mentioned: you brought up age. How much of the public\u2019s concern around a political figure\u2019s age is actually warranted from a medical perspective?<\/p>\n
Kuhlman: Well, I would state the obvious: age is the number-one risk factor for heart disease, it\u2019s the number-one risk factor for cancer, and it\u2019s the number-one risk factor for neurodegenerative conditions or cognitive decline.<\/p>\n
So when I look back at history James Madison was 36 years old when he submitted his final draft of the Constitution; he was the lead author. And, you know, the first president, George Washington, he was considered an elder statesman, and he was president from age 57 to 65. And then when he left office he died a year and a half later. During the late 1700s very few of them lived to age 60. So when the Constitution was written it doesn\u2019t list any physical or mental qualifications to be president.<\/p>\n
I think that age is important. We have a gerontocracy. We have the oldest person ever elected to be president as the current president, and he\u2019ll be 82 when he completes his second term. We have a senator who\u2019s 91. New York Times invited me to write an essay about neurocognitive assessment. It is a fact of science, it\u2019s not a political attack, that humans past the age of 60, [nearly] every single human starts to have cognitive decline\u2014now, some people faster than others, but every single human past the age of 60 they start to have decline with memory, reasoning, speed of processing, spatial visualization. Those are the four parts of cognitive decline. The fifth one, vocabulary, is interesting; they actually stay the same or some actually increase a little bit \u2019cause you\u2019ve just been around longer, so your vocabulary actually expands.<\/p>\n
My opinion would be\u2014President George W. Bush, he\u2019s probably the fittest president in history. He was in the top 2 percent [in] cardiovascular fitness. He could run three miles in [about] 18 and a half minutes during his first term. And when it was President Biden against former President Trump, he famously said, \u201cI\u2019m younger than both of them, and I\u2019m too old for the job,\u201d so he knows the physically demanding part of the job.<\/p>\n
That\u2019s where we would benefit from neurocognitive assessment on a periodic basis. And maybe you don\u2019t release every result to the public, but you at least give it to the president, their family, the doctors taking care of them, so that you can see over time. The current president, who\u2019s 79, he would benefit from a neurocognitive assessment. And that\u2019s testing that does memory, reasoning, speed of processing, spatial visualization. So it just needs to be [a] more comprehensive assessment for these senior citizens that are in elected positions of great decision-making in the world.<\/p>\n
Young: So when the president shares medical information with the public, what is your role as the physician in that process?<\/p>\n
Kuhlman: What I always told each of the presidents is: \u201cI will do my best to respect your personal privacy and your medical privacy.\u201d For example, the annual physical: with President Obama we were at Martha\u2019s Vineyard the first year, and I said, \u201cHey, your physical\u2019s coming up. We\u2019re gonna do it to take advantage of you getting assessment of the proper medical [condition] of a 48-year-old male.\u201d So we did his first colonoscopy and released that, but he said to me\u2014we were standing by a golf cart, and he said, \u201cI\u2019ve learned: never lie to the American people; they\u2019re gonna find out the truth in the end anyway.\u201dSo that was the approach that we took.<\/p>\n
Young: Mm-hmm.<\/p>\n
Kuhlman: So I laid out, \u201cHere are the things that we like to assess during your physical,\u201d and the report that I wrote up, I did submit it to him and submitted it to the press secretary at the time, and they both read through it, and they did not change one word. And then same thing\u2014I was involved with some of President Bush\u2019s, and neither of those presidents changed any words.<\/p>\n
Young: Right. When is it beneficial for a president or, you know, any political leader, to be transparent about a medical diagnosis? On the one hand, I\u2019m sure, you know, there\u2019s circumstances in which, you know, a leader opens up about a condition, it could bring positive awareness to it. On the flip side, it opens the person up to criticism. I\u2019m curious what your thoughts are on that.<\/p>\n
Kuhlman: I think it comes down to: Can you do the job? And so how I would assess that is: if you have an impairment\u2014like you\u2019re hard of hearing; you have trouble seeing; maybe one of your body organs don\u2019t work; you have trouble walking, ambulating\u2014we\u2019ve had presidents throughout history that have had all of those things. We can make reasonable accommodation, and so then those don\u2019t become a disability to be president or to whatever office they\u2019re holding. The only impairment that we cannot compensate for is critical decision-making, so we\u2019ve had history of people covering that up.<\/p>\n
Young: Mm.<\/p>\n
Kuhlman: So Woodrow Wilson had a massive stroke, he stayed up in his bedroom for months, and it was covered up by his wife, and it was covered up by his doctor, Cary Grayson, who had introduced the two of them. And so Cary Grayson was that young, dashing lieutenant doctor that all of a sudden became a rear admiral because of his friendship with President Wilson. So if you\u2019re the physician to the president and you cross the line into that personal friendship, you have a fiduciary duty not just to the president that you\u2019re taking care of but also to the American people. And some historians would say, you know, World War II grew out of some of the problems from that.<\/p>\n
Young: And my last question for you: What advice would you give to the current physician to the president?<\/p>\n
Kuhlman: I think you have a, a unique patient. There\u2019s a famous saying in history that, you know, if you have yourself as your doctor, then you have a fool not only as the doctor, but as the patient. So Dr. [Sean] Barbabella, I think if he sticks to \u201cno politics, no policy, just trusted medical advice,\u201d that will be what\u2019s best for the president and best for the American people.<\/p>\n
Young: Great, thanks so much for being on the show.<\/p>\n
Kuhlman: Good to be with you, Lauren, and good luck.<\/p>\n
Feltman: That\u2019s all for today\u2019s episode. We\u2019ll be back on Monday with our weekly science news roundup.<\/p>\n
Science Quickly is produced by me, Rachel Feltman, along with Fonda Mwangi and Jeff DelViscio. This episode was co-hosted by Lauren Young and edited by Alex Sugiura. Shayna Posses and Aaron Shattuck fact-check our show. Our theme music was composed by Dominic Smith. Subscribe to Scientific American for more up-to-date and in-depth science news.<\/p>\n
For Scientific American, this is Rachel Feltman. Have a great weekend!<\/p>\n","protected":false},"excerpt":{"rendered":"
Rachel Feltman: For Scientific American\u2019s Science Quickly, I\u2019m Rachel Feltman. Being a doctor is challenging enough, but imagine having a patient whose health has direct implications for national security and global politics. Presidential physicians face unique medical challenges, from preparing for gunshot wounds to managing the health care of someone with a grueling schedule. And<\/p>\n","protected":false},"author":1,"featured_media":27186,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[58],"tags":[165,5821,37,3140,3888],"class_list":{"0":"post-27185","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-science","8":"tag-care","9":"tag-challenges","10":"tag-health","11":"tag-medical","12":"tag-presidential"},"_links":{"self":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/27185","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27185"}],"version-history":[{"count":0,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/posts\/27185\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=\/wp\/v2\/media\/27186"}],"wp:attachment":[{"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27185"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27185"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/naijaglobalnews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27185"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}