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Doctor-Patient Confidentiality When the Patient Is the President

WASHINGTON, DC - AUGUST 05: U.S. President Donald Trump speaks during a news conference in the James Brady Press Briefing Room of the White House on August 5, 2020 in Washington, DC. Trump administration officials and Democratic Congressional leaders continue to negotiate on an extension of the unemployment benefits and an additional coronavirus economic stabilization and relief package.  (Photo by Alex Wong/Getty Images)
By Richard Dahl on October 08, 2020 10:41 AM

The Hippocratic oath requires that doctors keep patient information confidential.

But what happens when the patient who is encountering a serious, possibly life-threatening, medical situation is the president of the United States?

After President Donald Trump reported to the world via Twitter on Oct. 2 that he had contracted COVID-19, the information from his doctors about his condition has been erratic and contradictory.

In one sense, this is understandable. The Hippocratic oath states, “Whatever I see or hear in the lives of my patients … which ought not to be spoken of outside, I will keep secret."

The problem, though, is that middle part, “which ought not to be spoken of outside." It's important to realize that the Hippocratic oath is an ethical pledge and not a law. So, when the patient is the arguable leader of the free world, ought not the public have a right to know what is going on?

The Impact of Presidential Medical Disclosures

Over the last century or so, there's evidence that many presidents haven't thought so. The public knew little about Woodrow Wilson's stroke, Grover Cleveland's cancer, Franklin D. Roosevelt's paralysis, or John F. Kennedy's Addison's disease.

Presidential administrations are usually motivated to cover up troublesome medical developments because there can be negative repercussions. Among other potential impacts, presidential health shocks have the power to send the stock market plunging, which is what happened on Oct. 2.

Three days later, however, the Dow had its best day since mid-July, finishing up 1.7%. At least in large part, the resurgence of the stock market that Monday was because Trump had begun tweeting and announcing that he intended to leave Walter Reed Hospital that very evening.

There's nothing the stock market hates more than uncertainty, and the episode of Trump's infection with COVID-19 is the latest example.

The Unpredictability of COVID-19

But are we really certain about Trump's health? Even though Trump tweeted “I feel better than I did 20 years ago," medical professionals warn that COVID-19 can have widely varied impacts on people, including the possibility that an infected person can quickly take a turn for the worse.

It's worth keeping in mind that this is what happened with British Prime Minister Boris Johnson. Johnson reportedly had “mild" symptoms after being infected in late March, but after 11 days he needed to be treated in a hospital intensive-care unit, where he remained for a week. He later tweeted his thanks to the National Health Service, saying the NHS “saved my life, no question." For a day or two, “things could have gone either way," he said.

Initially, Johnson enjoyed a political polling bounce after leaving the hospital. However, as Bloomberg News opinion writer Therese Raphael noted on Oct. 3, his public standing has been declining and there are now concerns about lingering effects from COVID-19: “(H)is demeanor since his return has sometimes seemed more subdued, his grasp of policy poor and his speech less commanding."

Covering Up For the President

At least at the start, when we were told Trump had “mild symptoms," it sounded a lot like Johnson's experience. Then, a few hours later came the troubling news that he was being airlifted to Walter Reed Hospital.

The next day, Trump's doctors assembled outside Walter Reed for a press briefing led by White House physician Dr. Sean Conley, who, the New York Times reported, “made it sound like the president had popped out for a weekend spa getaway."

Following the briefing, however, White House Chief of Staff Mark Meadows gave a far less cheery report, saying, “The president's vitals over the last 24 hours were very concerning and the next 48 hours will be critical in terms of his care. We're still not on a clear path to a full recovery."

It came to light that Trump had a high fever and required supplemental oxygen. He was treated with a variety of measures, including steroids and an experimental antibody treatment.

The next day, the medical team provided another briefing. While Conley provided a bit more detail, he remained elusive. He did confess a bit about his sunny description of Trump's health the previous day, saying, “I was trying to reflect the upbeat attitude that the team, the president, his course of illness has had."

Trump, His Doctor, and 'Patient Confidentiality'

Although presidents and their inner circles like to keep things hush-hush on the medical front, shouldn't that reticence change once the cat is out of the bag? If so, why isn't Dr. Conley and his medical team providing clear information to a public that wants it?

According to the New York Times, it's because the concept of patient confidentiality between Trump and Dr. Conley is a bit different from the one you have with your doctor.

Trump is not only Dr. Conley's patient. He is Dr. Conley's boss. Conley is a military doctor in the U.S. Navy and Trump is the commander in chief.

The Times reported that Trump, like most presidents, chose a military doctor as his physician because they are considered most trustworthy in protecting closely guarded medical information.

This means that if Dr. Conley does not follow the wishes of the commander in chief, he could be committing insubordination, one of the military's most serious offenses and one that could result in dishonorable discharge. Maybe he'd like to be more truthful; but maybe he's just following orders like a good soldier.

In other words, Dr. Conley has a difficult job. He must follow the orders of a notoriously demanding and mercurial boss while still trying to communicate his boss's medical condition as best he can.

It's probably safe to say that he is not the first doctor to find himself in this position with a president. But there is one thing that sets him apart from the others. All those other presidents had conditions that were theirs, and theirs alone. With Conley's boss, the illness is the same that has killed more than 210,00 Americans to date and threatens to kill far more as winter approaches.

The American people are more than just curious or concerned about the president's health. They have a personal stake in knowing because they are endangered by the same virus that infected him. They want straight information – not phony assurances.

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