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How patient confidentiality works when politicians' doctors are asked to testify


Senate Majority Leader Mitch McConnell returned from vacation last week and had a message for his colleagues and rivals.


MITCH MCCONNELL: Now, one particular moment of my time back home has received its fair share of attention in the press over the past week. But I assure you, August was a busy and productive month for me and my staff back in the commonwealth.

RASCOE: McConnell, who's 81, was referring to a news conference when he appeared to freeze in place and was unable to communicate. It was the second time this summer that happened. The attending physician of Congress, Dr. Brian Monahan, issued a public letter declaring there was no evidence McConnell had a seizure or stroke. But how honestly could Dr. Monahan talk about McConnell given patient confidentiality? Jacob Appel is a medical historian at Mount Sinai medical center in New York and joins us now. Welcome to the program.

JACOB APPEL: Thank you for having me.

RASCOE: So what did you think when you heard about Dr. Monahan's letter? How much trust should the public have in what he said?

APPEL: Well, I think the public should know that the primary job for Dr. Monahan is to serve his patients, and his patient is Senator McConnell. His patient is not the American public. So Dr. Monahan is following both medical confidentiality ethics rules, and Senator McConnell is protected by HIPAA, a law that many of us are familiar with that protects the privacy of all of us.

RASCOE: Oftentimes, the public will want to hear from, say, the president's physician. You know, I covered the White House for many years, so I would sit there when they - when, you know, former President Obama, when his, you know, physical would come out. And then when Trump had his physical, I sat there and, you know, would ask questions about how, you know, Trump seemed to have the sniffles a lot and things of that nature. But how confident can I be about the validity of the answers when the physician is answering to the president and not to us?

APPEL: You can't be. I mean, I would say that most physicians ethically also try to be candid with the public to the degree they can. So there's a difference between lying overtly and omitting information. But it also suggests that it's not very important whether we know the details of a president or a senior senator's health information. The vast majority of information we learn, whether it's that Jimmy Carter has hemorrhoids or that Mitch McConnell presumably didn't have a stroke or a seizure, isn't useful information for the public to make decisions on. Plenty of impaired senators have served for many years because the level of ability you need to be a senator or the president is not just different, but it's very distinctive from the skills that the average person needs.

RASCOE: Well, talk to me about that, because you wrote an op-ed this summer in the Hill. You know, it's a newspaper that covers Congress. And you said that, quote, "information about our political leaders' health is generally of minimal use to the public."

APPEL: Sure. Well, the first thing I point out is it's very hard to figure out what to do with that information even if you're a physician or an expert in presidential health. So what the average layperson can do, knowing how many cigarettes, for example, that Barack Obama smokes each day, isn't very useful.

But more importantly, if you were to choose to vote for the healthier candidate, often you'd actually get a less healthy senator or a less healthy president in the medium term, because who we are today and who we are five years down the line is very different. People who voted based on health would have voted for Wendell Willkie rather than Franklin Roosevelt in 1940. Wendell Willkie was fit as a fiddle. Roosevelt had polio, severe hypertension. Four years later, Wendell Weekley was dead as a doornail, and Franklin Roosevelt was just fine.

RASCOE: This idea of the health of the president came up in 2020 because then-President Trump caught COVID. There was a lot of concern about what was going to happen, whether he was going to make it. The White House physician at the time said that Trump was doing very well after being hospitalized. But then directly afterwards, Trump's chief of staff, Mark Meadows, basically said the opposite. What should take precedence if the American public wants to know but it seems like it could have geopolitical implications?

APPEL: Yeah, well, I think, in real time, in the acute moment, the American people knowing really isn't going to affect their choices or help them in any way. And although we all hope our presidents, no matter which party they belong to, live and stay healthy, if they don't, that's why we have a vice president. And you can look at the many times when there's been a peaceful succession to a vice president and the country has survived just fine. The other thing that's important to remember is, we may not want to know the health of our presidents or our senators because anything we know, the Chinese government and the Russian Secret Service will know as soon as we know it, if not sooner. And that's information that, probably, we don't want them to have.

RASCOE: But what about, you know, something like Woodrow Wilson, who was nearly paralyzed after a stroke? Some historians say his wife and doctor essentially took over the duties of president. Is there a point in which the public does deserve to know what is going on health-wise with the president out of the concern that who is making the actual decisions?

APPEL: Oh, yeah. There clearly is a tipping point. And there have been some presidents who were extraordinarily impaired in office, probably too impaired to do the job. That being said, we, unlike then, now have a very precise mechanism for removing a president who is disabled. There is a process that involves the 25th Amendment and the cabinet and confirmation by the Congress. And if a president ever reached that point today, I'd like to think that action would be taken and the public would know. It's more intermittent health problems or minor scares that generate lots of storm and fury, but really don't signify very much.

RASCOE: Jacob Appel is a bioethicist and medical historian at Mount Sinai. Thank you so very much.

APPEL: Thank you for having me.

(SOUNDBITE OF THE BAR-KAYS' "KNUCKLEHEAD") Transcript provided by NPR, Copyright NPR.

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Scott Simon is one of America's most admired writers and broadcasters. He is the host of Weekend Edition Saturday and is one of the hosts of NPR's morning news podcast Up First. He has reported from all fifty states, five continents, and ten wars, from El Salvador to Sarajevo to Afghanistan and Iraq. His books have chronicled character and characters, in war and peace, sports and art, tragedy and comedy.
Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.