The Physical

-by Helen Klein

It is rather surprising that “The Physical” is not getting more attention in the media. The lack of mention in the New York Times is particularly troubling and disappointing.

Trump recently had his first annual physical by Dr. Ronny L. Jackson, Navy Rear Admiral. When I saw a brief clip of the doctor’s presentation of his findings on MSNBC, I was surprised and struck by his manner and wording, which seemed weird and veered off toward inappropriate and unprofessional. He was gushing with praise and positivity for Trump and he was rather loose with his words. This is not what Americans expect of their doctors.



Clearly, I was not the only one with this reaction. In yesterday’s editorial in the Washington Post, “Is Trump’s Doctor Okay?” Dana Milbank was “alarmed, not about the president’s health, but the doctor’s.”

Rear Adm. Ronny Jackson was so effusive in extolling the totally amazing, surpassingly marvelous, superbly stupendous and extremely awesome health of the president that the doctor sounded almost Trumpian. “The president’s overall health is excellent,” he said, repeating “excellent” eight times: “Hands down, there’s no question that he is in the excellent range... I put out in the statement that the president’s health is excellent, because his overall health is excellent... Overall, he has very, very good health. Excellent health.”

And just how excellent is His Excellency’s excellent health, doctor? “Incredible cardiac fitness,” was Dr. Jackson’s professional opinion. “He has incredible genes... He has incredibly good genes, and it’s just the way God made him.”

Really? Some of this sounds much like Trump’s own doctor, the disheveled hippie one who claimed that Trump’s health was better than any President ever. And Johnson’s comment about “his incredibly good genes” is virtually a direct quote from Trump.

Dr. Sanjay Gupta of CNN, making a rare house call to the White House briefing room, offered a second opinion. “He is taking a cholesterol-lowering medication, he has evidence of heart disease, and he’s borderline obese,” Gupta pointed out, citing Jackson’s own findings. “Can you characterize that as excellent health?”

Milbank further noted:

And not just his heart! The doctor rhapsodized about Trump’s vision, his stamina (“more energy than just about anybody”) and above all his mental acuity, which, Jackson made sure to note, he examined only “because the president asked me to.” Trump is “very sharp, and he’s very articulate... Very, very sharp, very intact... Absolutely no cognitive or mental issues whatsoever... The president did exceedingly well.”

There is definitely something not quite right here. In fact, Howard Dean, also a physician, questioned Johnson’s last statement, “absolutely no cognitive or mental issues whatsoever” when he was interviewed about his impressions on MSNBC.

Dean stated that the physical did not indicate that Trump was mentally fit for office and it was evident that Dean did not think so. He described Trump as having Narcissistic Personality Disorder, which has been zeroed in on by many professionals along with other possible categories in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the bible for psychiatrists. In fact, while not a bona fide diagnostic category, Malignant Narcissism has often been described as fitting Trump to a T. Surely it is becoming increasingly obvious that Trump is “malignant” for our country.

What is important to emphasize is that Jackson did not actually assess Trump’s cognitive or mental acuity or his psychological or language functioning: Jackson had no basis for his conclusion that Trump has “absolutely no cognitive or mental issues whatsoever.”

Dean mentioned that Trump was administered the Montreal Cognitive Assessment. What is this scale?

The Montreal Cognitive Assessment (MoCA) was designed as a rapid screening instrument for mild cognitive dysfunction. It assesses different cognitive domains: attention and concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. Time to administer the MoCA is approximately 10 minutes. The total possible score is 30 points; a score of 26 or above is considered normal.

Thus the MoCA scale is a screening instrument, a brief battery for dementia. It is by no means comprehensive and it is not a neuropsychological battery, an intelligence test or an assessment of psychological or language functioning. It is a mini mental state neuropsychological assessment tool that screens for cognitive decline. The scale uses “snippets” from various neuropsychological measures-- it does NOT provide in depth assessment of any cognitive area. While it is helpful in picking up moderate to severe dementia, it is not necessarily effective in picking up some aspects of mild dementia. An individual could have other issues related to declining cognitive functions that would not show up on the MoCA.

While Trump’s 30 out of 30 score on the MoCA doers not indicate signs of dementia, findings do not rule out the possibility of other aspects of brain function that could be problematic and revealed through further neuropsychological and medical evaluations. The test takes only ten minutes!

While Trump has been crowing about the results, claiming he did “exceedingly well,” as usual he is way off base-- not showing signs of dementia is nothing to crow about.

Furthermore, there is absolutely no basis for Jackson’s conclusion that Trump’s physical indicates he has “absolutely no cognitive or mental issues.” This is not the case as Jackson did not examine these areas at all, or are they typically assessed as part of a routine physical. Trump did not undergo intelligence testing or psychiatric evaluation, which would zero in on his fitness for office. This is a broad area of concern by the American public, many in Congress and via Wolff’s book, many in the White House.

Jackson also viewed Trump as “very articulate.” This was obviously based on his superficial impressions during their brief interaction. This description is shocking, given the many examples of Trump’s off topic ruminations, incoherent remarks, difficulty putting a full sentence together, inability to finish a thought, poor grammar and syntax and struggles with word finding. A language evaluation would certainly be another area to pursue.

More from Milbank:

Jackson has been a well-regarded doctor. But since finding himself in Trump’s orbit, he has adopted the hyperbolic style and excessive flattery of the boss that we see in other, previously respectable members of Trump’s court.

In conclusion, while Trump’s basic general health appears satisfactory, Jackson’s presentation of the findings leaves much to be desired and is alarming to many. His use of over the top superlatives was unwarranted and uncalled for. His conclusions about Trump’s mental, cognitive and language skills are well beyond that indicated from a routine physical and appear misleading, unethical, unprofessional and even untrustworthy. Unfortunately, Jackson gives the impression of being a political lackey rather than a professional doctor of medicine. This is worrisome. One wonders if there were any findings he is hiding.

By the way, this morning Dr. Jackson commented that Trump could live to be 200, a scary thought. Need I say more?

Gail Collins: "Trump took something called the Montreal Cognitive Assessment and got a perfect score. Not perhaps the highest bar possible, unless you were concerned about whether he can identify pictures of animals and draw hands on a clock."