Rachel Feltman: For Scientific American’s Science Quickly, I’m 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 then there’s the question of transparency: How much should the public know about a president’s health?
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’s their conversation.
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Lauren Young: Tell me how you became a physician to the president. How does one find themselves in such an important medical role?
Jeffrey Kuhlman: Like many things in life it’s 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, “Shots fired,” for President Reagan—his code sign was “Rawhide,” so: “Rawhide down”—and they had taken him to the hospital, to George Washington [University Hospital]. And that’s where they treated him like a trauma patient instead of like a VIP and saved his life.
So that was that installation in the brain of, “Hey, there’s actually doctors and nurses that take care of the president.” I didn’t think much of that. I went to college, went to medical school—the 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’s helicopter squadron in Quantico, Virginia.
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’s on those trips. And that’s when the White House physicians at the time were just extremely glad that I was taking care of everyone and said, “You’re gonna work here,” 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.
And one of the toughest things is getting the top-secret Yankee White clearance. And so that’s—you 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—luckily, I’ve lived a pretty boring life, so I didn’t 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’s ensuring continuity of the presidency to the commander in chief.
Young: Wow, what a journey. You mention that you’ve served five and a half—I think you said, right—five and a half presidents. Who’s the half [laughs]?
Kuhlman: If you read the book Transforming Presidential Healthcare, it goes through the five. So it goes through: President Clinton—I 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’re the most important person in the world, that he’s 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.
Then I was there for President George W. Bush. So he was president for eight years, and he’s the one that gave me the nickname “Leno.” So he just liked to give people nicknames. I don’t know if it’s my monologues. Some people think it might be just how I’m built—my white hair or my protruding jaw. And it just stuck, that a lot of people wouldn’t even know my name. They would just say, you know, “Doc Leno.” And it continued on with President [Barack] Obama.
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’ve 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.
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, “I don’t really need a doctor, but Michelle and the girls do, and so I’m going with you,” which I thought, you know, it’s probably the highest compliment a father can give you. And then during that time Vice President [Joe] Biden was around, so that’s who I’d call the fifth president.
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’s first term; that’s when I was around. She had some medical conditions on some of the foreign trips that we went on—she was often present—and so I rendered help to her. So that’s who I count as the half president ’cause she came pretty close in the historic election of 2016.
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’s care is not, quote, unquote, “VIP care.” Can you elaborate a little bit on that?
Kuhlman: So what I found in life is, often, those that you think have the best access to care—Michael Jackson, Steve Jobs, you know, celebrities, rock stars, ultrahigh-net-worth individuals—they have horrible access to care. They often think that they’re smarter. They don’t 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.
So the doctor’s 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’t 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: “You’re gonna be the White House doctor.” And that’s when they started calling it the White House, ’cause before that it was the Executive Mansion.
So that’s basically what we try to do, is private, secure, and what I told each president is: “For me, no politics, no policy, just trusted medical advice. Luckily, if you are red or blue as a president, luckily, you’re all the same inside, so I could take care of the biology.”
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.?
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—it helps to have a trained individual but, more importantly, start defibrillating with equipment that works and that you’ve trained with. And so that’s the number-one threat to a president of the U.S., so that’s 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.
And then the other occupational hazard is gunshot wounds, knife stabbings. So in our history, if we’ve had, you know, 47 presidents, maybe there’s 45 individuals of that 47, but four of them have been assassinated. So we are prepared anywhere in the world—the doctor and the nurse and a tactical medical officer—to basically do what I coined “care under fire,” and so it’s: 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’re gonna get us there, but we’re gonna keep the blood in the body, we’re gonna get to that trauma center, and then they’re gonna save the president’s life.
The other big difference: if you’re not the president, you just call 911 …
Young: Right.
Kuhlman: But 911 doesn’t really work when you’re traveling with the president.
The other thing that we are prepared for is—what 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.
And then if you get to the kind of the more routine: you know, they’re human, so they’re gonna have upset stomach or different basketball injuries that—maybe they get their lip cracked open or teeth broken or something.
Young: I know, too—and I’ll just chime in for the audience—I know that you mentioned that basketball injury to the lip. I think that was President Obama. Is that right [laughs]?
Kuhlman: That was …
Young: Yeah [laughs].
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, “Okay, what you got? What’s the injury?” And so he told me a, a lacerated lip and wanted to know what he should do with him. And I said, “Bring him back here to the White House.”
And so they came back to the White House. He came right in. We evaluated the injuries and sewed ’em 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’s lip.
Young: [Laughs.]
Kuhlman: And luckily, we did it right; he later took his daughters to, I think, a Georgetown basketball game.
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’s concern around a political figure’s age is actually warranted from a medical perspective?
Kuhlman: Well, I would state the obvious: age is the number-one risk factor for heart disease, it’s the number-one risk factor for cancer, and it’s the number-one risk factor for neurodegenerative conditions or cognitive decline.
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’t list any physical or mental qualifications to be president.
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’ll be 82 when he completes his second term. We have a senator who’s 91. New York Times invited me to write an essay about neurocognitive assessment. It is a fact of science, it’s not a political attack, that humans past the age of 60, [nearly] every single human starts to have cognitive decline—now, 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 ’cause you’ve just been around longer, so your vocabulary actually expands.
My opinion would be—President George W. Bush, he’s 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, “I’m younger than both of them, and I’m too old for the job,” so he knows the physically demanding part of the job.
That’s where we would benefit from neurocognitive assessment on a periodic basis. And maybe you don’t 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’s 79, he would benefit from a neurocognitive assessment. And that’s 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.
Young: So when the president shares medical information with the public, what is your role as the physician in that process?
Kuhlman: What I always told each of the presidents is: “I will do my best to respect your personal privacy and your medical privacy.” For example, the annual physical: with President Obama we were at Martha’s Vineyard the first year, and I said, “Hey, your physical’s coming up. We’re gonna do it to take advantage of you getting assessment of the proper medical [condition] of a 48-year-old male.” So we did his first colonoscopy and released that, but he said to me—we were standing by a golf cart, and he said, “I’ve learned: never lie to the American people; they’re gonna find out the truth in the end anyway.”So that was the approach that we took.
Young: Mm-hmm.
Kuhlman: So I laid out, “Here are the things that we like to assess during your physical,” 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—I was involved with some of President Bush’s, and neither of those presidents changed any words.
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’m sure, you know, there’s 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’m curious what your thoughts are on that.
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—like you’re hard of hearing; you have trouble seeing; maybe one of your body organs don’t work; you have trouble walking, ambulating—we’ve had presidents throughout history that have had all of those things. We can make reasonable accommodation, and so then those don’t become a disability to be president or to whatever office they’re holding. The only impairment that we cannot compensate for is critical decision-making, so we’ve had history of people covering that up.
Young: Mm.
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’re 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’re 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.
Young: And my last question for you: What advice would you give to the current physician to the president?
Kuhlman: I think you have a, a unique patient. There’s 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 “no politics, no policy, just trusted medical advice,” that will be what’s best for the president and best for the American people.
Young: Great, thanks so much for being on the show.
Kuhlman: Good to be with you, Lauren, and good luck.
Feltman: That’s all for today’s episode. We’ll be back on Monday with our weekly science news roundup.
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.
For Scientific American, this is Rachel Feltman. Have a great weekend!
