The Role of the Presidential Physician
Dr. Kuhlman served as physician to five and a half presidents (Clinton, George W. Bush, George H. W. Bush, Obama, Vice President Biden, and “half president” Hillary Clinton as Secretary of State).
Path to the Role: His interest was sparked by the 1981 assassination attempt on President Reagan. He was a Navy doctor assigned to the president’s helicopter squadron, which led to an assignment at the White House due to his quality of care for staff on foreign trips.
Clearance and Access: The role requires a top-secret “Yankee White” clearance, granting unimpeded access to the president and their schedule for life-and-death medical situations.
The White House Medical Unit: The office has existed since the early 1900s, with the first full-time doctor appointed by Teddy Roosevelt.
Motto: Kuhlman’s approach with each president was: “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.”
Presidential Healthcare is Not “VIP Care”
Kuhlman argues that celebrity and high-net-worth individuals often have poor access to care due to self-imposed barriers, lack of time, and sycophantic doctors. The goal of presidential healthcare is:
Private and Secure: Providing care that is confidential, safe, and accommodates the president’s schedule.
Patient-Focused: Treating the president like a trauma patient (as with Reagan) rather than a VIP.
Major Differences in Presidential Medical Service
The care for a president differs from general public care primarily due to logistics and specific occupational hazards:
Immediate Response: The doctor is within two minutes of the president at all times to address the number-one threat to an adult: out-of-hospital cardiac arrest. A doctor, critical care nurse, and specialized equipment (including an AED) are constantly prepared.
Trauma Preparedness: Due to the history of presidential assassinations, the team is prepared for gunshot wounds and knife stabbings anywhere in the world. This involves “care under fire” to control bleeding and secure transport to a Level-One trauma center.
No 911: Standard emergency services are not an option when traveling with the president.
Asymmetrical Threats: Preparation is necessary for chemical and biological attacks, covering prevention, diagnosis, and treatment.
Routine Ailments: They also treat routine issues, such as colds, upset stomachs, and injuries (e.g., President Obama’s lacerated lip from basketball).
Age, Transparency, and Fitness
Age as a Risk Factor: Age is the number-one risk factor for heart disease, cancer, and neurodegenerative conditions/cognitive decline (memory, reasoning, speed of processing, and spatial visualization). Vocabulary is the only cognitive area that remains or increases with age.
Neurocognitive Assessment: Kuhlman suggests that periodic neurocognitive assessment would be beneficial for senior citizens in positions of great decision-making, though the results may not all be released to the public.
Transparency: A president should be transparent about medical information if it impairs their ability to do the job. Historically, impairments like trouble seeing or walking have been reasonably accommodated.
The Critical Line: The only impairment that cannot be compensated for is the inability for critical decision-making. A doctor has a fiduciary duty to both the president and the American people, and crossing into personal friendship can lead to the cover-up of conditions, as happened with President Woodrow Wilson’s massive stroke.
Advice to Current Physician: Stick to “no politics, no policy, just trusted medical advice.”
