President Biden just received his annual physical exam. Like everything else in today’s world the result was engulfed in political controversy. I do not want to do anything but state a few simple facts about the exam and its reception.
The President is 80 years old, young by comparison to this author. Virtually all American citizens are eligible for Medicare. Medicare requires that all recipients receive a cognitive test at the time of their annual medical examination. Such a test does not have to be the detailed 30 question test that was said to be given to President Trump. The tests of cognition usually administered at present are typically done by a nurse and consist of a combination of the following :
- What day of the week is it?
- What time is it?
- What year is it?
- Subtract by sevens from 100
- Repeat a phrase or combination of words after a brief interval
- What medications are you taking?
- Draw a clock that shows 2 o’clock (anytime will do)
The medical report makes no mention of any cognitive test. If none was done the President of the United States is not receiving the standard of care required in the evaluation of all Medicare patients. If it were performed, its omission likely was not because of a medical issue. BTW, I always did the cognitive test myself, feeling it too important to be done by anyone else.
The above is not a complete list, but it does cover the most commonly used tests of mental status. Another screening test for dementia is gait. I always observed my elderly patients walking up and down a hallway. An impaired gait may correlate with dementia. The President’s gait is noticeably different from normal. His physician says he has “significant spinal arthritis and the impact of a broken foot and neuropathy in his feet that changed how he walks. The President’s gait remains stiff, but has not worsened since last year.”
Another finding that seems to escape comment by the media, including the physicians employed by them, is the president’s persistent atrial fibrillation. As it is not due to valvular heart disease, the most common cause is hypertension. Atrial fibrillation is associated with an increased risk of heart failure, dementia, and stroke. There are a variety of treatments used to lower risk. He is taking the anticoagulant apixaban. Such treatment reduces, but does not eliminate, the risk of stroke. The most common side effect of the drug, obviously, is bleeding. He also receives rosuvastatin to lower blood cholesterol.
The medical report (it’s appended below) reveals the status of an 80 year old man with heart disease and osteoarthritis among other conditions common to the old. Whether this constitutes a clean bill, of health I’ll leave it to the reader. Similarly the report’s concluding sentence “President Biden remains a healthy, vigorous, 80-year-old male, who is fit to successfully execute the duties of the Presidency, to include those as Chief Executive, Head of State and Commander in Chief”, might seem to some beyond the purview of a family physician or indeed beyond that of any doctor. Ultimately the President’s ability to lead will be determined by fate or the voters.
