With Ronny Jackson out as chief White House doctor, Trump needs an independent medical evaluation

In light of new allegations against Dr. Ronny Jackson, we must ask, looking back, how credible was Jackson’s January report on the President’s physical? And going forward, can America trust a doctor beholden to the President to tell us the truth about his mental, cognitive and physical health?

Former subordinates described Jackson as “unethical” and “dishonest,” with a “kiss up and kick down” management style. If we needed evidence of these accusations, we need look no farther than his press conference early this year on the President’s health.

Like many loyal Trump staffers, Jackson was fulsome in his praise of Trump, opining about his marvelous genes and distorting the truth to protect his boss. He waxed poetic about his “excellent heart health,” when the lab numbers showed something closer to heart disease. And the President apparently grew an extra inch from his previously reported 6’2″, which allowed him to miss the cut off for obesity by half a pound.

But most important of all were Jackson’s misleading comments about the President’s mental and cognitive health…..

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Trump’s troubling behavior raises questions his medical exam didn’t answer

On the face of it, President Trump doesn’t seem like a paragon of health. He’s 71, sedentary and borderline obese, with high cholesterol and a high fat diet. Despite this, through the blessing of “good genes,” says Rear Adm. Ronny Jackson, the White House doctor, Trump is in “excellent health” and would more than likely be healthy straight through a second term.

Jackson’s fulsome praise for Trump’s health, including his “cardiac health,” generated widespread skepticism — and it was not limited to Trump’s physical condition. His account of Trump’s cognitive health was misleading as well, leaving the impression that all cognitive problems have been ruled out.

On one hand, we sincerely appreciate that Jackson gave the president a Montreal Cognitive Assessment test (MoCA), as we requested in a letter sent to him by 70 mental health professionals. We have now established the precedent that when enough concerns arise, presidential physicians can be expected to take a closer look at brain function.

But it is important to be clear on what we now know and don’t know about the president’s mental fitness. Jackson portrayed the Montreal Cognitive Assessment as a grueling comprehensive battery. “We picked one of the ones that was a little bit more involved, it was longer.  It was the more difficult one of all of them. It took significantly longer to complete, but the president did exceedingly well on it,” he said.

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Would the Air Force Let Airman Trump Near a Nuclear Weapon?

As a psychiatrist for the United States Air Force, one of my responsibilities was evaluating the mental stability of airmen who handled nuclear weapons, using the standards laid out in what is called the Nuclear Personnel Reliability Program. There is no need to justify why our military would take every precaution necessary to ensure that the men and women in uniform handling nuclear weapons were fit to do so, whether they were in charge of a missile silo or loading nuclear bombs onto aircraft — or giving the orders to them, on up the chain of command. Strangely, the commander-in-chief, the one who would decide when and how to use those weapons, is the only individual in the chain who is not subject to the ongoing certification under the program.

According to the program, or P.R.P., personnel who handle nuclear weapons are held to higher standards of physical and mental readiness than other personnel, and rightfully so. The Department of Defense Directive 5210.42 states: “Only those personnel who have demonstrated the highest degree of individual reliability for allegiance, trustworthiness, conduct, behavior, and responsibility shall be allowed to perform duties associated with nuclear weapons, and they shall be continuously evaluated for adherence to P.R.P. standards.”

On Tuesday the White House physician, Rear Admiral Ronny Jackson, gave the president a clean bill of health. And no doubt, by many standards, Mr. Trump is in decent shape. But the standards for a person’s physical and mental health are a different matter from his fitness to oversee our nuclear arsenal. What if President Trump were, instead, Airman Trump, and was to be assessed under the program’s guidelines; would I certify him as “P.R.P. ready” to work in the vicinity of nuclear weapons?

I have not had the opportunity to examine the president personally, but warning signs abound. What if I had reliable outside information that Airman Trump displayed erratic emotions? That I saw very clearly that he was engaging in cyberbullying on Twitter? That he had repeatedly made untruthful or highly distorted statements? That his language implied he engaged in sexually abusive behavior? That he appeared paranoid about being surveilled or persecuted by others, that he frequently disregarded or violated the rights of others?

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Why Trump needs a cognitive exam

Last Thursday, we sent a letter signed by more than 70 mental health professionals — psychiatrists, psychologists and others — urging Rear Admiral Ronny Jackson, the White House physician, to include a cognitive examination during his medical evaluation of the President.

Over the past year, we as well as other mental health professionals have grown increasingly concerned over the President’s behavior. On a near daily basis, President Trump publicly displays erratic emotional states, exhibits suspect judgment, and appears to struggle with impulse control, all while he rambles and often has difficulty completing a thought.

The President’s speech patterns are increasingly repetitive, fragmented, devoid of content and restricted in vocabulary, and his overuse of superlatives suggests reduced verbal fluency. This evidences a marked deterioration when compared to his previous level of verbal functioning, suggesting the possibility of an organically based process of cognitive deterioration.

We are not alone in our concern regarding Trump’s cognitive well-being. A majority of Americans see the President’s mental fitness as a legitimate concern. Providing any specific neurological or psychiatric diagnoses “from afar” is an ethical violation of our unique professions. However, it is not a violation of our profession to inform the public of our observations and urge action to evaluate these issues and thereby safeguard the American people. In fact, we believe it is our duty to do so….

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Dozens of experts urge doctor to examine Trump’s neurological health during physical

A group of more than 70 psychologists, psychiatrists and mental health professionals sent a letter to President Donald Trump’s physician on Thursday, imploring him to include an evaluation of the president’s neurological health in a physical examination scheduled for Friday.

The White House has said tests of mental fitness will not be part of the president’s physical. Press secretary Sarah Huckabee Sanders said on Thursday that the physician, Rear Adm. Ronny Jackson, would issue a statement following the exam and answer questions from the media next week.

A president’s cognitive functions are not typically tested during a physical, though such tests are advised for people Trump’s age — 71 — during annual checkups.

The letter comes amid questions about the president’s mental state following the recent publication of Michael Wolff’s tell-all book, which describes Trump’s erratic behavior and quotes top officials questioning his competence on the record.

Steven Buser, a psychiatrist and a signatory on the letter, formerly served in the Air Force, where he conducted psychiatric exams on airmen, including those tasked with duties involving the nuclear arsenal. That background has fueled his concern, he said.

“My biggest concern has really been the whole nuclear threat,” said Buser, who co-edited the book, “A Clear and Present Danger: Narcissism in the Era of Donald Trump.”

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