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Article is located here: http://www.cnn.com/2018/01/13/health/tr ... index.html

I can't seem to c/p the text for this post. If someone else can do it, please do.

What it's essentially saying is that a group of doctors appealed to the White House physician to include a mental health screen as part of President annual physical. It claims that mental health screen is part of Medicare physicals for persons age 66 and older. It lists observations of President' behavior as cause for concern.

Example: Increasingly diminishing language usage. This is observable even to viewers of his old video interviews when compared to his speech and language usage today.

Here are my questions.

1. To my knowledge (with the possible exception of Medicare standards) there is no such thing as a routine physical in terms of whether or not mental health screens for dementia, for example, are part of the process. My understanding is that doctors are free to choose the nature of the annual physical, what they will evaluate and how.

2. Even if there were a valid way to pressure the White House physician to perform a simple screen for dementia, is that physician compelled to publish the results? Thinking HIPAA here.

3. Does President have the right to decline a mental health exam?

4. Finally, are these reasonable, justifiable and lawful requests?


FYI, you're hearing from someone who thinks every candidate for President should be mental health screened. But, I doubt this can be forced on a candidate, a sitting President, and even if it could become a requisite for holding office, does the American public have the right to demand disclosure of results? Article indicates that the option to disclose lies with the patient--POTUS himself.

Next series of questions.

1. President agrees to mental health eval, fails to pass, diagnosed with dementia.

2. What happens next? Is the physician legally at liberty to disclose his/her findings? To whom?

3. If the 25th amendment is going to be used, how does the mental health information get from one hand to the next in order to make the decision to go forward in relieving President of his office?

Jersey Girl wrote:Article is located here: http://www.cnn.com/2018/01/13/health/tr ... index.html

I can't seem to c/p the text for this post. If someone else can do it, please do.

What it's essentially saying is that a group of doctors appealed to the White House physician to include a mental health screen as part of President annual physical. It claims that mental health screen is part of Medicare physicals for persons age 66 and older. It lists observations of President' behavior as cause for concern.

Example: Increasingly diminishing language usage. This is observable even to viewers of his old video interviews when compared to his speech and language usage today.

Here are my questions.

1. To my knowledge (with the possible exception of Medicare standards) there is no such thing as a routine physical in terms of whether or not mental health screens for dementia, for example, are part of the process. My understanding is that doctors are free to choose the nature of the annual physical, what they will evaluate and how.

2. Even if there were a valid way to pressure the White House physician to perform a simple screen for dementia, is that physician compelled to publish the results? Thinking HIPAA here.

3. Does President have the right to decline a mental health exam?

4. Finally, are these reasonable, justifiable and lawful requests?


FYI, you're hearing from someone who thinks every candidate for President should be mental health screened. But, I doubt this can be forced on a candidate, a sitting President, and even if it could become a requisite for holding office, does the American public have the right to demand disclosure of results? Article indicates that the option to disclose lies with the patient--POTUS himself.

1. That's my understanding, too.

2. I think HIPAA would require the president's permission to disclose any Private Health Information, which I think would include mental health.

3. I don't believe that any sort of medical exam is a constitutional requirement -- I think President could decline a physical exam.

4. I think it would be reasonable to ask every president to be evaluated for mental health. It certainly wouldn't be illegal to do so. But I don't think anyone can force the president to do so.

Jersey Girl wrote:Next series of questions.

1. President agrees to mental health eval, fails to pass, diagnosed with dementia.

2. What happens next? Is the physician legally at liberty to disclose his/her findings? To whom?

3. If the 25th amendment is going to be used, how does the mental health information get from one hand to the next in order to make the decision to go forward in relieving President of his office?

1. OK.

2. Not without the patient's permission.

3. Only with the president's permission, unless he disclosed the results to a third-party not bound by HIPAA.

Medicare guidelines prompt for a very basic screen for dementia among patients above a certain age as part of the recommendations for routine physicals. I don't think it is required, but it seems standard enough in my local experience. If a problem is found there, you are then referred to a more sophisticated battery of tests.

The president probably should receive comprehensive cognitive testing, but I'm not sure what you do with that information. You can't have a process for declaring the president mentally unfit that is walled off from the political process. Even if you try to establish a nonpartisan medical board, it will just be a major political battle to determine who sits on that board. There is a ugly history since the advent of modern psychiatry of nations weaponizing doctors to declare those with disfavored political views of being mentally incompetent.

Alas, if you suspect the president is mentally unfit, then you have to remove him with the same Congressional majorities you do in the case of conviction after impeachment. It's not an ideal option, but it is a necessary one.

EAllusion wrote:Medicare guidelines prompt for a very basic screen for dementia among patients above a certain age as part of the recommendations for routine physicals. I don't think it is required, but it seems standard enough in my local experience. If a problem is found there, you are then referred to a more sophisticated battery of tests.

The president probably should receive comprehensive cognitive testing, but I'm not sure what you do with that information. You can't have a process for declaring the president mentally unfit that is walled off from the political process. Even if you try to establish a nonpartisan medical board, it will just be a major political battle to determine who sits on that board. There is a ugly history since the advent of modern psychiatry of nations weaponizing doctors to declare those with disfavored political views of being mentally incompetent.

Alas, if you suspect the president is mentally unfit, then you have to remove him with the same Congressional majorities you do in the case of conviction after impeachment. It's not an ideal option, but it is a necessary one.

Lots of folks are unfamiliar with how the 25th Amendment works. There is a procedure that allows the President to be declared unable to perform his duties as president. But all the president has to do to reverse that is to send a letter saying that he is fit. To override that, you need a vote of 2/3 of each house of Congress. To impeach requires only a majority of the House and 2/3 of the Senate. So, it's actually easier to impeach than to remove a president who doesn't want to be removed using the 25th Amendment.

Jersey Girl wrote:Article is located here: http://www.cnn.com/2018/01/13/health/tr ... index.html

I can't seem to c/p the text for this post. If someone else can do it, please do.

here is it:

(CNN) President Donald Trump is "in excellent health," White House physician, Dr. Ronny Jackson, said following his physical Friday. But it's not clear whether any mental health tests were conducted, despite urging from mental health professionals.
Jackson received an urgent letter from dozens of doctors and health professionals Thursday urging him to perform basic mental health tests on the President.

While reviews of the past five presidents' physical exams show only a brief mention of mental health and none of the records includes a readout of the mental health tests, this letter points out that mental evaluations are routine during physicals, particularly for patients who are 66 or older. Trump is 71.
Medicare guidelines suggest patients in this age range should be evaluated for cognitive and neural health function.
The White House has dismissed questions about Trump's mental fitness, calling them "disgraceful and laughable." They said, prior to the physical, that mental health testing was not something Trump would undergo. It will be up to President Trump what information he shares with the public.
The letter was written to Jackson, who examined Trump.

"Without performing an evaluation of this kind, President Trump would be receiving care that is inadequate to the standard care regularly administered to millions of Americans covered by Medicare," the letter argues. "Equally important, without this evaluation, the American people will not have a clear understanding about the health and well-being of the President, which is essential for Americans to know of any president."
While a true mental health evaluation can only happen in person, these experts have noted there is some "increasing concern" that the President may be struggling with some mental health challenges and they recommend the President's doctor screen Trump for dementia.
The letter does not explain how these concerns arose.

Problems these experts say they have observed include rambling speech; episodes of slurred speech; failure to recognize old friends; frequent repetition of the same concepts; decreased fine motor coordination; difficulties reading, listening and comprehending; suspect judgment, planning, problem solving and impulse control; and markedly declining vocabulary in recent years, with overreliance on superlatives, according to the letter.
The issue of the President's mental capacity has received significant attention in recent weeks as Michael Wolff's best-seller, "Fire and Fury," has raised concerns about the commander in chief.
Citing people close to the President, Wolff has said the President has begun repeating three stories in conversations in less than 10 minutes, when he used to repeat stories in about a 30-minute window. Wolff told CNN's Christiane Amanpour that "100% of the people around the President believes he's incapable of carrying out the duties of office."
In full damage control, Trump and the White House trashed Wolff and his book as fiction and tabloid garbage while defending the President's mental fitness.
"Actually, throughout my life, my two greatest assets have been mental stability and being, like, really smart," Trump said in a tweetstorm earlier this week. He called himself a "very stable genius."

The US Preventive Services Task Force advises doctors to look for early signs or symptoms of cognitive problems that include problems with memory or language changes.
Among the medical professionals who wrote the letter, at least 15 made contributions to Democrats, and at least two have donated to Republicans, according to FEC records; however, not all have and many are well known experts in their field, from the United States, Canada and Germany.
The letter concludes that a mental health evaluation is a must because "the health of the President relies on it -- as do American lives and the safety of our nation."

So...

No one can force President to subject himself to a mental health evaluation.

Even if he did subject himself to a mental health evaluation and failed it*...

The doctor couldn't disclose the evaluation results without consent from President.

President sure as heck isn't going to disclose the evaluation results.

So...what's the point of the docs urging the White House doc to conduct the eval?

There isn't any.

*Failed it=evidence of dementia.

Thank you Choyo Chagas for posting the text of the article!