Instead of reassurance, Donald Trump's doctor delivers large dose of confusion, say experts

Bethesda, Maryland: When Dr Sean P Conley confessed that he had misled the public Saturday about President Donald Trump’s treatment for COVID-19 to reflect the “upbeat attitude” of the White House, he lost credibility with many colleagues in the medical world. “The briefing was a spin doctor, not a medical doctor,” Dr Carlos del Rio, an infectious disease expert at Emory University in Atlanta, said in an interview on Sunday. Over a busy weekend of medical briefings, the public has been looking to Conley — a navy commander and doctor of osteopathy who has been the White House physician since 2018 — for reassurance about Trump’s condition. Instead, experts say, Conley has delivered confusion and obfuscation. On Saturday, he ducked questions about whether Trump had been on oxygen, then revealed Sunday that indeed, the president had been on oxygen — an indicator that Trump’s illness may be classified as “severe.” On Sunday, he was similarly evasive, sidestepping questions about whether the president’s X-rays revealed any lung damage or pneumonia. “I’m not going to get into specifics of his care,” he said. Caring for any president presents a unique set of challenges. Like all doctors, Conley is bound by the Hippocratic oath to respect his patient’s wishes for privacy and to keep secret that which “ought not to be spoken of outside.” He is also a navy officer caring for the commander-in-chief, whose orders he is obliged to follow. But all of that must be balanced against the public’s right to have information about the health of the leader of the free world. And this particular leader, Trump, is well-known for not wanting to look weak. “I wouldn’t want to be in that position,” said Dr Stephen Thomas, a retired Army doctor who is now the chief of infectious diseases at SUNY Upstate Medical University and a columnist for Forbes. “I have sympathy for the guy. Think of it. He may have to tell one of the most powerful people in the world, ‘No, you’re not doing that,’ or ‘That’s not a good idea.’” Conley is supervising a team of medical experts at Walter Reed National Military Medical Centre, including Dr Sean Dooley, a pulmonologist, as well as an outside expert, Dr Brian Garibaldi, the director of the biocontainment unit at Johns Hopkins Hospital in Baltimore. To the surprise of many in medicine, one doctor not being consulted is Dr Anthony S Fauci, one of the world’s leading experts on infectious diseases. (Fauci is on the White House coronavirus task force, but he was sidelined when his statements of fact about the virus irritated the president.) “I tried to put myself in his place, and I would have had a ground rule with all of the people who surround the president,” said Dr William Schaffner, an infectious disease expert at Vanderbilt University. “I would have said: ‘We have a statement that we are going to put out and then I am going to be asked questions, and I’m going to answer the questions straight. If you are uncomfortable with that please have your press office to the briefing.’” This is not Conley’s first brush with controversy. In May, after the president announced that he was taking hydroxychloroquine, an anti-malaria drug that Trump was promoting without evidence as a way to prevent coronavirus infection, Conley released a letter in which he said he had “concluded the potential benefit from treatment outweighed the relative risks.” He later said the president had completed the treatment “safely and without side effects.” And in November, Conley found himself in the awkward position of explaining a highly unusual unannounced visit the president made to Walter Reed. Without disclosing details, he denied speculation that the president had chest pain or some other acute problem, adding that Trump “did not undergo any specialised cardiac or neurologic evaluations.” Conley, a Pennsylvania native who received his medical degree from the Philadelphia College of Osteopathic Medicine in 2006, is a decorated navy commander who served in Afghanistan. He was named the acting White House physician in March 2018 after Dr Ronny L Jackson was nominated to be the secretary of the veterans affairs. (Jackson, who withdrew from consideration amid allegations of inappropriate workplace behaviour, is now running for a House seat in Texas.) In May 2018, Trump appointed him to be the White House physician, a position created by Congress in 1928, although the White House has employed doctors at least since the late 1800s. The job involves caring for the president, the vice president and their families, and supervising the White House medical unit — a group of health professionals who travel with the president and are on duty at all times to provide for his care. It is ordinarily a low-profile job. One exception was in 1981, when then-president Ronald Reagan was shot and taken to George Washington University Hospital. Dr Daniel Ruge, the White House physician at the time, drew praise for insisting that Reagan be treated by the hospital’s trauma team, rather than taking charge himself.

On Sunday, Conley obfuscated. When asked about the president’s X-rays and lung function, he said the tests showed “some expected findings, but nothing of any major clinical concern.”

It was not a lie, experts said, but it was not exactly truthful either, especially given that the doctor said Trump was taking dexamethasone, a steroid that can have harmful effects on the immune system and is recommended only for coronavirus patients who are seriously ill. “He didn’t say the chest X-ray was normal,” said Dr Ezekiel Emanuel, a bioethicist at the University of Pennsylvania. “He said ‘what is expected,’ and mostly we expect serious damage in the lungs from COVID. And I assume that’s what they saw, since they started the dexamethasone.” Dr Rajesh Gandhi, an infectious disease physician at Massachusetts General Hospital and Harvard Medical School who is also a member of the National Institutes of Health’s COVID-19 Treatment Guidelines Panel, said that, both as a medical doctor and as a citizen, he would have liked to know what Trump’s X-rays or lung imaging showed. “I think the more information that can be provided the better because that helps us not speculate,” he said. Among experts, there is a debate about what, precisely, Conley is obligated to tell the public. Many say that Conley’s duty to protect Trump’s privacy is paramount, and supersedes his responsibility to the public. Del Rio — who based on Conley’s statements believes Trump can be classified as having “severe” COVID-19 — disagrees. “This is the President of the United States. This is a public figure. I think the American people have a right to know,” he said. “There’s no patient confidentiality here. You need to say what needs to be said, but we know that the president doesn’t like to look weak. I’m sure the president doesn’t like the name Trump next to ‘severe disease.’” No matter what Conley says or does not say, his colleagues in medicine agree on one thing: If he is going to put himself in the position of answering questions about the president’s care, he has to answer truthfully and to the fullest extent possible. “You can’t both wear the white coat and lie, evade, obfuscate the situation,” Emanuel said, “because you are using the white coat to give yourself credibility.” Sheryl Gay Stolberg c.2020 The New York Times Company