Lessons From a Former White House Doctor w/ Dr. Jeffrey Kuhlman

Photos of President Trump's bruised hands prompted a rare public medical update, but what really happens behind closed doors when a President's Health is at stake?

Dr. Jeffrey Kuhlman, former physician to President Obama and Chief Quality and Safety Officer at AdventHealth, joins hosts John Driscoll and David Williams to explore the tension between patient privacy and public trust, the need for cognitive testing in aging leaders, and how principles of presidential medicine can improve care for everyone.

🎙️⚕️ABOUT DR. JEFFREY KUHLMAN

Dr. Jeffrey Kuhlman is Senior Vice President and Chief Quality and Safety Officer for AdventHealth. Before joining AdventHealth, he served for 30 years as a Navy Physician, spending 16 years with the President and the White House as Physician to the President, Director of the White House Medical Unit, White House Physician, and Senior Flight Surgeon for Marine One. Dr. Kuhlman is triple board-certified in Aerospace, Family, and Occupational Medicine. He is board-certified in medical management, was awarded a certificate in traveler’s health, and holds credentials as a Certified Professional in Patient Safety and a Certified Physician Executive.



🎙️⚕️ABOUT CARETALK

CareTalk is a weekly podcast that provides an incisive, no B.S. view of the US healthcare industry. Join co-hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they debate the latest in US healthcare news, business and policy.


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Transcript

David: 0:00

Photos of President Trump's bruised hands prompted a rare public medical update, but what really happens behind closed doors when a President's Health is at stake? Welcome to Care Talk America's home for incisive debate about healthcare, business, and policy. I'm David Williams, president of Health Business Group.

John: 0:25

And I'm John Driscoll, the chairman of UConn Health.

David: 0:28

Our guest today is Dr. Jeffrey Kuhlman, sometimes referred to as Leno by certain presidents. He's former physician to President Barack Obama and he's author of Transforming Presidential Healthcare, which offers a rare insider's. Look at the protocols, politics, and people behind White House Medicine. Dr. Kuhlman, welcome to Care Talk. good to be with you

John: 0:47

both. And, Dr. Kuhlman, maybe we should sort of expand on David's, David's use of what another president had called you. Maybe tell us a little bit about the anecdote with, president Bush.

Dr. Jeffrey Kuhlman: 1:00

Sure. So I was, a White House physician from 2000 to 2013. So the last little bit of, president Clinton, he traveled a lot. The second term, he was kind of in, in trouble at home a little bit, so always tried to cement his legacy, with President Bush. I was there, during his time and, you know, he was that firstborn, fighter pilot, successful dad. The first NBA president. So he would, he would kind of take a stick, poke you a a little bit and want you to poke 'em back, just not quite as hard. So he would give different people, um, nicknames and that was just his style of connecting with them. So for some reason, he called me Leno. And, it got to be that people even in the White House, who I took care of, they couldn't remember my name, you know, but that's, that's a better nickname than Doc. And, um, uh, would just say, oh, you know, the Doctor Leno, and when he went on the, you know, tonight Show, he and Jay Leno would have a good laugh about it and show pictures and then later, you know, during, president Obama, I, he picked me to be the physician to the president. So, you know, it's a good thing, red or blue. luckily they're the same all inside. from a biologic standpoint, how, how do you end up becoming a, a

John: 2:18

doc, the, the White House doctor?

Dr. Jeffrey Kuhlman: 2:20

Throughout most of history, it's been a military, physician, The president can pick one person, to be the political appointee, and sometimes they pick a family friend, but sometimes they just go with, more often they just go with the senior most, white House physician that's there. the Army, Navy, and Air Force, each have doctors, that, that make it up. Today there's one physician to the president, and then there's maybe six other, white House physicians, to You know, go on the, go on the trips, do the preparation. Yeah.

John: 2:52

It's hard to imagine a more intimate relationship than the White House physician to the president at, you know, all, all presidential, periods or periods of extraordinary stress. What an extraordinary privilege to be able to kind of serve the president.

Dr. Jeffrey Kuhlman: 3:07

Yeah, it's the ultimate occupational medicine job. You work with them. You know, you don't, you don't wanna get in the way, but you wanna, provide the support. I always told the, the five and a half presidents I cared for. no policy, no politics, just trusted medical advice. So that's, that's what I felt my role was.

David: 3:26

So let's talk about, another president with a pension for giving nicknames, that sometimes are a little less friendly and, and don't always in invite, a pushback, gentle or, or not. what's your medical take on President Trump's recent diagnosis of chronic venous insufficiency?

Dr. Jeffrey Kuhlman: 3:44

So, you know, to be clear, I've never, met him. I've never physically taken care of him. So this is just, From afar. You know what I can read in the, what's been released? so there, there was a one page statement that Dr. Sean Barbella, released in the past week. chronic venous insufficiency is, you know, usually a diagnosis that we make after we've ruled out, Major things, you know, to, to make sure that we're not missing it. I am, I'm not sure they get any credit for being transparent. All of us in the medical profession could see swollen ankles, and, you know, even when you're wearing a business suit. So the, the swollen ankles, bipedal edema. you know, we, we can't really see if there's skin ulcerations or discoloration or anything else. so the first thing that we think of as physicians is, you know, is he having heart failure? So they put out that his, echocardiogram was normal and they put out that his BNP, you know, the blood test was also negative. So I think that's, appropriate. And then are they missing A DBT? and they put out that he had had a, an ultrasound of his legs done and also a D dimer. So I think they're trying to address. those, other things that can do it is sometimes some, you know, kidney failure. They said his comprehensive metabolic panel, which includes BON and creatinine, is normal. So I think Dr. Barbara Bella just stuck to the facts of, Hey, I thought of these, these other things. They got ruled out. so we made the diagnosis with the specialist of chronic venous insufficiency, which. The two highest risk factors are age. He's old, he's 79 years old. And then, if you are overweight or obese, you know, he's, he's had a lifetime of, overweight obesity in the past decade or two. and then also sedentary lifestyle. So, you know, if you think of your grandparents who sit around a lot. If you golf and you ride a cart, that does not count as physical activity. if, if you notice all the pictures of him at the, in his, in his workspace, you know, he, he is not standing up, moving around. He is sitting at a, at a big, desk. so my advice would be, extremely common in, old Americans who have sedentary lifestyles and are overweight. So, sit less. Walk more and lose a bit of weight. And that should help with, you know, the, the, the swelling. In the, in the ankles.

John: 6:23

Dr. Kuhlman much is who I would love to believe that the, the current president is listening to this podcast. Yeah. I think it's unlikely that we're gonna with it or, and knowing what little we know about his personality from the public side, whether he actually takes advice is, is another matter. But I guess I'd step back a second and, and, you know, you've really done a nice job in your book at talking about. Presidential health, presidential transparency. How does the current level of transparency on health, and you could feel free to go back as far as you want, compare to best practice relative to what you'd like to see.

David: 7:00

I think it's fine. He can go back as far as he wants, but not prior to George Washington.

John: 7:04

I dunno what, that's it. That's, that's legit. He had bad eyesight.

Dr. Jeffrey Kuhlman: 7:10

Yeah. Yeah. So in, yeah, in transforming presidential healthcare, Unfortunately what you said is, is true. you know, most American presidents are very reluctant to actually kind of be truthful with the, American people. And sometimes, you know, if you have a doctor that's complicit in that, think about Woodrow Wilson and having a stroke and he debilitated for nine months. You know, up in the second floor, in his residence and the cabinet members were in on it. his wife, his second wife, you know, she was in on it. And, it was all facilitated by, Carrie Grayson, who's the young dashing, doctor that, you know, in his, thirties, got magically elevated from a lieutenant to admiral. So. just, you know, with, with the, the Hippocratic oath since the beginning of, of, you know, time of more than 2,500 years ago, we should respect doctor patient confidentiality, but we also balance that out with, there's a fiduciary duty to the, to the American people. so I tried my best to always be factual. In the, the, reports that I released for the different presidents and that not used hyperbole and not stick in, extraneous, information. But you know, there's other people that have different styles and they get rewarded for that. Can

David: 8:37

we talk about cognitive testing? I first heard about you during the presidential election where we had, not just one, older person running for office, but two, everybody was old. Yeah. So, I mean, what, what's the argument for, more routine cognitive testing, which I think is what you're advocating for. If you could lay out that argument, that'd be great.

Dr. Jeffrey Kuhlman: 8:57

Sure. So since we're going back to, 250 years ago, so James Madison was kind of the lead author of the Constitution. So when he submitted his final draft, you know, to the congressional, congressional Congress, he was 36. He was 36 years old. The average American at that time, 20-year-old American. They were lucky if they lived, lived to age, 60, president, George Washington, when he, finished his office, he was 65. He died a year and a half later. So there was no concept of, Octogenarians. at that time, in the Constitution, there is no physical or medical or mental requirements. and if you think about it, most presidents have had some type of physical impairment. We can accommodate for. They're blind, they're deaf, they have a limb that doesn't work. They have different organs that don't work optimally, and we can accommodate for all of that. The only one we cannot accommodate for is critical decision making. So with critical decision making with which I laid out in transforming presidential healthcare, now it's ancient history, like more than a year ago of The, the, the one thing that we cannot accommodate for is critical decision making. it's a fact of life. It is not questionable that over the age of 60 humans, start to have cognitive decline. So the cognitive decline, they're ha having its memory, reasoning, speed of processing, spatial visualization, undeniable. Those cognitive declines accelerate. Vocabulary. The fifth one actually stays the same, and sometimes it improves. So that's kind of unique. But so, so if, when you had, a 79-year-old, an 82-year-old who are running for that office, the mocha, the Montreal Cognitive Assessment, you know, two, you know, two minute screen, 20, 30 questions. Absolutely. They're, they're gonna do perfect in that because they don't have, dementia, they don't have Alzheimer's, which that's usually, kind of what it, what it screens out for. but it does

John: 11:14

is that Dr. Kuhlman, just to be precise, that is the a test, I believe that Trump very proudly aced when he was, you know, basically kind of a c spot run kind of. Standard of, yeah.

Dr. Jeffrey Kuhlman: 11:26

Yeah. So yeah, cognitive clarity, and I have no doubt clarity, they wasted. I think they're being truthful with that, but that's sort of like, hey, they showed me the Stalin eye chart and I, I saw, you know, 20, 20 bunch of letters, 24 on, and so absolutely that's a good screening test. But, a 79-year-old, when they go to the eye doctor. They get a fundoscopic dilation, they get their retina looked at, they make sure they don't have diabetic retinopathy. they make sure that they don't have cataracts, they make sure they don't have glaucoma. So there's a whole comprehensive, so the same analogy would be, my opinion is, any national leader over the age of 70. Would benefit from, periodic, maybe once a year. Neurocognitive assessment that checks their memory reasoning, speed of processing, spatial visualization. Maybe take a couple hours and they could feed it back. Maybe don't release it to the public other than they had it done, but it would help. You know, it would've helped Dr. O'Connor with President Biden. It would've helped, Dr. Jackson and Dr. Conley with President Trump. and it's not just the president, you know, we have, 20, over 20 senators are over the age of 70. we have a 91-year-old. We have, Supreme Court justices that I think four of the nine are over the age of 70. so I guess, I guess Dr.

John: 12:55

Kuhlman, if you think about applying that standard at least, or that standardized test for a feedback mechanism for. The principal, whoever that is, the president or senator and the team, is it precise enough to say, look below this standard, we, we, you know, we gotta kind of take the keys away. And for that, those tests, is there a go, no go Level of competence, if you will, around critical decision making that you'd say clearly indicates impairment. They should. You, you are no longer qualified to fulfill the obligations and responsibilities of the job of president.

Dr. Jeffrey Kuhlman: 13:33

So I think that, most of healthcare, there's not a clear go or no go, but there's, there's a range and there's a, there's a spectrum. so to me if you do that two, three hour test and you do it every coup every year or so, you can at least address that. Hey, he's still at the baseline from, from when he was elected by the American people last November. You know, I think today or yesterday, president Trump is, is celebrating the first hundred, the first six months, I'm sorry, of, of this second term. so you could check over time and compare it to the individual of, Hey, he's had a little bit of cognitive decline, but it's, it's like reasonable, age related. It's not all of a sudden he's dropped off that cliff. you know, I think about my 85-year-old father that we've been following him for aortic stenosis over the past, several years. So you get an ultrasound every six months. He's completely asymptomatic and he just passed. Kind of the, the, you know, the, the numbers of, that are worrisome. And so now they put a TAVR in instead of waiting for the, and he did great instead of waiting for the event of, something catastrophic. So it's the same type of thing is, you know, we, we have a 79-year-old, and the next three years, three and a half years, he's gonna get 82 years old. He makes lots of mistakes in his speech. He makes lots of a mistake in his recall. does he really, you know, forget that he appointed the Fed Chairman or is that part of his political strategy? And I don't know. I'm not, I'm not part of the political machine, but I would, as his personal physician, I'd wanna know, is he losing his memory? It's his reasoning ability where, the problem with old people, you know, again, thank your grandparents, is they don't listen to other people. They just do whatever they want. And so they've kind of lost that normal David's

John: 15:39

somewhat the same way. Yeah.

David: 15:40

Yes. I've had that since I was 15 according to my mother. Now you mentioned, Dr. Kuhlman, that this information, would've been very useful, let's say to, you know, certain physicians who. Caring for, president Trump in first and second term. President Biden. Is President Obama. Less of an issue, since he was, significantly younger. but it raises the question of, you know, who should be the audience for this? it's one thing for the, you know, for the physician to have that as opposed to just the, the mocha or the, the, you know, the e on the eye chart, which even I can read. but who, who, beyond that, I mean, you, you've spoken about kind of the whole structure of the, about the medical office in the White House, you know, where, where do we go besides just the physician having access to that information.

Dr. Jeffrey Kuhlman: 16:24

Well, the position to the president has, you know, the higher you get, the more responsibility you have. So first of all, the patient you're taking care of, you have a responsibility to give them accurate information and not just something that they want to hear. So give them accurate information. their spouse, their family, their senior advisors around them. With the permission of the patient, you would also want to, share that with them. And then who do they work for? Well, they work for the American people. and you know, president Obama, I, when I, we were planning his first physical, you know, I asked him about certain things and said, Hey, this is what we're gonna do. And he said, you know, I've learned never lie to the American people. Eventually they'll find out the truth. So that's what we tried to do is, you know, we may not mention, about of traveler's diarrhea after coming back from a certain country'cause that just wasn't relevant. or we may not, you know, mention every hemorrhoid or skin tag or, you know, day-to-day, situation. But I made sure that, cardiovascular cancer. neurocognitive that those, those things that, affected the duties of the president, were, reasonably explained and competently evaluated.

John: 17:44

Dr. Kuhlman. It's gotta be, everybody's gotta feel pressure of politics. When you're in these jobs. Just, I, I think back to, you know, the, the claims that a lot of Jack President Kennedy's illnesses were, were shielded, I think of the, the pressure that w, that Eisenhower's doctors were under when he went through, you know, multiple heart attacks and Yeah. And, and el president Johnson's, heart attacks the question of how much do you disclose without impacting the, the image of. Effectively, power and strength of the United States is very much tied to the leader. How do you navigate that as a doctor in the White House? The pressure of doing the right thing for the country around disclosure versus the, the, the, perhaps the political thing, which is to, PR present the president as stronger than he may, may he, he or she may be relative to their actual health.

Dr. Jeffrey Kuhlman: 18:46

That's the dilemma of, of, being a physician and every single patient that I take care of. So, number one, I make sure that I have a higher level of understanding of what I'm doing. Number two is, integrity. You gotta do the right thing, whether anybody's looking or not. you have to have the appropriate level of formality in your communication formality of following, procedures. You have to have a questioning attitude, and you have to kind of, you know, back each other up. So there are, you know, lots of doctors in the, in US history that they are willing to, sell out for personal gain, for political gain. And, if you look at history, the ones that have, been unsuccessful. It's usually that they've crossed the line over into friendship instead of, staying on the, on the correct side of the line of the doctor patient relationship, which is information relationship built on trust. And so that's, you know, every patient that you care for, you have to make sure that, you follow those, those simple rules.

David: 19:58

So John mentioned that, he's not sure whether the current, president will listen to this podcast and, and take your, your advice no matter how valuable it would be to him. So I'm wondering, for others, business leaders, hospitals, CEOs, military officers, you know, what can they take from, your insights into Presidential medicine podcast cast hosts? Yep. What can they,

Dr. Jeffrey Kuhlman: 20:22

what can they apply

David: 20:23

for their own organizations?

Dr. Jeffrey Kuhlman: 20:24

Yeah. Yeah, so that's, that's, that's a really good question. if that sort of, that sort of goes on VIP or concierge care, and often those are, high net worth individuals or, you know, CEOs, they often don't have, enough time. I would make sure that you find a. that you don't think you're smarter than, you know, the personal physician that is caring for you. You know, there's famous quotes about, you know, if, if, if a patient is their own doctor, then you have a full for the patient and the doctor. So, there is no shortcut to, to good healthcare. Actually health is just the absence of disease, but fitness is the fountain of youth. So the fitness is, it's, it's not a secret. Is live a physically active life Progress to a more plant-based diet. Be temperate in your, you know, your personal habits. You know, it's best if you don't smoke. It's, you know, it's best if you, don't drink alcohol or you're. you're temperate in that. And then also you have a positive, outlook and you have those, you know, invest in a community or personal, family relationships, that that's the secret to good health. find a physician that, has integrity, that follows, evidence-based, medicine, which unfortunately is only about 20% of, of, healthcare. But you're, but you're

John: 21:58

also, Dr. Kuhlman, you're also reinforcing the fact, the, the notion that you may be the CEO or leader or general on, in, in, in, in, in, when you've got your uniform on. But when you've got the white coat that opens in the back, yep. Basically a, a poorly fitting apron. Yep. You listen to the, you listen to the person with the, with the, with the degrees and the, and the experience. And I do think that's an important. for, for, for any leader. That's, that, that's sort of a critically important, piece of advice. So I think that, that, that, that, that, that's, that's, you know, before we get, before we gotta moving around and, and, and reversing aging, you gotta first listen to the doctor, right?

Dr. Jeffrey Kuhlman: 22:41

Yeah. And history is full. It's in transforming presidential healthcare. The, Steve Jobs, Michael Jackson, you know, the list goes on and on of they thought they were smarter than the doctors, or they found a doctor, Matthew Perry, you know, Anna Nicole Smith, Elvis Presley. There's a whole list of, just, just, celebrities, ultra high net worth individuals, and often you think they have the best care and they often have the worst. and so you gotta, you gotta find, a physician and who he or she will, have solid information communicate to you, and you have to make the decision to listen to them and follow their, their guidance.

David: 23:24

Well, that's it for yet another episode of Care Talk podcast. We've been speaking today with Dr. Jeffrey Kuhlman. He was physician to President Barack Obama, and he is the author of Transforming Presidential Healthcare. I'm David Williams, president of Health Business Group.

John: 23:40

And I'm John Driscoll, the, the, head of Yukon Health. if you liked what you heard or you didn't, we'd love you to subscribe on your favorite service. And Dr. Kuhlman, thank you so much for joining us and, reminding us of the importance of science, healthcare, and following the best advice of doctors, even if you happen to be the president.