Obama's doctor is critical of care decision by Biden's doctor

Washington Post

07-06-2025

Joe Biden's doctor should have given him a cognitive test during his final year as president because of his age, Barack Obama's former physician said in an interview, contending that the results would have helped the White House and the public understand whether Biden was up to serving another four years.
A report by White House physician Kevin O'Connor in February 2024 didn't include any mention of neurocognitive testing for the then-81-year-old Biden. Jeffrey Kuhlman, who held the same job under Obama and has called for cognitive testing for presidents and presidential candidates, said Biden would have benefited from such a test given his age.
'Sometimes those closest to the tree miss the forest,' Kuhlman said of O'Connor, Biden's physician since 2009.
The rare criticism of one White House doctor by another comes as Republicans have increased scrutiny of O'Connor and other former White House aides. House Republicans subpoenaed O'Connor on Thursday, a day after President Donald Trump ordered White House attorneys to determine whether Biden's inner circle tried to conceal his alleged cognitive decline.
Kuhlman also said the 2024 report merely assessed Biden's health when it should have considered his fitness to serve in one of the most taxing jobs on the planet.
'It shouldn't be just health, it should be fitness,' Kuhlman said. 'Fitness is: Do you have that robust mind, body, spirit that you can do this physically, mentally, emotionally demanding job?'
O'Connor did not respond to repeated requests for comment.
Biden's recent disclosure of metastatic prostate cancer and reporting about his alleged physical and cognitive decline have fueled suspicion — among Democrats as well as Republicans — that the true state of Biden's health toward the end of his term was known only by O'Connor and a few others closest to Biden.
Journalists Jake Tapper and Alex Thompson sketched a picture of a well-meaning but weakened president in a book they released last month. The book, which draws on interviews with dozens of Democratic insiders after the 2024 election, paints a portrait of a man suffering at times from forgetfulness, incoherence and fatigue.
It also says that O'Connor was reluctant to give Biden a cognitive test, though he was assessed by a neurologist for conditions such as Parkinson's disease.
Biden gave a sarcastic response last week. 'You can see that I'm mentally incompetent, and I can't walk, and I can beat the hell out of both of them,' he told reporters at a Memorial Day event, apparently referring to Tapper and Thompson. Biden's granddaughter Naomi Biden has called the book 'political fairy smut.'
The book isn't the first time Biden's cognitive state has been questioned. Special counsel Robert K. Hur said in February 2024 that Biden had 'limited precision and recall' — including not remembering when his vice-presidential term ended — after Hur conducted two days of interviews with Biden about his handling of classified documents.
Kuhlman formerly worked alongside O'Connor in the White House medical unit, a nonpartisan post, and appointed him in 2009 to serve as then-Vice President Biden's personal doctor. Kuhlman was Obama's physician from 2009 to 2013.
O'Connor examined Biden — and signed his name to the February 2024 medical report that said the president 'continues to be fit for duty' — four months before a disastrous campaign debate between Trump and Biden prompted Democrats to call for Biden to step down as the nominee.
Kuhlman, who left the medical unit in 2013, said he tries not to criticize those who have held similar positions. He called O'Connor 'a good doctor' who seemed to do his best to 'give trusted medical advice.'
'I didn't see that he's purposely hiding stuff, but I don't know that,' he said. 'Maybe the investigation will show it.'
O'Connor's six-page report included Biden's lab results and an explanation of various conditions for which he was being treated. It also listed 10 medical specialists, including a neurologist, who also examined Biden.
'President Biden is a healthy, active, robust 81-year-old male, who remains fit to successfully execute the duties of the presidency,' O'Connor wrote.
White House doctors have long been under intense public scrutiny, balancing the deeply personal doctor-patient relationship with a responsibility to tell the American public whether the president is fit to serve — and if not, why.
Some have gone to great lengths to hide when the president is severely ill — as Grover Cleveland's doctors did when they turned a yacht into an operating room to secretly remove a tumor from the president's mouth in 1893.
Presidential physicians also are expected to communicate to Americans personal information about the very person who could fire them.
'Whether it's family who are worried for them or people who work for them and don't want to lose their jobs, no one has a vested interest in hearing the truth about the president's health — except for the American people and the world,' said Barbara Perry, a presidential historian at the University of Virginia.
It has not always been clear what role the White House doctors see for themselves. Even as they are often close confidants of the president, they must consider the good of the country in their recommendations about what tests and treatments to pursue.
O'Connor repeatedly refused last year to administer a cognitive exam to Biden even as aides privately expressed concerns about his mental fitness, according to Tapper and Thompson's book.
Trump's former doctors, including Ronny Jackson and Sean Conley, have at times sounded more like cheerleaders for the president than sober judges of his health. His current doctor, Sean Barbabella, mentioned Trump's 'frequent victories in golf events' in the first medical report of his second term.
Jackson suggested to the media in 2018 that Trump had 'incredibly good genes' and joked that he might live to 200 years old if his eating habits were more healthful. Jackson, now a Republican congressman from Texas, was demoted by the U.S. Navy after an inspector general report shed light on multiple misdeeds involving alcohol and harassment while he served in the White House medical unit.
Conley, who succeeded Jackson, repeatedly downplayed the severity of Trump's symptoms when he was hospitalized with covid-19 in the fall of 2020.
Past presidents who didn't want the public to know the truth about their poor health have orchestrated elaborate cover-ups.
After Woodrow Wilson suffered a major stroke in 1919, leaving him with a paralyzed left side, his doctor conspired with Wilson's wife to keep his condition hidden from his own Cabinet.
Cleveland insisted the operation to remove his tumor be secretly performed on a friend's yacht, under the guise that he was on a fishing trip near his summer home on Long Island. The administration denied an initial report about the surgery, and the truth wasn't widely accepted until after Cleveland's death many years later, when one of his doctors publicly confessed.
On the other hand, Dwight D. Eisenhower reportedly ordered his press secretary to 'tell them everything' after suffering a heart attack in 1955. His surgeons regularly briefed the public after his heart surgery.
But medical transparency is only as strong as the president wants it to be. Like regular Americans, the president is protected by medical privacy laws, so disclosing any health information is ultimately up to him.
An additional challenge, former White House doctors and presidential historians say, is that there is no official requirement for how often a president should undergo an exam, what the exam should include and which of the results should be made public.
'There's nothing codified about what to do,' said Kuhlman, who also served on the White House medical unit under George W. Bush.
White House doctors traditionally conduct an annual physical exam on the president and release a memo of varying length that includes vital signs, a summary of the physical examination and the results of blood tests. These memos generally conclude with some kind of pronouncement from the doctor that the president is fit to execute the duties of the presidency.
Trump's and Biden's doctors have largely followed that pattern, although the reports on Biden's health have been significantly longer and more detailed than the reports on Trump.
Kuhlman and Lawrence Mohr, who served as physician to Ronald Reagan and George H.W. Bush, said they were never asked by any president to withhold medical information in their reports. Mohr said he recalls that there was 'never any question' about being candid about the president's health.
'You never lie; never, never say anything that's not true,' Mohr said. 'You put out a clear press release about what's going on, what to expect and you get it out there. If you don't do that, you end up with all sorts of speculation.'
Reagan was 77 when he left office and five years later announced he had Alzheimer's disease. He faced similar questions about his fitness to serve. Mohr recollected administering the Mini-Mental State Examination — a test used to assess cognitive function — to the 40th president.
Trump's doctors have given him a different cognitive test, the Montreal Cognitive Assessment. But cognitive tests are not standard practice. Neither George W. Bush nor Obama took one, Kuhlman said. But they were much younger while in office than Biden.
'I was fortunate to have 50-year-old patients instead of 80-year-old ones,' Kuhlman said.