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Nicole Saphier, MD is a physician at Memorial Sloan Kettering Cancer Center, an assistant professor at Weill Cornell Medical College, and bestselling author of ‘Panic Attack.’ Her opinions are her own and not a reflection of her employers.
John Fetterman’s hopeful campaign in the US Senate last week released a doctor’s letter declaring he was fit to serve in public office.
For the sake of Fetterman and his family, I hope that’s true.
But we have to take his doctor’s word for it. Because as a doctor, I can tell you that that letter doesn’t tell us much.
As the people of Pennsylvania tune in to the lone debate between Fetterman and his Republican opponent Dr. Mehmet Oz on Tuesday night, they should not be led to believe that his doctor’s note shows a clean bill of health.
It doesn’t.
This is what we do know.
Fetterman was hospitalized on May 13 after a near-fatal stroke. Two days later, his campaign revealed that fact to the public as he headed to win his party’s nomination.
Fortunately, Fetterman appears to be on the road to recovery. But admittedly, he is showing lingering effects of his health anxiety; difficulty processing spoken language and occasional verbal stumbling.
During the debate, he will use a captioning system to convert spoken words into written form that he can read.
The Washington Post and Pennsylvania’s Pittsburgh Gazette have called on Fetterman to release his medical records for independent assessment of his health. But to date, the campaign has not, and they have refused to allow reporters access to its doctors.
Instead, they released doctor’s notes.
To be clear, I do not believe that all candidates for office should disclose their personal health information. In fact, I don’t even ask Fetterman to do that.
I am saying that these shorthand notes from doctors are not a substitute for extensive medical records that allow independent confirmation of one doctor’s prognosis.
In mid-May, the first doctor’s letter came out stating that Fetterman “should be able to campaign and serve in the US Senate without any problems.”
Fetterman was seen during a captioned NBC News interview (above).
As the people of Pennsylvania tune in to the lone debate between Fetterman and his Republican opponent Dr. Mehmet Oz (above) on Tuesday night, they should not be led to believe that his doctor’s note proves a clean bill of health.
Since then, the call for transparency has only grown louder. Fetterman was seen during a captioned NBC News interview. On Thursday, Fetterman’s wife brushed off reporters’ questions at a public event with President Joe Biden in Pittsburgh.
“We’re not here to do interviews, we’re here to celebrate,” she said as her husband moved to her right.
The last doctor’s letter, from Fetterman’s GP Dr. Clifford Chen, declared him fit for full duty in public office, but left me with more questions than answers.
First, how healthy is Fetterman’s heart?
By his own disclosure, we know that Fetterman’s stroke was caused by pre-existing heart disease.
In particular, he suffered from the undertreatment of an abnormal heart rhythm called atrial fibrillation. Fetterman was aware of his diagnosis, but admittedly he was not taking any prescription medications to control it. This eventually led to the stroke.
dr. Chen writes that Fetterman’s heartbeat was “normal,” but he didn’t comment on the rhythm of his heartbeat.
President Biden also has atrial fibrillation and details of his heart rate and rhythm are disclosed in full on his annual physical record.
If Fetterman’s heart rhythm is still abnormal, if he again falters on his prescribed medication and lifestyle, his risk of another stroke is significant.
Fetterman was also diagnosed with cardiomyopathy, which means his heart has trouble pumping blood, which also increases the risk of stroke. So he had an implantable cardioverter-defibrillator put in to help his heart pump effectively and shock it if it got into a dangerous rhythm.
His heart’s rhythm and function are important to know, and without that information, no statements can be made about Fetterman’s overall health and his risk of another stroke.
Second, how was Fetterman’s brain affected?
The letter claims that Fetterman is cognitively fit to serve, but does not mention that a formal neurocognitive evaluation was performed to make that decision.
On Thursday, Fetterman’s wife brushed off reporters’ questions at a public event (above) with President Joe Biden in Pittsburgh. “We’re not here to do interviews, we’re here to celebrate,” she said as her husband moved to her right.
“He spoke intelligently without cognitive impairment,” his doctor wrote. “His speech was normal and he still shows symptoms of an auditory processing disorder that can come across as hearing problems.”
“Occasionally he will miss words,” the note continues, “it seems he doesn’t hear the word, but it’s actually not being processed properly.”
Most doctors recommend comprehensive evaluations for all stroke patients because cognitive impairment is common and difficult to identify.
It can significantly affect quality of life and is a documented factor for long-term disability.
If not addressed early, subtle deficiencies can worsen over time. Some deficiencies do not become apparent until the patient returns to regular social and occupational activities.
dr. Chen wrote that he spoke to Fetterman’s cardiologist and neurologist, but no evidence was made available.
As a doctor, I suspect they have done the right comprehensive evaluations, but these details have not been made public.
Third, what adjustments will Fetterman need if he becomes a US Senator?
The doctor says Fetterman has no work restrictions – that’s just not true.
We know that he uses closed captioning to process spoken language.
dr. Chen wrote (above) that he spoke with Fetterman’s cardiologist and neurologist, but no supporting file was made available.
The Rehabilitation Act protects the civil rights of people with disabilities by requiring all federal entities to make provisions for equal access. An auditory processing disorder of a stroke would qualify.
But the doctor’s note made no mention of this requirement and brushed aside the medical need when he wrote that Fetterman may “perform full service in public office.”
dr. Chen has also not disclosed a plan of action on how Fetterman will be able to handle conversations and events outside of federal buildings where captioning may not be available.
These observations are not trivial, and this research is not out of line or unprecedented.
When President Donald Trump released a similar doctor’s note during his presidential campaign, it was rejected by the media and rightly so.
“If elected, Mr. Trump will be, I can say unequivocally, the healthiest person ever elected president,” Dr. Harold Bornstein, a gastroenterologist at Lenox Hospital in New York, wrote at the time.
Trump’s letter also stated that a recent medical examination showed “only positive results” and that “his physical strength and stamina are extraordinary.”
Doctor’s notes full of exaggeration and lack of detail are not proof of a patient’s physical and mental fitness.
It turned out that Trump allegedly dictated the note to his doctor, but Americans couldn’t know without seeing the full details of the medical examination.
No one outside the Fetterman family or the campaign has the information to determine with any degree of certainty how well Fetterman is recovering from his stroke or what his prognosis is, because certain basic information has not been made public.
In Tuesday night’s debate, Americans should not be led to believe otherwise.