Sean Conley's appearance in front of the television cameras on Monday was everything Donald Trump wanted to see from one of his advisers: it was confident and upbeat and – most importantly – it cast the US president in an unflinchingly positive light.
"He's back," Dr Conley triumphantly told reporters outside the Walter Reed military medical centre, where the president had spent three days receiving treatment for coronavirus.
However, as Trump’s personal physician, Conley is neither an adviser nor a political appointee, and his comments on Monday again prompted concern in sections of the medical community who fear he was not giving the public the unvarnished truth about the president’s health.
"As the physician to the president of the United States, Dr Conley should understand that transparency and clarity in communicating the facts are absolutely essential," said Howard Koh, professor of public health at Harvard and a former assistant health secretary under Barack Obama.
“So far, his inconsistent messaging has contributed to the overall confusion and distrust surrounding the federal government’s handling of this virus – putting the American people at greater risk as it becomes less and less clear who to look to for guidance through this pandemic.”
Patient confidentiality
Conley refused to say on Monday whether the president had suffered pneumonia or any inflammation in his lungs, citing patient confidentiality. He also refused to say when the president had last tested negative for the disease, crucial information that could help establish when Trump contracted the disease and whom he might have exposed to it.
The physician’s appearance in front of the cameras on Monday followed a turbulent weekend during which there was little clarity over the president’s condition.
Conley on Saturday insisted the president was suffering only "mild" symptoms, but was soon undermined by Mark Meadows, the president's chief of staff, who told reporters Trump's condition was more worrying.
The doctor later admitted the situation had been more serious than he had originally depicted, with Trump twice having to receive supplemental oxygen after his levels dipped.
Conley then sowed further confusion by saying he had not been candid about the severity of the symptoms because he did not want to “steer the course of illness in another direction”. Finally, he admitted he had been addressing his early upbeat remarks not to the wider public but rather to Trump, who was watching on television from his hospital bed.
Experimental treatments
Some also believe that Conley has acted riskily by allowing Trump to take a mix of three experimental treatments, two of which are usually reserved for patients suffering serious cases Covid-19.
"It worries me when the president is the only person in the world receiving this cocktail of drugs," said Leana Wen, an emergency physician and public health professor at George Washington University. "We should not be doing a clinical trial for the first time on the president of the United States."
The White House defended the president's doctor on Monday, saying: "Dr Conley is an imminently [sic] qualified, talented physician with a wealth of experience well-suited to serve President Trump and ensure he fully recovers from Covid-19 and remains very healthy to continue his work on behalf of the American people."
Conley is not the first physician to the president who has had to walk a fine line between pleasing his only patient and keeping the American public informed. Woodrow Wilson’s doctor, for example, helped to hide the severity of the former president’s stroke in 1919.
In recent decades, however, this has become an even more fraught relationship thanks to the practice of appointing military doctors to the role, who must technically defer to the president as commander-in-chief.
Afghanistan
Conley was a trauma doctor for the US navy who served in Afghanistan, where he treated soldiers with life-threatening injuries from his medical centre on an airfield in Kandahar.
In 2014 he described how his team had helped save the life of a Romanian soldier deployed to Afghanistan with Nato by opening his chest and pumping his heart by hand.
Nevertheless, treating a president suffering a potentially lethal disease while also reassuring the public that he is fit to continue working has presented a unique challenge.
“This has nothing to do with politics and is simply about ensuring the president receives the treatment he needs and the American people are updated with transparent and accurate information,” said one White House aide.
But the person added: “Is this a stressful time for everyone? Yes.”– Copyright The Financial Times Limited 2020
