Clinician Insights

Diagnosing Candidates From Afar: Most Clinicians Say Don't

Marcia Frellick

September 20, 2016

Results of a Medscape survey show that most clinicians say it's never okay to publicly diagnose the mental health of a presidential candidate without first examining the person.

Of 1230 respondents, 75% answered no, it is never okay; 17% said yes; and 8% were unsure. Results were published in Medscape on September 1, and the results were tabulated September 15.

Speculation about Donald Trump's mental fitness led the American Psychiatric Association to remind its members to honor the Goldwater rule, the ethical statement adopted in 1973 forbidding psychiatrists to comment about a person's mental status without personally examining them.

Likewise, Hillary Clinton has been subjected to speculation about her stamina and her neurologic conditions and balance, only heightened by her recent pneumonia diagnosis.

Responses to the question did not vary much by specialty. The range for "never okay" was from 70% (medical students and physicians) to 82% (pharmacists).

Most Said They Had Never Made Such Comments

The poll also asked, "Have you ever made public statements about the health status of a public figure you have never examined?" Most readers (82%) answered no, 14% said yes, and 4% were unsure.

Answers didn't change much to the question of whether such diagnoses were okay for public figures, rather than just presidential candidates.

For some, the answer is black and white. Art Caplan, PhD, the founding head of the Division of Bioethics at New York University Langone Medical Center in New York City, said in a recent Medscape video commentary: "No one should be diagnosing anyone they haven't examined personally. It isn't right to do it for presidential candidates, and it's not right to do it for anyone else."

Comments accompanying the survey included a response from a reader in plastic surgery/aesthetic medicine who agreed: "This is not a subject that should be up for discussion, debate or survey. Such actions are unethical and unprofessional."

Still, Opinions Vary

But not all respondents agree or agree completely.

A doctor in general surgery commented, "Public figures are judged by [the]public, including physicians. Public figures have to [sacrifice] their privacy by default."

Another provider said, "Public office/leadership positions come with significant responsibility over populations, budgets, resources, national/organizational reputation, legal authority, etc. Thus such positions require vetting to ensure credentialed and stable people are chosen. The presidency is among the most important positions, and so requires even greater scrutiny, including specialized assessment of [a] candidate's physical [and] emotional health."

A reader in psychiatry/mental health responded: "I think it's Ok to express concerns, but what's wrong is making a diagnosis. We don't diagnose portly senators as 'probably suffering from hyperlipidemia or diabetes.'"

Another healthcare provider commented: "With extreme or apparent behaviors in our candidates, causing many to raise questions, it is appropriate for professionals to not make a diagnosis using only media reports — since that requires a higher standard of certainty — but instead offer a summary of inappropriate behavioral patterns and what in their opinion this could indicate. Such pronouncements must always include the caveat that they are not making a diagnosis, and their assessment may be shaped by inaccurate editing or misportrayals of videos/articles."

Some readers called for the candidates to make full health disclosures: "Mrs. Clinton and Mr. Trump need to release their entire unredacted medical records. If we were examining a 70 yo pilot, lawyer or doctor we would expect no less," wrote a reader from general cardiology. (Both candidates have since released more detailed medical records.)


A final question in the survey asked what, if any, repercussions should follow an armchair diagnosis, and there was no resounding conclusion. The most prevalent responses were issuing a public apology (47%) and public reprimand (38%). But 14% felt strongly enough about the situation to agree that termination of employment was in order.

A related question about the health of presidential candidates was raised by Dr Caplan earlier this year in his Medscape commentary: Why aren't all candidates given an independent physical by an independent group of doctors, given the importance of the office?

He said: "[I]t doesn't make any sense to rely on a doctor who is a partisan advocate for the candidate — and often a friend of the candidate — and have them tell us that they believe there's no health problems with their friend as well as their patient. … I think we need a group that can really stand outside the politics, stand outside the personal associations, and give the American people information that they then may choose to believe is relevant or not."

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