From the outside, it seems like the President fell into this category of patient when he was being treated for Covid-19 at Walter Reed National Military Medical Center. But before we upbraid the seemingly weak-kneed medical team treating President Donald Trump for his too early (in my opinion) release from the hospital, it is important to remember that in American health care, the patient is always right.
Well, almost. There are two extremely important limitations on this freedom of choice — and each has been discussed regarding President Trump’s discharge from Walter Reed.
I don’t know which jurisdiction would address Trump’s infection — the state of Maryland where Walter Reed is located, Washington, DC, where the President resides, or the federal government. Adding to the confusion, it seems possible that an attempt to place the President into mandatory quarantine would likely be seen as politically, not medically, motivated.
Given these uncertainties, reasonable, respectful and socially responsible behavior is certainly expected. Hopefully, for the next several days, Trump will remain isolated at the White House, allowing only the medical personnel who are appropriately gowned and masked to enter his room.
I also hope that the people who oversee how the air in the White House is filtered and recirculated have been working around the clock to minimize spread of the virus from suboptimal air handling.
It is important that no other visitors, even family or those on high priority national business, see the President in person. They must instead communicate with the President in a virtual fashion until his medical team determines that he is not infectious.
If, however, the medical team, using real evidence, determines that he is not infectious and the public health authorities in charge of the case formally agree that he is not a risk to others he is free to meet with visitors and go about his business. (Whether his medical condition was sufficiently stable to recommend discharge is another matter entirely).
I am not privy to the discussions that occurred between Trump and his medical team, so I can make no informed assessment of his current mental condition.
It also requires frequent reexamination, given the up and down, in and out turbulence of a person’s mental state over time. Patients in hospitals, especially the elderly, may “sundown” — that is, become confused at night, then be clear as a bell in the morning. They may have a reaction to a pain medication or other drugs, leading to transient confusion. For a patient with pneumonia, variations in the amount of oxygen to the brain may cloud judgment for a period of time. And on and on.
If Trump is indeed assessed to have medical decision-making capacity and is deemed to not be a health threat to others, he is free to roam, whether his physicians agree it is in the best interest to his health or not. Clear documentation of these formal assessments in his medical chart would be necessary — these are not casual “he seems OK” determinations.
Caring for a patient with even reasonable requests therefore is always a challenge. The doctor wants to be a kind and accede to a patient’s wishes. After all, the person in the bed before them is miserable, scared and lonely. Why not do the patient a favor — let him start eating a little bit early post-op, stop the medication that is causing the headache, even let him go home a bit earlier than is advisable. We all want to be seen as kind and giving.
I surely hope this tough love approach informed the work of Dr. Conley and his team as they cared for a sick, elderly man in denial of the risk to his health that leaving too early may create.
But I seriously doubt it.