17 Nov The Rigors of Treating the Patient in Chief

The New York Times | November 15 – No patient gets closer medical attention than the president of the United States. Wherever he goes, a doctor, nurse or paramedic trails a few footsteps behind, ready for any medical need. It is the ultimate in concierge medicine.

For the president’s doctor, it is a little different. The job of White House physician combines professional responsibility with the glamour and trappings of proximity to history. The White House medical office is only a few steps from the Oval Office, and the doctor has automatic access to the president’s living quarters.

A medical staff member stays overnight in the White House. When the president travels, the doctor rides in a limousine near the head of the motorcade. Jet lag and stress make the job one of near-constant fatigue, shadowed by dread of assassination attempts.

Now a recent holder of the job, Dr. Connie Mariano, has written an account of her nine-year tenure under three presidents, Bill Clinton and both George Bushes. The book, “The White House Doctor: My Patients Were Presidents — a Memoir” (Thomas Dunne Books), is one of just a handful of autobiographical accounts by presidential physicians.

Dr. Mariano’s story is an inspiring one. The daughter of a Navy steward, she was the first Filipino-American of either sex to rise to rear admiral, and the first woman in the military to become the White House physician. But her account gives scant attention to some important points and passes over others.

For example, the 25th Amendment deals with succession when a president becomes disabled or incapacitated. Dr. Mariano does mention that to avoid invoking the amendment, Mr. Clinton received spinal rather than general anesthesia when he needed surgery to repair a torn quadriceps tendon. But she has little more to say about the amendment, which is central to any serious discussion of presidential health.

Asked about that in an interview, Dr. Mariano replied: “There was a lot I didn’t put in the book because the publisher said it wasn’t of interest to the general public. They said this isn’t a scholarly thing — it’s a memoir.”

Since the Civil War, the White House medical staff has been drawn largely from the military. The doctors are from a variety of specialties and are chosen by the president. One reason is that few civilian doctors can afford to suddenly abandon a practice for four years. Also, Dr. Mariano said in the interview, because the medical staff members are first responders in the field, “White House medicine was like practicing battlefield medicine.”

The White House medical unit — Dr. Mariano supervised a staff of 24 — also cares for the vice president and his family, for White House staff members in some cases and even for guests at state functions. But if the president or his family members need attention, everyone else is pushed aside, even if seriously ill or injured.

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