Learning from Donald Trump’s recent physical exam memorandum

Flu shot, Covid shot (!), and a not-so-routine ECG

Below is a copy of the memorandum sent by the president’s physician to the White House press secretary about his recent physical. There are many claims that could be scrutinized herein, but the three most vital ones are the Covid shot, the flu shot, and the ECG:

It is good to see a patient reported to be in good health. This memo is very short on details compared to previous presidential physicals. And yet three items stick out to the primary care eye.

#1. The President got an updated Covid shot

Good for him. He’s been reading Covidlandia on the side perhaps. Nonetheless my jaw dropped a bit. This is the same person who publicly undermines vaccines in general and Covid vaccines in particular.

Pandering to his base about vaccines has only worsened the partisan divide with respect to updated Covid vaccine plans:

Maybe the gap is more narrow for the 65 and older crowd? Nope. Vaccination rates for the updated Covid shot among adults 65 and older in 2024 were:

• Democrats (65+): 66%

• Republicans (65+): 24%

That being said, I tip my hat to the physician who tipped his cards (although surely with the president’s consent). I’m going to try using this knowledge to motivate some of my older and higher risk patients who have concerns about staying up to date with shots. I won’t be pushy, especially if the person has had a bad prior reaction. But for those who are making a decision based on party affiliation, might it help to state:

You are in a higher risk group for which staying up to date with Covid vaccines has been shown to provide additional benefits against getting sick for a while, staying out of the hospital, reducing long Covid rates, and even death. Did you know that Donald Trump just got his Covid shot this month? It was his choice, and he chose to get one!

Recall that Mr. Trump might have died from his first bout with Covid were it not for the cutting edge medical treatments he personally received (but that were not available to the general public at the time). Recall that it has also been reported that he debated Joe Biden three days after an undisclosed positive Covid test.

I’m glad the president got the updated Covid shot. Some propaganda art for a parallel universe?

#2. The President got a flu shot

Nice.

October is a good month to get a flu shot.

Don’t forget that last year’s flu season was the worst we’ve had in the US in over a decade in terms of hospitalizations and deaths. Almost 300 kids died of the flu, 90% of them unvaccinated, and half with no high risk medical problems. This winter in the southern hemisphere was also rough, and current flu shots worked fairly well.

Again, the partisan divide extends to flu shots and can be illustrated with this poll from KFF:

I’m planning on getting my own flu shot this week FYI. It would seem that trained medical doctors’ choices might influence people more than they do these days. 95% of us get the flu shot each year.

Did I mention the president just got his flu shot?

#3. Maybe his ECG predicted that his cardiac age is better than his actual age.

This was a fascinating and intriguing claim for many reasons. There are very few doctors using ECGs to estimate someone’s heart health right now. We don’t have consensus guidance or the tools. It’s more of an experimental and research concept at this time, derived from deep learning by AI models. Using deep neural networks to compare raw ECG waveforms and patient outcome data, these models confirm that certain ECG wave characteristics align with known cardiac aging processes. This tech will be coming to a primary care or cardiology office near you soon. We will probably use it like cholesterol panels and coronary artery calcium scores to deepen our discussions with people about their cardiac risk.

Artificial intelligence can accurately estimate age from standard 12-lead electrocardiograms. Large-scale studies analyzing over 1.5 million patients have achieved prediction accuracy within 6-9 years on average, with strong correlations between predicted and actual ages across diverse populations.

For example, when an AI-predicted ECG age exceeds a patient’s actual age by more than 7-8 years, this age gap serves as a predictor of negative health outcomes. These patients face 40-80% higher risk of death from any cause compared to those whose ECG age matches their chronological age, and up to 3.5 times higher risk of cardiovascular death specifically. The age gap is also associated with increased risks for stroke, diabetes, kidney disease, and other conditions.

When a patient’s ECG looks younger, they have a statistically reduced mortality risk, although more like 10-20% less risk than their actual age alone would predict.

The president’s ECG was not released for independent verification that I can find. Are there any other files that have not been released lately?

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If you want, in a future post I can circle back and review a fascinating article about how measured physical activity seems to be the strongest predictor we have of overall mortality. I’m guessing ECG analysis will not top that.

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Take home

An updated Covid shot and an annual flu shot were pumped into the arm of our president. I choose to do the same with my arm, and I follow good advice from our medical professional organizations (AAFP, AAP, ACOG, IDSA) when it comes to counseling patients. I’m expecting that AI deep learning analysis of routine ECGs during primary care physicals will be a thing soon, but for now it only shows up in research papers and White House memoranda.

Do you think that knowing the president quietly stays up to date on vaccines might leave some people scratching their heads?

Rolling up their sleeves?

Questioning words versus actions?