Cameras rolling, Manhattan gastroenterologist Harold Bornstein was confronted last week with a letter that carried his signature. In that letter, the writer “state[d] unequivocally” that Donald Trump “will be the healthiest individual ever elected to the presidency.”
Donald Trump would be the oldest individual ever elected to the presidency. He sleeps little and holds angry grudges. He purports to eat KFC and girthy slabs of red meat, and his physique doesn’t suggest any inconsistency in this. His health might be fine, but a claim to anything superlative feels off.
Bornstein might have jumped on that opportunity to get out of this mess—to say that Trump had dictated the letter, and Bornstein only signed it. Or that Trump had at least suggested phrases. Because it’s not just the facts of Trump’s life that don’t add up, but the linguistics of the letter.
To readers with a keen eye, the hand of Trump might seem evident, particularly the descriptors: “his strength and physical stamina are extraordinary” and his “laboratory test results are astonishingly excellent.” There is even an instance of the Trumpian habit of beginning a sentence with “actually,” for purposes of building on (as opposed to contradicting) the prior sentence: “Mr. Trump has had a complete medical examination that showed only positive results. Actually, his blood pressure and lab results were astonishingly excellent.”
EXCLUSIVE: Trump doctor says he wrote health letter in just 5 minutes as limo waited https://t.co/hy9CLowPJt pic.twitter.com/CyoqDpVhIl
— NBC Nightly News (@NBCNightlyNews) August 26, 2016
But Bornstein only stuck to his guns. Not only did he double down on the letter, he said he rather liked the line about Trump being the healthiest person ever elected president. So I’d like to go through this letter a little more closely.
The adjectives are the most obvious clue. Doctors describe lab results as “normal” or “within normal limits.” If in some rare case these results warranted qualitative assessment, “reassuring” or “encouraging” would be more likely than “excellent.” Were it ever warranted to choose “excellent” as the qualifier, the effect would never need heightening with an adverb like “astonishingly.”
Especially to describe normal lab tests. Many doctors do experience astonishment, but we are trained to keep medical documentation within a regimented, almost militant set of rhetorical boundaries. That serves a couple purposes, primarily to limit subjectivity. During my medical internship, I had a patient who was taking blood thinners, and she came to the hospital after she had accidentally taken too much. Our plan was to keep a close eye on her until the medication wore off. I wrote in the patient’s chart, in one hurried stroke, that the action plan was to discharge her from the hospital as soon as her blood coagulation rates were “cool.”
I received an irate page from my attending physician as soon as he read that. “WHAT DOES IT MEAN FOR A TEST TO BE COOL?”
Point taken, I was supposed to write “when the INR [international normalized ratio] is between 2 and 3.” This way there would be no ambiguity for anyone who reads that chart. He knew what I meant, but his point was that every nurse and social worker and phlebotomist (and lawyer) who picked up that chart needed to be on the same page. So always write this way.
One key place where he does use the right language—“positive results”—he’s using it a way that would be nonsense in clinical parlance. We would say that a test had a positive result, for example, if an HIV assay detected the presence of a virus. Negative results would mean no HIV. Bornstein writes that Trump’s “medical examination showed only positive results.”
Again, in everyday conversation, people would know what that means. Over years of medical training and practice—decades in the case of Bornstein—the instinct to write in a colloquial way is washed out of you. Whether qualitative hyperbole and superlatives would often be of any use in a doctor’s assessment is moot, because they are simply not part of the lexicon. If a physician were going to break from that lexicon, it would not be in a career-defining document when the task is predicated on conveying credibility and authority.
So for linguistic reasons alone, it would shock me if Bornstein wrote this letter. Add to that the other bizarre elements, and it was jarring to hear him stand by it last week, laughing in the process. In video footage that appears to have been taken covertly, Bernstein also admitted that he “wrote the letter in five minutes” while a car was idling outside waiting for him. This is a critical fact: It means that he cowed to the demands of his patient. (Trump had tweeted two days prior, “I have instructed my long-time doctor to issue, within two weeks, a full medical report—it will show perfection.”)
Patients don’t instruct doctors. Bernstein didn’t admit to taking instruction or dictation from Trump, or to signing a prewritten letter, but he did admit last week to throwing together a haphazard letter under unreasonable time constraints so as not to keep the idling car waiting. The letter is dated December 4, and Trump tweeted his promise on December 3. The two-week deadline was nowhere near. The writing could’ve waited another hour. If the car was in such a hurry, Bornstien could’ve emailed it later that afternoon.
And Bornstein does use email, as we know from the letterhead, which includes “E-mail: hornist@gmail.com.” That is another oddity. Gmail isn’t a secure platform, so it’s not meant for patients to communicate medical information. And that is why you’d be communicating with a doctor in the professional sense. This isn’t just for fear of google being hacked; it’s the law (HIPAA).
(A quibble from an editor: Is writing “E-mail:” necessary? If you saw simply “hbornst1@gmail.com,” would you think, “What is that?”)
Another physician, Jennifer Gunter, an obstetrician-gynecologist and “sexologist,” made similar observations recently in an article for The Huffington Post titled "I’m A Doctor. Here’s What I Find Most Concerning About Trump’s Medical Letter.” (That made me want to start every headline with “I’m a Doctor.”)
What she found most concerning was ... many things. Among them, Bornstein’s signature line says that he is part of the “section of gastroenterology” at Lennox Hill hospital. He is not. And only partly because there is no section of gastroenterology at Lennox Hill hospital. There is a gastroenterology division. And he is not part of that, either.
It may just be that the footer is outdated. And also the header, as it includes two names: Harold Bornstein and Jacob Bornstein. The latter is deceased. He died not recently, but in 2010. That leaves plenty of time to remove his name from the letterhead.
The letterhead also includes a web address, haroldbornsteinmd.com. I visited immediately when I first read the letter. It was a nonfunctioning site. (And now I see that the URL redirects to a site that sells prank teddy bears, of the sort that sing “Happy Birthday” when squeezed, for three solid hours.)
These are all small things in isolation, but together the evidence suggests that this letter was written at a time distinct from the dating of the letterhead and signature, which are seriously outdated. The letter also does not appear to be written by a physician. It does appear to have been written by someone who speaks like Donald Trump.
If Bornstein is the author of these words, and they were written under the circumstances he described on Friday (in five minutes while the limo idled outside), then not only is Bernstein not a meticulous physician, but he has shown that he will compromise professional standards in order to do what Trump asks of him.
So, is Trump in good health? There is no legal requirement mandating transparency in that regard. With the bizarre letter before us, he has not been transparent. That may be the best that can be said. I’m less concerned with his health than his character.
Last week Bornstein laughed when he mentioned Trump’s mental health: “His mental health is excellent. He thinks he’s the best.”
I caught some criticism recently for suggesting that Trump is—as the man’s own ghost-autobiographer described him— “a sociopath.” I was careful not to give him an actual medical diagnosis. Sociopath is a colloquial term for something in the venn diagram between antisocial and narcissistic personality disorders. I thought it was a worthwhile exercise to go through the diagnostic criteria and think about them. The dean of Harvard Medical School, for one, agreed. He said that, at least in this circumstance, more physicians should be speaking out.
Normally it’s inappropriate for physicians to weigh in on patients they haven’t seen personally. Out of respect for the process of diagnosis, some physicians are deferring to Bornstein. What would it take for more in the medical community to break the code and say that this man’s appraisal is inadequate?
Even the reserved CNN correspondent Sanjay Gupta spoke out last week: “I don’t even know what to make of this letter.” That is the Gupta equivalent of spitting fire. “It's just a strange letter that's absurd.”
Bornstein has not replied to request for comment. (I wrote to him at the email address on the letterhead, which might be his actual email address.)