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Dick Cheney’s heart problems were never a national secret.

I was Mr. Cheney’s cardiologist for 27 years, including his two terms as vice president. During his time in the White House, he needed stents, a defibrillator and medical treatment for an arrhythmia and a blood clot in his leg. After the defibrillator was implanted in his chest in 2001, he would frequently show visitors to his West Wing office a sample device provided to him by the manufacturer.

Mr. Cheney’s candor about his health was an anomaly for an American politician. Grover Cleveland underwent secret cancer surgery while he was president (on board a yacht for maximum privacy). Franklin Delano Roosevelt hid his use of a wheelchair from the public. Ahead of his campaign for a fourth term, he struggled with severe hypertension and congestive heart failure, but the public was told that the president’s health was “excellent in all respects.” Joe Biden’s disastrous debate performance raised concerns that the White House had attempted to conceal the president’s decline. For weeks after his hospitalization this summer, Senator Mitch McConnell shared almost no details about why he was absent from office.

In June, President Trump celebrated his 80th birthday, and at the end of this term he will be the oldest person ever to serve as this nation’s leader. After Mr. Trump’s medical evaluation in May, Dr. Sean Barbabella, the physician to the president, wrote that Mr. Trump “remains in excellent health” and that his “demanding daily schedule, including multiple high-level meetings, public engagements and regular physical activity, continues to support his overall well-being.”

Despite reassurances from the White House to the contrary, at times over the past year, the president has not looked well. I am not Mr. Trump’s doctor, and have only reviewed his records that have been made public. But Mr. Trump is probably the most photographed president in American history, and a variety of physical ailments are easy to see. He’s had large bruises on both hands, swelling in his legs and episodes when it appears that he is struggling to stay awake. He’s also had advanced imaging performed for unclear reasons. The public is again left to wonder whether the nation’s leader is OK.

Despite the unparalleled power afforded to the president of the United States, there is no formal requirement for the commander in chief to certify his fitness for duty. That’s a mistake. Members of the military, Secret Service agents, commercial pilots, school bus drivers and air traffic controllers all must periodically demonstrate that they are well enough to perform their work. The current practice of reporting the results of a yearly medical examination for the president began in the Nixon administration, but it’s only a custom, not a formal obligation. And, as history has shown, it can be unreliable.

This does not mean that every detail about a president’s health must be disclosed. It’s appropriate to withhold elements of a medical history that could be exploited by an adversary. In 2007, when we replaced Mr. Cheney’s defibrillator, we didn’t share information about a new wireless feature of the device that I considered a security threat to the vice president. (We ultimately were able to get the manufacturer to disable that capacity.)

The 25th Amendment to the Constitution allows for the best solution to this problem: It permits Congress to establish a panel outside the executive branch to assess the health and fitness of the president. In April of this year, Representative Jamie Raskin introduced a bill to create a congressional commission that would do just that. Ideally, such a panel would be empowered to review data from routine presidential physical examinations, as well as assessments performed when medical concerns emerge.

If such a commission were in place today, these are some of the medical questions it could clarify concerning Mr. Trump’s health. The American public deserves answers to all of them.

1. Dr. Barbabella’s recent report states that the president was evaluated by 22 consultants, an extraordinary number of specialists for even the most extensive executive health evaluation. Why were so many physicians summoned, and what were their specialties?

2. Mr. Trump often shows prominent bruising on his hands, which the White House attributes to frequent handshaking and frequent use of aspirin. Trauma from handshaking has never seemed plausible, and it doesn’t explain why the president’s left hand is often similarly discolored. Also, why would the president take a dose of aspirin four times as high as the dose typically recommended by doctors?

3. Swelling in the president’s legs last summer led to an unscheduled medical evaluation. The president’s physician described the problem as “chronic venous insufficiency,” a condition common in older people, that results from leaky valves in the veins of the legs. It usually develops gradually over a long period. But during Mr. Trump’s comprehensive physical examination just a few months earlier, Dr. Barbabella documented no swelling in the president’s legs. If that’s true, his swelling would be by definition acute, not chronic. Acute leg swelling is a potentially much more consequential finding that can be caused by issues such as heart and kidney disease. What’s the reason for this discrepancy?

4. The president often appears to struggle to stay awake, signs of a condition doctors refer to as excessive daytime somnolence. This problem, which is sometimes evident during Oval Office events, was not addressed in the report after Mr. Trump’s comprehensive physical exam in May. Although the president is a renowned night owl, his sleepiness seems relatively new. There are several possible causes for the president’s symptoms, some of which could have serious complications if left untreated. Has the president’s medical team identified the source of this issue? And how are they addressing it?

5. In October 2025, Mr. Trump underwent advanced imaging of his heart and abdomen at Walter Reed National Military Medical Center. The president’s physician offered a vague description of the reason for the tests: “to identify issues early, confirm overall health and ensure he maintains long-term vitality and function.” He said the tests did not reveal any abnormalities. Was there a specific symptom or clinical event that prompted this testing?

6. Past Trump medical reports have disclosed the president’s use of the drug finasteride, which prevents hair loss. The drug was not mentioned in the report after Mr. Trump’s most recent medical examination. In response to a query from The Washington Post about its absence, the White House responded, “The current report reflects all medications deemed clinically relevant to disclose at this time.” It does not matter, in any material way, if the president is or isn’t taking a hair-loss drug. The more important question is, what medications prescribed for Mr. Trump, if any, has the White House decided to withhold from the public?

7. The president has spoken about how well he performs on cognitive testing. However, the exam that Mr. Trump describes, the Montreal Cognitive Assessment, is a brief and basic screening tool, with simple questions (draw a clock, identify a camel), often performed in response to a concern from the patient or a member of the family. Why has the president undergone this test numerous times, and have there been more sophisticated neurocognitive assessments performed?

Some people would argue that these personal medical details are more than the public deserves to know: After all, Buckingham Palace has not revealed many details about King Charles’s cancer or his treatment.

But the United States does not have a king. In a representative democracy, the people must have confidence in the health of their leader, and in the leader’s capacity to guide the nation. We have been kept in the dark too long.

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Kenny Holston/The New York Times

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