THE ORIGINS, EVOLUTION, AND PRESENT ORGANIZATION OF THE OFFICE OF THE WHITE HOUSE PHYSICIAN

Abstract

The medical care of incumbent presidents has evolved greatly during the two hundred years that have elapsed between the presidencies of George Washington and George W. Bush. The development into its present day organizational structure has not always been in a straight line, but its general direction has been from episodic to continuous, therapeutic to preventative, civilian to military, solo to bureaucratic, and disorganized to structured. The responsibilities of the White House Physicians have increased over time, most notably in recent years with the ratification of the Twenty-Fifth Amendment to the Constitution on presidential disability. Two troubling tendencies have disturbed the physician - presidential patient relationship from time to time: the intrusion of political considerations into medical decision making and intraprofessional squabbling between the president's civilian and military doctors.