You are on the board of a national corporation. What would you do if you had a CEO, Mr. AB, who appeared to have the genetic condition of Marfan syndrome, with very long limbs and high risk of fatal aortic aneurism, and episodes of severe depression as well. Make sure he was cared for by an expert cardiologist, and urge him to seek psychiatric treatment for his mood disorder. What if he were the POTUS? (President of the U.S.) Further, you might also be sure that he had Secret Service 24/7.

What if you had a different CEO, Mr. DE, up in years, recovering from a heart attack? Make sure he had the best heart doctor and was in structured cardiac rehab, not just golf. What if he were the POTUS? 

What if you had another elderly executive officer, Mr. DC, who had pacemakers and defibrillators in his heart, and had an unexplained episode where he shot a fellow hunter in the face? You would make sure he continued to have the best cardiac care. What if he were the VP?

What if you had just hired a new CEO, Mr. D., also a senior, who seems to be unwilling or unable to read company documents, and can’t recall the last, or any, book he has read. Instead he spends four to six hours a day watching TV, stays up all hours on his insecure cell tweeting about news from what some would call “fringe” websites. Then he tweets out misinterpreted versions of what he saw there, putting himself and the company at legal risk. And intersperses these tweets with tweets about the emcee of a TV show he used to star in. Indeed, Mr. D. appears to have a short attention span. He can’t focus long enough to answer a two- or three-part question. On receiving counsel from several advisors, he usually attends to the last person’s advice only. He forgets what he has said or done weeks, days, or hours ago. He takes the slightest criticism personally and treats those who offer it as enemies, exhibiting poor anger control. You would see that he gets his next annual physical from a nationally renowned clinic, rather than his current internist. If you were the physician doing this exam, you would do thorough tests to rule out all medical conditions that could account for these behaviors. Start with the simplest, an eye exam to see if he needs glasses but may be too vain to use them in public, and get him contacts if appropriate. Failing the discovery of treatable illness, you would do a “mini-mental-test,” the first in a series of psychological and psychiatric evaluations, looking for early dementia. Then, if indicated, proceed to a full neuro-psychological evaluation. What if Mr. D. were the POTUS? Insist that he receive the best available medical care, or, as it is called these days, “health care.”

Jeanne Gail, Ph.D, PA-C, Belfast