A call for an urgent medical assessment of Donald Trump has been published in the British Medical Journal. In the BMJ article, neurologist David Nicholl of Sandwell Health Campus and primary care expert Trish Greenhalgh of the University of Oxford argue that while using public statements and behavior alone to diagnose cognitive decline is inappropriate and falls short of clinical standards, the available concerns justify an immediate clinical evaluation. The authors emphasize the distinction between making a formal medical diagnosis and raising evidence-based concerns, noting that in 2016 several prominent psychiatrists expressed doubts about Trump’s fitness for office but explicitly avoided issuing a diagnosis and instead requested an impartial medical assessment.

As the oldest person ever elected U.S. president at age 79, Trump’s health has been under scrutiny for some time. Observers have pointed to images of spots on his hand, inconsistencies in remarks, and other public behaviors as prompting speculation. The authors acknowledge that heads of state are entitled to medical privacy, but say that because their decisions can have wide-ranging consequences, there are circumstances in which the usual professional reticence of clinicians about public commentary may need to be reconsidered.