Healthcare professionals often perform the “eye test” when they first meet a patient. Through their observational skills, information is gathered quickly and often unconsciously to determine whether a patient is ill.

We listen to the rhythm of their speech, we observe their mannerisms, posture and gait, we analyze their face, the turgor of their skin and their complexion – we immediately assess whether the patient is ill or not. It is a rudimentary tool, but it works. It may not provide a complete diagnosis, but it can signal to clinicians that the patient needs help.

It appears the nation took this “eye test” during a presidential debate in June and an assassination attempt in July — and we determined that more information was needed. After the debate, party leaders, the public (especially donors), and the media scrutinized President Biden’s health. Without clear information about his health, calls for his resignation were dismissed. Meanwhile, the Trump campaign kept the public in the dark for days after the assassination attempt on former President Donald Trump, refusing to discuss his health or release a medical report.

Ultimately, President Biden has decided not to seek a second term, but that doesn’t diminish the public’s need to know the health of his presidential candidates. Right now, the focus is on Trump and Vice President Kamala Harris and their running mates, Sen. J.D. Vance (R-Ohio) and Minnesota Gov. Tim Walz (D). This information should not be used to discriminate, but to ask legitimate questions about each other’s fitness to lead a nation.

This is not the first time that public opinion has been questioned about its leaders.

In the past, the public was not informed about the health problems of their elected officials. For example, President Franklin Delano Roosevelt was paralyzed by polio, but this was masked by images of Roosevelt standing or sitting with others around a table or in a car. His condition was largely invisible in the media, and the narrative continued to be that of a man who had overcome his disease.

President John F. Kennedy suffered from Addison’s disease, a serious condition requiring corticosteroids. In the early 20th century, sufferers were considered to be on death row. However, in a 1959 interview as Kennedy was campaigning for president, he denied having the disease. He reportedly said, “Nobody with real Addison’s disease should run for president, but I don’t have it.” It is notable that patients with the disease can have a tanned skin color due to increased melanin production; his administration cleverly used his dark skin as a sign of vigor and athleticism rather than disease.

President Ronald Reagan may have begun to develop signs of Alzheimer’s disease during his second term. As an actor, his ability to read scripts with emotion may have helped him communicate with audiences without appearing cognitively impaired.

But in this day and age, public opinion is inclined to be on the lookout for any suspicious element concerning the health and fitness of their candidates to run for office. This could have positive consequences, and lead to a more open debate about the level of health required to exercise the presidential office.

This speech should not be punitive, but should be based on realistic ideas about what the public expects from their elected officials, particularly presidents and vice presidents. Physical challenges can often be overcome with assistive devices and other technology. However, good executive functioning and emotional intelligence are essential to succeed in this role and ensure public trust in their leaders. It is not unreasonable to expect a president to be able to analyze complicated scenarios, make informed decisions, and communicate clearly and with empathy.

It is imperative that mental status and comprehensive cognitive testing be included in the physical examinations of all candidates. This is especially important for senior officials who make decisions that may impact the safety and well-being of the public. Requiring all candidates to undergo standardized assessments would help prevent ageism and political party influence.

However, it is important to remember that patient privacy is sacred. There are laws in place to protect our medical information, such as the Health Insurance Portability and Accountability Act (HIPAA). Healthcare professionals must follow strict guidelines. Healthcare systems are designed to accommodate these restrictions, including access to electronic medical records.

So where are we with the release of presidential evaluations and medical records? Here’s an analogy to support my proposition:

In medicine, physicians have a legal, moral, and ethical responsibility to report to their state’s health and regulatory authorities if they observe that their colleagues have a physical and/or psychological impairment.

The Federation of State Medical Boards has issued an official statement on what should be reported and how it can be done confidentially. Yet, research published in 2010 showed that 17% of physicians surveyed had direct personal knowledge of a fellow physician who was incompetent to practice medicine in their hospital, group, or practice, and of those who did have this knowledge, only 67% reported their disabled colleagues to authorities. Reporting colleagues can be emotionally difficult, but it must be done not only to help the colleague, but also for the safety of one’s patients.

Imagine that the president is the doctor and the public is the patient. If the doctor is in trouble, the patient’s life is in danger. Decisions made by the doctor can harm the patient.

My proposal is to create an independent, nonpartisan commission that would require all presidential and vice presidential candidates to submit their complete medical records, which would be shared with the public when alarming situations arise. There would need to be an impartial discussion about how much information should be released and by whom.

The Hippocratic oath to “do no harm” should apply to everyone, including our leaders.

Saralyn Mark, MD, is the former Senior Medical Advisor to the White House, HHS, and the National Aeronautics and Space Administration (NASA). She is the lead for COVID-19 and health innovation at the American Medical Women’s Association. Mark is the Founder/President of iGIANT (Gender/Sex Impact on Innovation and New Technologies) and SolaMed Solutions. She is the author of Stellar Medicine: A Journey Through the Universe of Women’s Health and host of the “Still searching” podcast.