‘The report of my death was an exaggeration.’ — Mark Twain, 1835 -1910
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
It has been a challenging week for me in my interactions with American institutions. I had a primary care appointment for my annual checkup and to manage my ongoing respiratory issues related to burn pit exposure. I fancy myself savvy in how the healthcare system works (and how it does not), so I used the Johns Hopkins MyChart system to request my routine blood work before my visit. This electronic medical record and communication system performed flawlessly, and my labs were ordered a week before my appointment. I was feeling rather smug concerning my patient prowess after reviewing my results and having the opportunity to inquire about some abnormal values via MyChart. The day arrived for my clinical visit, and I wanted to double-check the appointment time, so I logged on to my trusted electronic medical record. MyChart informed me that my account had been disabled.
This unpleasant information resulted in a few hours of phone calls to determine why I had been placed in medical record purgatory. When I was finally transferred to an individual who could review my electronic record status, I was sheepishly informed that my record had been disabled, because the computer indicated I was deceased. To my credit, I had remained calm throughout the phone marathon, only to learn that I was pronounced electronically dead. I informed the kind gentleman I was still very much alive and having difficulty not being angry about the whole situation. I was then told that my appointment for that day had automatically been canceled because I was dead, of course. The irony and humor overwhelmed me at this point, and I could not help but parrot Mark Twain’s quote above. Kudos to the Johns Hopkins computer team humans who resurrected me (electronically) in just a few hours and found me another appointment the following day. As disconcerting as my sudden untimely demise was, at least it was humorous and makes for an excellent bar stool story. Even my primary care doctor commented on how good I look for a dead person.
Notwithstanding the issues brought on by my computer execution, this week’s genuinely horrifying institutional occurrence, not funny at all, was the Supreme Court of the United States decision on July 1, 2024, granting former President Donald Trump presumed absolute immunity for official acts (Donald Trump vs. The United States of America). Specifically, Chief Justice John Roberts wrote, “The President therefore may not be prosecuted for exercising his core constitutional powers, and he is entitled, at a minimum, to a presumptive immunity from prosecution all his official acts.” For the first time since our country’s founding, an American citizen is above the law because of their position in government. From my perspective, the Supreme Court, through this ruling, has given us the king we fought so hard to free ourselves from.
Why should you be concerned about these seemingly disparate issues? Simply put, words matter, and ignorance of those words will be no excuse. I believe my electronic death was caused by a nonmalevolent individual tasked with cleaning the electronic records of patients who had expired. At one time in America, there were three men named Chester Church Buckenmaier. My father passed away a few years ago, and I have been mistaken for him (physically and electronically) for years. It was an understandable mistake and a simple moment of inattention by the computer technician that led to hours of inconvenience and grief on my part. I have recovered from my premature departure from life, thank you. Precision in the meaning of language, whether in the medical records or patient conversations, is critical to good federal medicine. It also is crucial in managing a democracy.
The Supreme Court’s words are far more concerning regarding federal medicine practice. The president is also the commander-in-chief of the military. Early in my career as an officer, military instructors drilled into my ethos that I was duty-bound to disobey an unlawful order. To understand what an unlawful order looks like, check out the Vietnam My Lai massacre. With the Supreme Court’s ruling, a president could, as an official act, demand practically anything from federal practitioners and remain immune from prosecution. Of course, other than the president, any official following those orders will have no immunity. Now that this ruling has fundamentally changed the nation’s Constitution, how do federal officers resist an unlawful order originating with the president (or should I say king)?
I imagine many readers are scoffing at this editorial, damning me for such raw hyperbole. For our democracy to survive, an informed and engaged electorate is imperative. Every citizen is responsible for participating in the government they elect. This responsibility is even greater for those who work in government and receive a paycheck from taxation. Like many who consume this column, I have spent my career protecting and defending the Constitution of the United States, never a king or monarch. I have only one weapon left in this latest attack on our democracy: my vote. I will vote in November to preserve the rule of law governing every American citizen, including the citizen president (king?).
The opinions expressed here belong solely to the author and are not necessarily those of U.S. Medicine, the United States government, or any of its agencies.