Former President Barack Obama’s once-longtime doctor said the medical records Joe Biden’s campaign disclosed are concerning and incomplete.

“He’s not a healthy guy,” Dr. David Scheiner, who was Obama's personal physician for 22 years before he became president, concluded after reading the records . “He’s not in bad shape for his age, but I wouldn't say he’s in outstanding health. Could I guarantee he won't have issues for the next four years? He has a lot of issues that are just sort of sitting there.”

A three-page letter from Biden’s physician concluded the former vice president is a “healthy, vigorous, 77-year-old” that is fit to be president. But the letter also revealed Biden receives treatment for an irregular heartbeat and high cholesterol and that he deals with acid reflux and seasonal allergies. It noted his already known history of aneurysms and that he took blood thinners.

The details from the letter made Scheiner, 81, concerned about Biden’s potential for strokes, and he said he would want to see results from an MRI or CT scan. Because Biden also used to have sleep apnea before getting surgery on his sinus and nasal passages, Scheiner said he would also like to review the results of a sleep study.

The report doesn’t mention an MRI despite the fact that Biden had two brain aneurysms in 1988, the first of which almost killed him. Earlier this year, the Washington Examiner interviewed Biden’s former surgeon, who vouched the 2020 front-runner was in the clear.

But the latest health information doesn’t mention details of any checkups that likely occurred to screen for future issues. The report also included mention of surgeries that hadn’t been previously disclosed, including one for an enlarged prostate. Previously, the public only knew Biden had received treatment for the disorder.

Dr. Kevin O’Connor, who wrote the assessment, also stated that Biden had “received multiple physical therapy treatments and surgeries, for various sports medicine and orthopedic injuries” but declined to specify any further.

“I had no idea Biden had such a history. My goodness gracious, he’s got a lot of history,” Scheiner said.

Biden’s last medical records disclosure, from when he was Obama’s running mate in 2008, was 49 pages . He has faced speculation this election cycle about his age and mental capacity, including from President Trump, who has said Biden is “ not playing with a full deck .”

The most recent doctor's letter doesn’t address Biden’s vision, even though Biden blamed a contact lens mishap for his eye filling with blood during a town hall, nor does the letter address whether he has had multiple cosmetic surgeries .

Historically, presidential candidates have relied on letters from their personal doctors to disclose details of their health to the public. As a result, there’s no uniform way that a candidate’s medical information is presented to voters, and there’s no guarantee the information is complete.

For instance, former Arizona Republican Sen. John McCain made more than 1,500 pages of medical and psychiatric records available to reporters because he had a history of cancer and was a prisoner of war, but rumors about his health persisted. In contrast, Hillary Clinton released a two-page letter that omitted her weight.

During his 2016 campaign, Trump’s doctor declared he would be the “healthiest individual ever elected to the presidency.” Later, the press learned the phrase had been dictated by Trump himself, and the White House provided few details of an unscheduled visit the president made in November to Walter Reed National Military Medical Center in Bethesda, Maryland.

Scheiner said he wants to see MRI results for Trump to check for strokes, as well as a neurocognitive assessment. He raised concerns about the president’s speech pattern and behavior, saying it may be a sign of neurological damage.

“Something happened,” Scheiner said of the Walter Reed visit.

Health information from this year’s presidential field has been similarly sparse. Michael Bloomberg, 77, released records from his doctor on Dec. 12 declaring him to be in “ outstanding health ,” a phrase Scheiner called “hyperbole” because the medical records also disclosed he previously had problems with his heart and takes blood thinners.

“'Outstanding health'? With that history, I wouldn’t call it outstanding health,” Scheiner said.

Elizabeth Warren, 70, released a one-page medical report this month from her physician concluding the Massachusetts senator “ is in excellent health ” and listed a number of tests showing a normal heartbeat, cholesterol, blood pressure, and other vital signs. Unlike Biden, Warren excluded a detailed record of her medical history. Instead, her physician made a passing mention to a thyroid disorder in which medication is prescribed.

Warren’s doctor also mentioned exams such as mammogram tests and that she recently had a flu shot.

Scheiner said it seemed like Warren is in good health but said he would want more information on all of the candidates. Bernie Sanders, 78, hasn’t released his medical records yet but had a heart attack in October.

Scheiner signed off on Obama’s health ahead of his presidential campaign, and while he still believes the former president had a clean bill of health and that another assessment would have been “superfluous,” he firmly believes that all candidates for the presidency should disclose far more medical information than they do now and that it should be collected and disclosed by an independent medical panel.

“The stakes are too high,” Scheiner said. “If they make a mistake because their cognitive skills are diminished, we pay the price.”