What Does It Mean That the Doctor Who Wrote the Trump Medical Letter “thought about it all day”?

Well, maybe he’s just careful.  Or maybe he was deeply torn, because he knew, for whatever reason, that he could not tell the truth, so put it off and off, swinging back and forth between refusing to do it, telling the truth, or writing obvious soviet dissident “confession” style hyperbole.

I have wonderful doctors, but I really doubt that when they write something about me, they have to “think about it all day.”  Or at least, if and when they do, whether it comes out like this letter did.  Maybe I should check!