Four days after a gunman's attempt to assassinate former US president Donald Trump at a Pennsylvania rally, the public is still in the dark over the extent of his injuries, what treatment the Republican presidential nominee received in the hospital, and whether there may be any long-term effects on his health.

Trump's campaign has refused to discuss his condition, release a medical report or records, or make the doctors who treated him available, leaving information to dribble out from Trump, his friends and family.

The first word on Trump's condition came about half an hour after shots rang out and Trump dropped to the ground after reaching for his ear and then pumped his fist defiantly to the crowd with blood streaming down his face. The campaign issued a statement saying he was “fine" and “being checked out at a local medical facility.”

“More details will follow,” his spokesperson said.

It wasn't until 8:42 pm, however, that Trump told the public he had been struck by a bullet as opposed to shrapnel or debris. In a post on his social media network, Trump wrote that he was “shot with a bullet that pierced the upper part” of his right ear.

“I knew immediately that something was wrong in that I heard a whizzing sound, shots, and immediately felt the bullet ripping through the skin,” he wrote.

Presidents and major-party candidates have long had to balance their right to doctor-patient confidentiality with the public's expectations that they demonstrate they are healthy enough to serve, particularly when questions arise about their readiness. Trump, for example, has long pressed President Joe Biden to take a cognitive test as the Democrat faces doubts after his stumbling performance in last month's debate.

After a would-be assassin shot and gravely wounded President Ronald Reagan in 1981, the Washington, D C, hospital where he was treated gave regular, detailed public updates about his condition and treatment.

Trump has appeared at the Republican National Convention the past three days with a bandage over his right ear. But there has been no further word since Saturday from Trump's campaign or other officials on his condition or treatment.

Instead, it has been allies and family members sharing news.

Rep. Ronny Jackson who served as Trump's White House doctor and travelled to be with him after the shooting, said in a podcast interview Monday that Trump was missing part of his ear — “a little bit at the top" — but that the wound would heal.

“He was lucky," Jackson said on “The Benny Show,” a conservative podcast hosted by Benny Johnson. ”It was far enough away from his head that there was no concussive effects from the bullet. And it just took the top of his ear off, a little bit of the top of this ear off as it passed through."

He said that the area would need to be treated with care to avoid further bleeding — “It's not like a clean laceration like you would have with a knife or a blade, it's a bullet track going by," he said — but that Trump is "not going to need anything to be done with it. It's going to be fine.”

The former president's son Eric Trump said in an interview with CBS on Wednesday that his father had had “no stitches but certainly a nice flesh wound.”

The lack of information continues a pattern for Trump, who has released minimal medical information throughout his political career.

When he first ran in 2016, Trump declined to release full medical records, and instead released a note from his doctor that declared Trump would be “the healthiest individual ever elected to the presidency.”

Dr Harold Bornstein later revealed that the glowing, four-paragraph assessment was written in 5 minutes as a car sent by Trump to collect it waited outside.

Jackson, after administering a physical to Trump in 2018, drew headlines for extolling the then-president's “incredibly good genes” and suggesting that “if he had a healthier diet over the last 20 years he might live to be 200 years old.”

When Trump was infected with the coronavirus in the midst of his 2020 re-election campaign, his doctors and aides tried to downplay the severity of his condition and withheld information about how sick he was and key details of his treatment.

Former White House chief of staff Mark Meadows wrote in his book that Trump's blood oxygen dropped to a “dangerously low level" and that there were concerns that Trump would not be able to walk on his own if he had waited longer to be transported to Walter Reed for treatment.