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The Dreaded Medical

by Bill Cuccinello
Reprinted with permission from Bill Cuccinello

We all know the feeling. Sheer fright. That time of year when we take the physical to renew our medical to prove that we are still fit to fly. And with the physical comes all the stress and anxiety that we bring to the aviation medical examiner's (AME) office.

Why are we so concerned, and what do we do about it?

Well, for some pilots who fly for a living, it means their careers. For others, it may simply mean getting their wings clipped.

To answer the many questions surrounding the dreaded physical and to get more information as to what to do should something go wrong during the physical, we decided to go directly to a FAA Regional Flight Surgeon, Dr. Paul Clark, located at the FAA Regional Office in Burlington, Mass.

Just mentioning the Regional Flight Surgeon normally sends shivers up a pilot's spine. Somehow, we think of the Flight Surgeon as a huge ogre who sits high above in an ivory tower, much like the Grand Oracle of Delphi, and dispenses simple yes's or no's, and mostly no's on your medical. How surprised we were! No way, no how is this true.

After meeting Dr. Clark, you realize how wrong we have been. We found him not only to be exceptionally knowledgeable regarding aviation physicals but very compassionate regarding pilot problems.

But it's understandable. He comes from a 'flying family.' His father was a top executive with a regional airline. He had two brothers who flew'-one retired from Delta Airlines'and a sister who recently retired number-one in seniority as a flight attendant for Air Canada.

Dr. Clark, originally from Prince Edward Island, served with the Canadian Air Force. He moved to Portland, Maine, in 1978, where he practiced medicine and later, in 1982, became an aviation medical examiner for the FAA. In 1989, he moved to Nashua, NH, as Flight Surgeon at the Boston Center.

There are nine regional flight surgeons in the country, each responsible for the review of questionable medicals in their respective region. The medical certification review program in the regions was recently increased by the Federal Air Surgeon to help alleviate the tremendous workload handled by the medical division in Oklahoma City. The Federal Air Surgeon, Jon L. Jordan, M.D., J.D. recently established a major step, in an additional effort to reduce the delay in medical certification. Entitled Aviation Medical Examiner-Assisted Special Issuance (AASI), Aviation Medical Examiners (AME) are now allowed to issue and reissue Special Issuance medicals for about 20 medical conditions after initial approval from FAA officials. This should help reduce the backlog in Oklahoma City and allow pilots with relatively simple Special Issuance problems be approved on the spot in the AME's office.

Recently, Dr. Clark was among seven medical officers that underwent 28 hours of intensive work in Oklahoma City, generating 724 medical review decisions for airmen pending needed medical authorization to fly. This 'Tiger Team,' as it is called, is an elite group of highly qualified experts that tackle time-sensitive problems. The Medical Certification Division Manager, Dr. Warren Silberman, initiated the program to improve customer satisfaction by reducing a backlog of cases. The intensive effort highlights another step in the FAA's commitment to service medical certification.

When asked what pilots could do to expedite their physical, Dr. Clark replied, 'If you feel you have any medical problems such as high blood pressure, eyesight, or other problems, it's normally a good idea to see your own doctor first to assess your condition, and if necessary, resolve the condition before you meet with the AME. Oftentimes, your doctor can write a letter, which will explain the situation. It'll certainly facilitate any paperwork with the FAA you might have to encounter.

'Some people become anxious about the examination, and this, too, tends to raise blood pressure. It's the  'white coat syndrome.' In some individuals, anxiety can raise the pressure substantially. Pilots who tend to become apprehensive should tell the AME promptly. It allows the doctor to take multiple measurements for a more accurate reading. This is especially important when visiting a new doctor.

'Many pilots face this problem each year as their medical expiration date rolls near. The problem is twofold. First, aviation is one of the few professions that require medical certification on an annual basis to perform the job. Lose your medical and you lose your livelihood. That, in itself, creates a lot of pressure. Second, pilots tend to be controllers. Pilot personalities reveal that pilots are strong willed leaders who like to be in charge. They like to be in control of day-to-day situations, and that trait is denied when a pilot walks into the doctor's office. Now someone else is in control, not only of the exam, but of his or her future as well.'

Dr. Clark continues, 'If you have questions, you can always go to our web site, http://ame.cami.jccbi.gov. That's the main site for the FAA Office of Aerospace Medicine, Civil Aerospace Medical Institute (CAMI). There's a wealth of information available there in addition to other FAA web sites.'

The AOPA site also has a section on drugs or pharmaceuticals that are allowed while flying. Oftentimes, AMEs may not be able to answer medically related flying questions. As Dr. Clark says, 'If your AME is not able to answer your question, feel free to call your Regional Flight Surgeon direct. There are always modifications or changes being made, and usually the flight surgeon is kept abreast of them.'

One important aspect pilots should appreciate' Regional Flight Surgeons don't like to 'clip the wings' of pilots. They realize many pilots depend on their physicals for their livelihood, while others simply enjoy the excitement of flying in the wild blue.

'If your medical is denied,' suggests Dr. Clark, 'don't just automatically call it quits if you're intent on flying. Pursue it. Check to see what must be done to rectify the situation.'

'Only 0.7% of all airmen are denied certification. This is reduced to less than one-half of one percent when airmen follow up and provide the requested information, certainly far better than the figures for life-insurance applicants. With approximately 450,000 pilot exams per year, that's a pretty good record.'

'However,' as Dr. Clark explains, 'there may be a time when we have to call it quits. If, at any time, you feel your reflexes are not up to par or you experience any type of dizzy spells or strange feelings, perhaps it's time to reassess your health. Safe flying demands a pilot with good, proficient skills and a healthy condition.'

'Remember,' he continued, 'only you know how you physically feel. If you - re tired or stressed out, or if you've been taking 'meds' that are disqualifying, don't fly. Use your good pilot judgment to decide if you're safe to fly that day.'

Dr. Clark went on to say, 'If you have some specific medical problems and need more information, start with your AME. A list of AMEs can be found on our CAMI web site.' In addition, the Aviation Safety Counselors of New England list the regional AMEs on their web site.

Many pilots question eyesight surgery. Any vision corrective surgery must be reported, if it has potentially adverse effects with flying duties. That also includes lens implants. A report of your eye evaluation should be presented to your AME. If you were to seek a commercial rating, in the past there were certain vision standards for a Class-II medical, but now there are no uncorrected limits, providing your eyesight is correctable to 20-20.

Many other cases require [that] you discuss medical issues with your AME, such as benign positional vertigo, prostate cancer, diabetes mellitus. In short, discuss any questions you might have with your AME prior to the physical. If in doubt, you can always call the Regional Flight Surgeon.

Recently, the Sport Pilot ruling came into effect, stating that only a driver's license is needed for a medical. But if you have [had] a denial, the Sport Pilot rule states that if an individual's most recent application for an FAA medical certificate has been denied, suspended, or revoked, that person may not use a driver's license as a medical certificate until the denial is cleared from the record.

Many conditions causing denial in the past are no longer cause for denial. An estimated 80% of all denials are simply caused by the applicant not correctly providing all the paperwork or medical tests requested. These can be corrected simply by providing the missing information. Once the record is cleared by the issuance of a medical certificate, the applicant never need go through this again but can use the valid drivers license in lieu of a medical certificate.

And as we are all aware, gliders (including motor gliders) and balloon licenses do not require a medical or driver's license.

So if you lose your medical, it may not necessarily mean that you must give up flying. Remember, if your medical is denied, you have the right to appeal. But a denial by the AME is not a denial by the Administrator, whereas a denial by the Federal Air Surgeon, the Manager of the Certification Division in Oklahoma City, or the Regional Flight Surgeon is considered a denial by the Administrator. Incidentally, if you are denied, you must (apply) request reconsideration of the denial within 30 days; otherwise, it is considered you accept the denial and are withdrawing the application. Further information can be found in Title 14 Code of Federal Regulations Part 67, which outlines the appeal process for applicants who are denied medical certification.

So as we mentioned, the dreaded physical doesn't really have to be dreaded after all. There are many ways to fare better during the AME's examination. If you have a problem, contact your regular doctor first to rectify the situation or have him write a letter to the AME describing your plight. If in doubt, p resent the question to the Regional Flight Surgeon's office.

As one pilot recently said to me as we flew along, 'We are the luckiest people in the world. Here we are, at our age, doing exactly what we want to do'enjoying the freedom of the skies, the scenery below'and still on our way to that one hundred dollar cup of coffee. What a wonderful life!'

This article is reprinted with permission from Bill Cuccinello of the Hanscom Beacon, a quarterly newsletter for 'pilots, mechanics, and anyone connected with aviation' in and around Hanscom Field. Located about 20 miles northwest of Boston, MA, Hanscom Field is part of the towns of Bedford, Concord, Lexington, and Lincoln, world-renowned for their rich colonial history and tradition. On its south side, the airfield is bordered by one of the Commonwealth's most important sites, Minute Man National Historic Park.