Does a 3rd Class Medical do more harm than good?

Old Geek

Old Geek

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Old Geek
I've been wondering about that for a long time.

Does the need to report and jump through hoops discourage pilots from getting minor medical stuff taken care of? Specifically, what about blood pressure? The latest propaganda says your BP should be no more than 80/120. That's miles away from the FAA max of 95/155. I've read the FAA hypertension page and I understand what they are saying. OTOH, it seems that there are probably many pilots flying with mild hypertension and delaying treatment because their hypertension isn't bad enough and they don't want to go through the risk, hassle and expense of the tests.

There are other examples I can think of. Anyone else have thoughts on this?
 
My father almost died from blood pressure medications. His doctor gave him six months to live and he just quit using them. Then he made a miraculous recovery. Yeah he has blood pressure well over what the books say it should be but he's alive now. And no, nobody in the family has ever died from hypertension, stroke, heart attack or some other root cause of high blood pressure.

This is stupid. I'll give up my certificate before I will let myself fall in to that trap.
 
My back of the envelope study of crashes of powered versus gliders is that you're as likely to have a incapacitation accident in situations that require a third class as otherwise.

This means the 3rd class is either completely useless because the incidence of pilot incapacitation is such a statistically insignificant occurrence OR that it's such a lousy screen that pilots are getting in trouble even with it. Either way in my opinion it should be abolished as a waste of taxpayer money and effort/
 
At the very least you can argue it provides a set of health standards for us to keep in mind. I don't see it so much as a worry of incapacitation (expiring or passing out) but checking for conditions that interfere with perception & judgement.

Besides, without visiting the AME how would I get to hear "Let me make a note of your scars in case they have to ID your body." (really, he said that)
 
Yes.

I am discouraged from getting any checkups at all. Don't want to report having seen a Dr. for any reason. The questions make it sound like there is something wrong with you because you may have seen a Dr for a cough or something else regardless of how minor.
 
Sadly I would have to agree. Being part of the under-40 crowd with the longer timeframes on Medicals has the down side of trying to remember every damn time you went to the Doc for even a round of antibiotics to kick a nasty cold, or risk the beureacracy in OKC finding an unreported Doc visit even if you properly self-grounded and played by all the rules otherwise.

Not worth it. I'll just suffer at home in bed for an extra day unless it turns into full-blown pneumonia. Then I'll spend a month trying to find the exact date to put on the medical form three years later. Sigh.
 
Or do as I do - be required to see your doc every three months in order to retain your 3rd class medical, and thus always have a good reason to visit :)

(insulin-dependent diabetes ends up on the opposite side of extreme)
 
flyingron said:
My back of the envelope study of crashes of powered versus gliders is that you're as likely to have a incapacitation accident in situations that require a third class as otherwise.

This means the 3rd class is either completely useless because the incidence of pilot incapacitation is such a statistically insignificant occurrence OR that it's such a lousy screen that pilots are getting in trouble even with it. Either way in my opinion it should be abolished as a waste of taxpayer money and effort/
Click to expand...

What we don't know is the number of people who do not fly because of they cannot meet even the 3rd class requirements. And of those people, the rate of incapacitations that could have caused an aircraft accident if they had been flying.
 
Bob Noel said:
What we don't know is the number of people who do not fly because of they cannot meet even the 3rd class requirements. And of those people, the rate of incapacitations that could have caused an aircraft accident if they had been flying.
Click to expand...

Glider and LSA data suggests no difference.
 
Bob Noel said:
If you assume that Glider and LSA pilots are a representative subset.
Click to expand...

Which they probably are not. I belive that it is safe to assume that at leas some glider and many (most?) LSA pilots would be individuals who are likely to have a problem getting a 3rd class medical for one reason or another. And, yet, we don't appear to be falling out of the sky for medical reasons.

Now LSA's and gliders do have a poorer safety record, but more due to issues with flying, not medical - as you may be aware, most glider landings are dead stick, and LSA's tend to be lighter than your typical Bo and need to be handled differently.
 
Capt. Geoffrey Thorpe said:
Which they probably are not. I belive that it is safe to assume that at leas some glider and many (most?) LSA pilots would be individuals who are likely to have a problem getting a 3rd class medical for one reason or another. And, yet, we don't appear to be falling out of the sky for medical reasons.
Click to expand...

But we don't know how many with medical issues don't try to fly gliders and LSA's.

I know that if I failed my 3rd class medical, I wouldn't fly gliders or an LSA.
 
Absolutely, I have a great Dr. who has been watching me for 20 years. I trust him and he is very good. Having said that, he has made a couple recommendations that I have not complied with purely to avoid drama with the FAA bureaucracy. I’m not dead, so it hasn’t really harmed me I guess, but it certainly seems odd that a doctor that has never examined me trumps the doctor that knows me well in the eyes of the bureaucrats.
 
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If you assume that Glider and LSA pilots are a representative subset.
Click to expand...

The first round of light sport enthusiasm was fueled by quite a few old, well-off pilots that either couldn't or didn't want to deal with medicals. As others have said, they don't appear to be falling out of the sky.
 
I'm relatively young, early 40's and decided since I mostly fly gliders and LSAs and am unamused by spam cans, I let my medical lapse. Right now I could renew easily, on the other hand I can get a script for prozac, ambien, and adderrall if so inclined. That would eliminate/complicate getting a medical in the future but that doesn't concern me. I only go to the doc once a year but it sure is nice not having to care about reporting it. People respond to incentives and the worse medical reporting gets the more people are going to opt out or never start, even if they can easily pass.
 
Old Geek said:
I've been wondering about that for a long time.

Does the need to report and jump through hoops discourage pilots from getting minor medical stuff taken care of? Specifically, what about blood pressure? The latest propaganda says your BP should be no more than 80/120. That's miles away from the FAA max of 95/155. I've read the FAA hypertension page and I understand what they are saying. OTOH, it seems that there are probably many pilots flying with mild hypertension and delaying treatment because their hypertension isn't bad enough and they don't want to go through the risk, hassle and expense of the tests.

There are other examples I can think of. Anyone else have thoughts on this?
Click to expand...
Good luck if you can't meet 155/95. The Framingham data show a 4 fold increase in MI and stroke if you let it run that range.

There is basically no risk nor hassle. You go to your doc once per year. You get put on a $18/month ACE inhibitor, and the doc will rightly get an EKG and three lab tests. All you need in subsequent 2 years is the doc's letter.

If you won't do that much, good luck on not ending up like Rose Kennedy.
If you can get it controlled below 130/80, you can cut the risk another twofold.

Sigh.

LightandSportyGuy said:
Glider and LSA data suggests no difference.
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You've been drinking the Kool Aid provide by EAA and AOPA. There are actually several medical incapacitations. The latest guy in my district crash landed during the middle of his MI Dec ~7. He died at Northwestern Hospital about 2 weeks ago, from Congestive Failure.

You're right, there as yet no statistically significant evidence that LSA rates are similar. P on that is about ~.70 last I was told. Not too hot yet.
 
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Bob Noel said:
What we don't know is the number of people who do not fly because of they cannot meet even the 3rd class requirements. And of those people, the rate of incapacitations that could have caused an aircraft accident if they had been flying.
Click to expand...

What we don't know is how many "accidents" could have been prevented if pilots had been able to seek appropriate treatment without losing their medical.

Denial only works up to a point.
 
bbchien said:
You've been drinking the Kool Aid provide by EAA and AOPA. There are actually several medical incapacitations. The latest guy in my district crash landed during the middle of his MI Dec ~7. He died at Northwestern Hospital about 2 weeks ago, from Congestive Failure.
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I only drink water and milk (once a day at breakfast). :wink2:

I can't find anything like this in the NTSB data base - I assume because the accident itself was not fatal?
 
Henning said:
Most people use separate PCP and AMEs so they can lie to the AME.
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When the government is paying for your primary care (medicare) with all the associated documentation in their records, it could be a little risky to lie to the AME.
 
Graueradler said:
When the government is paying for your primary care (medicare) with all the associated documentation in their records, it could be a little risky to lie to the AME.
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Yep, or collecting disability... That doesn't apply to the majority of pilots though. Then again, there are AMEs out there that you don't have to lie to, they lie for you.
 
bbchien said:
There is basically no risk nor hassle. You go to your doc once per year. You get put on a $18/month ACE inhibitor, and the doc will rightly get an EKG and three lab tests. All you need in subsequent 2 years is the doc's letter.
Click to expand...

Mine's a $4.00 per thirty days generic. It's worked superbly for 21 years.
 
Happy to be flying with P of A, I'm new.

As a naturally focused physician I agree that the typical standards for things such as BP 120/80 etc are ridiculous.

However, the much bigger problem is that most are so truly unhealthy and medicated to begin with, and that our medical system does not focus on true health at all.:nono:

I think all pilots such undergo true health and healing through which most of these much less meaningful than we think health markers (BP, cholesterol, etc.) and the need for dangerous and toxic medications would disappear!

When I was flying my awesome Col400 I know that while one gets comfortable in any plane at a certain skill level, you'd better be healthy and unmedicated when you're flying at 100knots or 500knots!

Be well and enjoy the skies fellow pilots:thumbsup:
 
Bob Noel said:
What we don't know is the number of people who do not fly because of they cannot meet even the 3rd class requirements. And of those people, the rate of incapacitations that could have caused an aircraft accident if they had been flying.
Click to expand...

And the other side of that same coin are the ones that continue to fly with no medical at all, they just don't bother with any paperwork at all. Turns out the airplane doesn't know the difference...
 
dr.edward said:
Happy to be flying with P of A, I'm new.

As a naturally focused physician I agree that the typical standards for things such as BP 120/80 etc are ridiculous.

However, the much bigger problem is that most are so truly unhealthy and medicated to begin with, and that our medical system does not focus on true health at all.:nono:

I think all pilots such undergo true health and healing through which most of these much less meaningful than we think health markers (BP, cholesterol, etc.) and the need for dangerous and toxic medications would disappear!

When I was flying my awesome Col400 I know that while one gets comfortable in any plane at a certain skill level, you'd better be healthy and unmedicated when you're flying at 100knots or 500knots!

Be well and enjoy the skies fellow pilots:thumbsup:
Click to expand...

Welcome to PoA, Doc.

Where do you fly?
 
Greetings Stan-

My brief history...initial 40 hours 1999 4th year med school in Traumahawk (half of that year a BIG waste of time and money!), didn't finish up until horrible commercial island flying experiences in 2006-7. Private 5/08, IFR 8/08, Comm 7/10. 2/3 through MEL but waiting for the real need to finish.

Spoiled rotten in a 2006 Col400 flew as far as Lethbridge, CN to Crooked Island, BH. Amazing plane.

Right now staying active in a couple Saratogas with local FL, GA, and BH flying.


;)
 
dr.edward said:
Happy to be flying with P of A, I'm new.

As a naturally focused physician I agree that the typical standards for things such as BP 120/80 etc are ridiculous.
Click to expand...
The standard is <155 systolic, <95 diastolic. Not ridiculous.
However, the much bigger problem is that most are so truly unhealthy and medicated to begin with, and that our medical system does not focus on true health at all.:nono:

I think all pilots such undergo true health and healing through which most of these much less meaningful than we think health markers (BP, cholesterol, etc.) and the need for dangerous and toxic medications would disappear!

When I was flying my awesome Col400 I know that while one gets comfortable in any plane at a certain skill level, you'd better be healthy and unmedicated when you're flying at 100knots or 500knots!

Be well and enjoy the skies fellow pilots:thumbsup:
Click to expand...
FAA is not about your health. It is about having a disabling failure during the certification period.

But I do agree there is excess conservatism, mostly because the senior regulatory docs have never had to see patients in their lives. The conversation is,

ME: "this is a benign disease state currently and progress very slowly"
Them: "I've read about it".

sigh.
 
Understood 155/95 may be the exam cutoff, 120 / 80 for good resting pressure (in a doctors office but both bogus in my viewpoint) but my point is they are not able to truly identify a potential crisis on their cursory exam as more than half of cardiovascular or other events occur in patients / pilots who have no history / evidence of CV issues. So BP alone, and the entire exam in general, is very poor in finding the risks of an acute event as all are destined for them these days, and hopefully not while several miles up controlling a very complex and FAST machine!

To truly get ahead of the curve and prevent dangerous acute events while piloting, exams and healthcare in general need to be completely refocused in their accuracy, completeness (homocysteine, C Reactive Proteins?) and effects on preventive and restorative health goals and education in general.

The solution? I believe an exam is absolutely needed. But as does the entire medical system, we need to refocus our efforts on uncovering true health issues far upstream of acute events and help our patients and pilots easily regain truly enjoyable natural health and avoid the increasing illness and emergency risks comprehensively.

I appreciate your reply! :D
 
Understood 155/95 may be the exam cutoff, 120 / 80 for good resting pressure (in a doctors office but both bogus in my viewpoint) but my point is they are not able to truly identify a potential crisis on their cursory exam as more than half of cardiovascular or other events occur in patients / pilots who have no history / evidence of CV issues. So BP alone, and the entire exam in general, is very poor in finding the risks of an acute event as all are destined for them these days, and hopefully not while several miles up controlling a very complex and FAST machine!

To truly get ahead of the curve and prevent dangerous acute events while piloting, exams and healthcare in general need to be completely refocused in their accuracy, completeness (homocysteine, C Reactive Proteins?) and effects on preventive and restorative health goals and education in general.

The solution? I believe an exam is absolutely needed. But as does the entire medical system, we need to refocus our efforts on uncovering true health issues far upstream of acute events and help our patients and pilots easily regain truly enjoyable natural health and avoid the increasing illness and emergency risks comprehensively.

I appreciate your reply! :)
 
Dr. Bruce, meet Dr. Bruce Chien. ;)

Already enjoying reading what two Docs think about things. ;) ;) ;)
 
There's no difficulty here. Everyone knows American Medicine is essentially bass-ackwards. "I'm fine, and don't need a thing" and the guy wonders when he has his MI why there was no warning.......

Do you want fries with that?
Do you want to Supersize that?

"on and on, on and on, on and on...."

The FAA makes no pretense about your health. They just want to know if it's going to fail in the next 1 year, 2 years, or five years.
 
Agreed, but the ridiculous and scary part is that even WITH exams 50% of initial acute / emergent events are without warning.

ie. the elite runner who was a sudden myocardial infarction (heart attack). Or the thin person who all of a sudden is found to have 3-5 vessel disease.

They are not trained to look deeper in side the body for the true signs of developing illness, and then correct and empower the patients to avoid the epidemics of all cause chronic illness.

And make it scientific, but natural, and easy, and even fun. Its fun to be healthy. Its not fun to be sick, tired, and obese. Heck most of these planes (that I fly anyways) aren't THAT big. I'm not a huge guy, 5'9" and 175 in shape, and don't know how anyone much bigger is comfy in that left seat. Much less thinking clearly and sharp if not truly healthy and / or off medications.

ps just got into a cherokee -6 club here at beautiful KSUA, excited :p
 
airguy said:
And the other side of that same coin are the ones that continue to fly with no medical at all, they just don't bother with any paperwork at all. Turns out the airplane doesn't know the difference...
Click to expand...

Yep, that doesn't include the rest who never got a medical or license to begin with, they just own a plane and fly it.
 
bbchien said:
The standard is <155 systolic, <95 diastolic. Not ridiculous.
FAA is not about your health. It is about having a disabling failure during the certification period.

sigh.
Click to expand...

Thank you for pointing that out again.
 
airguy said:
And the other side of that same coin are the ones that continue to fly with no medical at all, they just don't bother with any paperwork at all.
Click to expand...

Yep. I've actually had the pleasure to be standing on the ramp after a couple of those types landed their airplane. :rolleyes:

airguy said:
Turns out the airplane doesn't know the difference...
Click to expand...

Plane doesn't need to know the difference. ;)
 
Henning said:
Yep, that doesn't include the rest who never got a medical or license to begin with, they just own a plane and fly it.
Click to expand...
When I was looking, at least a couple of the airplanes I looked at were operated that way. (One guy did end up getting his ticket after the NTSB caught on...)
 
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