Educate me on the aviation medical debate

SixPapaCharlie

SixPapaCharlie

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Aviation social media is ablaze with people asking for medical reform.
The common thing I hear / see is people stating that mental health is poorly addressed and the complaint I see most is pilots are avoiding mental health treatment for fear of getting grounded.

I am trying to be sympathetic but if someone is wanting to harm themselves or others, I prefer them to be grounded.

Are they grounding pilots for going to couples therapy or grieving a loss? I assume not and if so, then that is a problem.
If they are grounding pilots that really need to be inpatient, I don't have an issue with that.

So does the current system really end careers of people going in for a little bit of clarity or is this just social media blowing things out of proportion?
 
There is a fear of the unknown - of opening Pandora's box. Go in because you're down because your dog died... Now, do you need a special issuance medical?

And what if you are seriously messed up from a mental health perspective? Is being grounded going to help that?

I think pilots see participating in anything in the mental health realm as a lose/lose, at least as it relates to their flying privledges.
 
Plus... every week some 19-year old would-be pilot posts on POA "When I was 10 years old I was prescribed ADHD meds, haven't been on them for years, now what do I do?". Usually with time/$$$, the FAA hurdles can be overcome... but just seems a severe and discouraging hurdle.
 
the issue also is the complexity of mental health meds. Everyone who is on them will say they are "better" - but better in relation to whom ? Someone who isnt on them ? Because no one knows how people will act/react when on mind altering drugs, and thats what the FAA has to deal with. There is also the unknown fear of what some of these mind altering drugs can/will/possibly do to ones mental state for the long term - which no one wants to admit to, confirm/deny or address either. Its just a real mess.

So its not just "being sad" - its being said and being administered something to address that - that that becomes the issue.
 
Most of the problem, in my opinion, is ignorance.

If you’re situationally sad because your dog died of your wife was boinking the milk man then all you “should” need is someone to talk to and help gain perspective. That’s generally all good man.

If you want to go talk to a doctor and be given a pill that will make you not feel sad then get out the seat. Enjoy your time off. Pills come with diagnosis. Generally. Although thanks to the great effort of some really good docs even pills are not permanently grounding under certain specific scenarios.

Bottom line… I think it’s generally over blown but the FAA is very slow and processes to gain SI takes way too damn long but that’s more of a budget shortfall than any nefarious intent. Plus the general fear pilots have of losing their livelihood due to ignorance.

The way the FAA handles alcohol doesn’t help. Just about every pro pilot knows at least one guy getting ****ed by the alcohol policies.

Just my swag.
 
Look at what is happening with gliders and light sport aircraft where FAA medicals are not required. Flaming death raining down from the sky. Compare that with the rest of aviation where we the FAA is protecting us from things like a guy going bonkers or dropping dead at the yoke from a heart attack and you realize the true value of a third class medical and all the hoops and bureaucracy that goes with it.
 
The biggest problem IMO is the inability to correct the record. Once something gets put in your record you're screwed, even if it's totally wrong. So darn right I avoid anything that might get something put into my record. For me, (as far as you know ;) ) it's not an issue, but if I were to develop an actual dangerous mental health issue, it's less likely to get caught because of that attitude. And IMO, you're a fool if you don't hold that attitude. Which is exactly the problem IMO.
 
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The FAA is a boogyman. And the Internet is full of OWTs and bad advice. Most of the pilots I know who lie on their medicals are lying about stuff that doesn't matter. And then there are those who won't get treatment for treatable conditions because they'd rather die of something treatable than have to report a doctor's visit. There are some things the FAA is behind on, and some conditions that prevent certification that should maybe be SIs. And some that require SIs that shouldn't.

But preferring to mess with herbs that might get your BP just barely into the acceptable range instead of going to a doctor and taking real meds because you're protecting your right to put no drugs on medxpress? **** like that is 100% stupid pilot tricks.
 
Lindberg said:
The FAA is a boogyman. And the Internet is full of OWTs and bad advice. Most of the pilots I know who lie on their medicals are lying about stuff that doesn't matter. And then there are those who won't get treatment for treatable conditions because they'd rather die of something treatable than have to report a doctor's visit. There are some things the FAA is behind on, and some conditions that prevent certification that should maybe be SIs. And some that require SIs that shouldn't.

But preferring to mess with herbs that might get your BP just barely into the acceptable range instead of going to a doctor and taking real meds because you're protecting your right to put no drugs on medxpress? **** like that is 100% stupid pilot tricks.
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True, but there are many horrible stories out there that are not OWT's.
 
Salty said:
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REM also not a comment. or maybe it is exactly a comment.
 
There is mentally ill, then there is mentally ill. To start, going to get a pill because your dog died is kind of red flag IMO. Life sucks, then you die.... that's reality. If a person can't deal with what is a typical life stressor with out medical intervention, I'm not sure they are cut out to deal with the stress of being a pilot, especially a professional pilot where you have to sweat out a medical every 6 months, a schedule that really sucks when you are starting and check rides that can get you fired if you can't get it right. Note, I do not count seeking someone out to talk it out as medical intervention.

Then you get into things like adhd, ocd, clinical depression, substance dependency, things that I think of as milder illnesses (unless you are the one suffering from it) but still with a range that can be dynamic. Do we want people with these issues in the cockpit of an airliner? I have my inclinations, the answer is way above my pay grade, but I think people with these issues need to be vetted.


Then you get into the more serious mental illness IMO, like bi polar, schizophrenia, things like that. I don't think people with those issues should be flying. If you've ever lived through one of these people with these issues having an episode or crisis, you would understand.

We are all subject to having issues that can ground us, such as cardiac issues, strokes, injuries, whatever. Part of being a pilot is acting like an adult, which means seeking out help if something is up and grounding yourself, even if it can end your career.
 
Tarheelpilot said:
Most of the problem, in my opinion, is ignorance.

If you’re situationally sad because your dog died of your wife was boinking the milk man then all you “should” need is someone to talk to and help gain perspective. That’s generally all good man.

If you want to go talk to a doctor and be given a pill that will make you not feel sad then get out the seat. Enjoy your time off. Pills come with diagnosis. Generally. Although thanks to the great effort of some really good docs even pills are not permanently grounding under certain specific scenarios.

Bottom line… I think it’s generally over blown but the FAA is very slow and processes to gain SI takes way too damn long but that’s more of a budget shortfall than any nefarious intent. Plus the general fear pilots have of losing their livelihood due to ignorance.

The way the FAA handles alcohol doesn’t help. Just about every pro pilot knows at least one guy getting ****ed by the alcohol policies.

Just my swag.
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“…dog died of your wife was boinking the milk man…” Sounds like the dog could have used some therapy when he found out about the milk man and the wife. :rofl::goofy:
 
SixPapaCharlie said:
Aviation social media is ablaze with people asking for medical reform.
The common thing I hear / see is people stating that mental health is poorly addressed and the complaint I see most is pilots are avoiding mental health treatment for fear of getting grounded.

I am trying to be sympathetic but if someone is wanting to harm themselves or others, I prefer them to be grounded.

Are they grounding pilots for going to couples therapy or grieving a loss? I assume not and if so, then that is a problem.
If they are grounding pilots that really need to be inpatient, I don't have an issue with that.

So does the current system really end careers of people going in for a little bit of clarity or is this just social media blowing things out of proportion?
Click to expand...

Not just mental health, but regular health as well. I know people who prefer not to do voluntary and optional tests because if they flag an issue, it will become reportable. The belief is that it is better to keep flying until you die rather than stop flying due to a medical issue and then you die anyway.
 
PaulS said:
Then you get into things like adhd, ocd, clinical depression, substance dependency, things that I think of as milder illnesses (unless you are the one suffering from it) but still with a range that can be dynamic. Do we want people with these issues in the cockpit of an airliner? I have my inclinations, the answer is way above my pay grade, but I think people with these issues need to be vetted.
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For some things, I get the feeling that the FAA medical system does not differentiate sufficiently between people who will be flying for hire and those who will not.
 
I know someone who's dog "has anxiety" and is prescribed Xanax. Knowing this person, the dog isn't getting it's meds.
 
SixPapaCharlie said:
…So does the current system really end careers of people going in for a little bit of clarity or is this just social media blowing things out of proportion?
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Like most things, there’s a bit of truth to both sides, and it’s not unique to the FAA.

During my .mil career, going to the Flight Surgeon for anything other than the annual medical certificate was to be avoided at all costs. The worst case scenario was walking out medically grounded (Duties Not Including Flying - DNIF) for seven days for a cold. You got a nifty little scarlet DNIF patch for your flight suit so everyone knew not to put you on the schedule and you ended up making popcorn in the squadron bar.

I proactively brought up a mole with a Flight Surgeon who’s response was “we can biopsy it, but if it comes back melanoma, you’ll face a Medical Evaluation Board”. There’s only two outcomes, a DoD equivalent of an SI or separation. I did the biopsy and sure enough it was melanoma. My waiver (SI) effectively grounded me. I could do operational roles that were ground based…the FAA requires a documented annual full body skin exam for a Class 3 medical.

As a child I had open heart surgery. DoD didn’t really care about it and had no special requirements for my flight physical. For a class 3, the FAA requires an annual cardiology report, Bruce stress test, and bubble echo for a procedure that occurred 42 years ago and the cardiology evidence shows a lower than average risk of structural or functional problems in the 5+ year outlook.

Is there a case for medical reform? Sure; it needs to be evidence based though and even then as a public safety checkpoint, it’ll be conservative and contentious.
 
I think the FAA works on the premise better safe than sorry. Does it protect the public from pilots who can be suddenly incapacitated ? I do not know but I doubt it. Is there a better way to do it. I am certain of that, but do not know how to do it. Do I think that a better way can be devised? Yeah, but I doubt the FAA will figure that out until someone forces them to do so.
 
douglas393 said:
I think the FAA works on the premise better safe than sorry. Does it protect the public from pilots who can be suddenly incapacitated ? I do not know but I doubt it. Is there a better way to do it. I am certain of that, but do not know how to do it. Do I think that a better way can be devised? Yeah, but I doubt the FAA will figure that out until someone forces them to do so.
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Or maybe 'better paranoid than litigated.'
 
douglas393 said:
I think the FAA works on the premise better safe than sorry. Does it protect the public from pilots who can be suddenly incapacitated ? I do not know but I doubt it. Is there a better way to do it. I am certain of that, but do not know how to do it. Do I think that a better way can be devised? Yeah, but I doubt the FAA will figure that out until someone forces them to do so.
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I think “let’s not say yes to anything that jeopardizes my retirement” lives in lots of .gov offices.
 
Tarheelpilot said:
I think “let’s not say yes to anything that jeopardizes my retirement” lives in lots of .gov offices.
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Uh, this can be said about a lot of entities that are not government offices, including where I work. I would change your statement slightly and replace the word retirement with paycheck, and extend it further by saying that the act of doing the right thing and fighting for change to make our organizations and rules provide improved, and appropriate services is no longer the value it used to be. The motto now is do as little as possible and extend as little energy as possible to get through the work day.
 
There are a few issues here... I think one is which medical are we talking about? There's a world of difference between a third class and a first class. I imagine the majority of us here are most concerned about issues around the third class.

Basic med is still pretty new, but I think we should take a good look at the real world safety record of it once we have a few years worth of data to look it. If it looks a lot like Sport Pilot where going without this medical screening process hasn't been a problem then I'd suggest that the 3rd class medical isn't doing anything for safety and should either be scrapped or we should drop the requirement to have passed a 3rd class to get basic med. Our opinions are one thing but data is data and if we know it isn't making us safer we shouldn't be putting people though this or excluding them from aviation.

For the first class and really all class medicals though I think we do need some clarification. I know a lot of us non-commercial pilots will not set foot in a therapist's office just in case they write the wrong thing down in our chart. I wouldn't and I just fly for fun- I'm not depending on it for my livelihood. I can't see how that wouldn't have an impact. I'd agree that someone who is thinking about harming themself or others probably shouldn't be flying but I'd hope that person would get help with their issues before they get to that point.
 
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cowman said:
Basic med is still pretty new, but I think we should take a good look at the real world safety record of it once we have a few years worth of data to look it. If it looks a lot like Sport Pilot where going without this medical screening process hasn't been a problem then I'd suggest that the 3rd class medical isn't doing anything for safety and should either be scrapped or we should drop the requirement to have passed a 3rd class to get basic med. Our opinions are one thing but data is data and if we know it isn't making us safer we shouldn't be putting people though this or excluding them from aviation.
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The FAA is ahead of you: https://www.faa.gov/sites/faa.gov/files/data_research/research/med_humanfacs/oamtechreports/202118.pdf

Here’s the money quote: This study could not detect a significant overall difference in aviation safety outcomes such as accident rates . . . between BasicMed pilots and pilots holding third-class medical certificates.
 
cowman said:
I'd agree that someone who is thinking about harming themself or others probably shouldn't be flying but I'd hope that person would get help with their issues before they get to that point.
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The FAA is right with you on the “hope” strategy. Hence the existence of this thread.
 
OneCharlieTango said:
The FAA is ahead of you: https://www.faa.gov/sites/faa.gov/files/data_research/research/med_humanfacs/oamtechreports/202118.pdf

Here’s the money quote: This study could not detect a significant overall difference in aviation safety outcomes such as accident rates . . . between BasicMed pilots and pilots holding third-class medical certificates.
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Logical response - Since there’s no significant difference, we should eliminate the 3rd class medical and rely on Basic Med. That would also reduce our caseload and let us concentrate on revenue pilots.

Bureaucrat’s response - Since there’s no significant difference, we should make the 3rd class more arduous, thereby creating a difference. That would also increase our caseload and ensure job security.

Which do you think will happen?
 
Half Fast said:
Logical response - Since there’s no significant difference, we should eliminate the 3rd class medical and rely on Basic Med. That would also reduce our caseload and let us concentrate on revenue pilots.

Bureaucrat’s response - Since there’s no significant difference, we should make the 3rd class more arduous, thereby creating a difference. That would also increase our caseload and ensure job security.

Which do you think will happen?
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I so dearly wish you were wrong. I really do. You're not, though.
 
You guys are missing something though. Basic Med is AFTER another class of medical. If you are saying that there isnt a difference between BM and 3rd class - that doesnt mean opening BasicMed to EVERYONE will result in the same statistical numbers. You've already eliminated the really problematic group from the numbers for either group. Even Sport Pilot has by its very nature has eliminated a ton of problematic people. So saying that statistically it isnt any different - is arriving at an incorrect conclusion.
 
Anthem said:
You guys are missing something though. Basic Med is AFTER another class of medical. If you are saying that there isnt a difference between BM and 3rd class - that doesnt mean opening BasicMed to EVERYONE will result in the same statistical numbers. You've already eliminated the really problematic group from the numbers for either group. Even Sport Pilot has by its very nature has eliminated a ton of problematic people. So saying that statistically it isnt any different - is arriving at an incorrect conclusion.
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You have a point, but....

People could have had their last class 3 exam 15+ years ago. Pilots who had to get a first-time class 3 may have now gone 5+ years or so. And nobody flying on Basic has to do regular follow-ups with an AME or a HIMS shrink like many of those with a class 3.

And there’s really no reason to think that the one-time class 3 exam is any better than the Basic Med exam anyway. Both use the same exam checklist.

Regarding “You've already eliminated the really problematic group from the numbers for either group,” I contend just the opposite. Remember that over 99% of applicants get a medical eventually. Basic Med collects that problematic group. If anything, Basic Med pilots as a group are more likely to have conditions that the FAA is worried about, since pilots (like me) go Basic to avoid unnecessary FAA tests and hassles.

Yet Basic Med pilots aren’t crashing any more often than class 3 pilots.
 
SixPapaCharlie said:
Are they grounding pilots for going to couples therapy or grieving a loss? I assume not and if so, then that is a problem.
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I'm pretty sure relationship counseling has never needed to be reported. One problem with that is when the airman doesn't report it but the counseling provider codes it with a mental health diagnosis and the FAA gets the code as a by-product of the persons other medical record. Electronic medical records are fraught with errors, often innocently entered.

Grieving itself is fine and a normal process, but too many providers create a disease and a medication around it, sending the airman down the FAA rabbit hole.
 
Half Fast said:
People could have had their last class 3 exam 15+ years ago.
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21+ years ago. It is "held a valid medical after July 14, 2006", which means the Class 3 could have been 4 years before that.

There is zero statistically defensible point to the initial 3rd Class before Basic Med. 25,000 pilots went on Basic Med within the first year it was available.
 
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