How FAA Medical Policies INCREASE Risk

VWGhiaBob

VWGhiaBob

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VWGhiaBob
Three years ago, I experienced some headaches and as a precautionary measure, I had a brain scan, which turned out 100% normal. The headaches went away shortly after the scan.

Well, for the FAA, this was a MAJOR event. Since then, I have had to prove that it was nothing...written lab results, copies of actualy scans (which they lost once), and two letters from my doctor stating I am completely normal.

This time around, they inquired again and again I sent copies.

So what's the lesson learned here? For me, it's "be careful what you tell your doctor, and don't get tests unless things are really bad."

I am extremely healthy, though technically I get a special issuance due to pre-diabetes that's now undectable. The FAA's policies make me think twice about reporting anything to my doctor.

Yes, I know my health is more important than flying. But whereas I always erred on the side of over-reporting before, now I think, "Should I mention this to my doctor, given the FAA will be right behind me questioning my health?"
 
Me to Doc: "What code are you putting in?"
Him to me: "coded as xxx.xx"
Me: "wait a sec, lets look that up"
Him: "It describes serious/debilitating pain, localized inter-cranial"
Me: "Um - no thank you"
Him: "What code would you like?"
Me: "something like general pain, non-localized"
Him: "I can do that"
Me: "Thank you"
 
Yup. This is an obvious result of a bad policy.

Anyone know if "medical tourism" would be an answer here? Does the FAA have access to results / tests / diagnosis made in other countries and paid for in cash?
 
VWGhiaBob said:
The FAA's policies make me think twice about reporting anything to my doctor.
Click to expand...

Did the FAA require further testing, or was it just a matter of assembling the paperwork for therm?
 
So the OP is blaming the FAA for a conscious choice for a pilot to be deceptive on their medical history? Sounds legit.
 
Doggtyred said:
So the OP is blaming the FAA for a conscious choice for a pilot to be deceptive on their medical history? Sounds legit.
Click to expand...

I don't see any discussion of deception by the OP. Deception would be getting a test and not duly reporting it. The OP is instead talking about simply not getting the test.
 
Dave, you missed the point.

Let's review the point. The FAA's policies discourage pilots from reporting symptoms unless they are really obvious. There's no argument here, or right or wrong: some pilots will refrain from reporting some symptoms to their doctors out of fear of consequences.

It's a simple fact.

A more legit question is, "How many pilots avoid reporting symptoms to their doctors or even visiting their doctors out of fear of FAA consequences?" I bet the number is higher than we all think.
 
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Ectully, I was the one being deceptive. Well, maybe disingenuous. When the gov starts telling the absolute truth, then I'll start. But -- them first.
 
I don't get it. If you had a test and the results were negative, why would you need to report it? :confused::confused:

OTOH, if the results were positive...........
 
Deny deny deny, counter accuse.
 
KPTK...Because the FAA requires a report of all doctor visits and outcomes.
 
VWGhiaBob said:
Dave, you missed the point.

Let's review the point. The FAA's policies discourage pilots from reporting symptoms unless they are really obvious. There's no argument here, or right or wrong: some pilots will refrain from reporting some symptoms to their doctors out of fear of consequences.

It's a simple fact.

A more legit question is, "How many pilots avoid reporting symptoms to their doctors or even visiting their doctors out of fear of FAA consequences?" I bet the number is higher than we all think.
Click to expand...

There's no question. I know of multiple situations where pilots have avoided seeking treatment because they didn't want the hassle explaining it to the FAA. I can't blame them....and think hard about Dr visits myself.
 
People can say what they want, I am certain that people value their ability to fly airplanes more than their health sometimes. Right or wrong pilots will avoid doctors because it risks their medical certificate. They invest heavily in flying and the idea that they could loose the ability to fly because they go to a doctor for an ailment is real and tangible. So they don't go, and may be risking long term health as a result.
That said, if they went to a doctor and found out they have a serious ailment which should end their flying, they would quickly give it up because it is the smart thing to do.
 
Interesting. One would think that this avoidance of doctors would be quantifiable?

Are there any statistics on life expectancy of pilots?
 
This is long, but quasi-interesting.

Pilots: “A group of 3707 male pilots was followed over 70,832 person-years. There were 342 deaths vs. 362.8 expected, with a standardized mortality ratio (SMR) of 0.94… Aircraft accidents… had a major influence on total mortality and the SMR for all other causes was 0.68 (95% CI 0.59-0.77). The SMR for cancer was 0.89 (95% CI 0.71-1.11) and for circulatory diseases 0.53 (95% CI 0.42-0.67). The highest SMR for total mortality in pilots < 30 yr old was 3.52 (95% CI 2.54-4.76). For this age group 38 of a total of 42 deaths were caused by aircraft accidents. It was indicated that almost half the deaths of aircraft accidents took place in private aircraft.

CONCLUSIONS: Due to aircraft accidents young pilots have a higher mortality rate than the general population; other harmful effects on the mortality of pilots in their workplace were not found. At all ages pilots have a better life expectancy than the general population.” Aviat Space Environ Med, 2002, Volume 73, pages 587-592 Aircraft accidents and other causes of death among Norwegian commercial pilots. Haldorsen T, Reitan JB, Tveten U. Abstract at: http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=12056676&dopt=Abstract

A Standardized Mortality Ratio study (SMR) using England and Wales as the comparison population was carried out for 6209 male pilots and 1153 male flight engineers employed for at least 1 yr between January 1, 1950 and December 31, 1992... The all-causes SMR for pilots of 61 (592 deaths) and 56 for flight engineers (127 deaths) confirmed the expected Healthy Worker Effect. In pilots apart from the known excess of deaths from aircraft accidents (SMR 14694), most of the comparisons showed significant deficits in mortality. The SMR's for brain/CNS cancer (143) and colon cancer (111) were no longer statistically significant. The SMR of 333 for melanoma was significantly raised in pilots but was not evident in flight engineers. Life expectancy for longhaul pilots and flight engineers was 4-5 yr better than England and Wales for ages 55-65 while the advantage for shorthaul pilots was reduced to between 2-3 yr….

The study confirms that flightdeck crew live longer than the England and Wales population and do not exhibit patterns of death that could be directly attributable to occupation. Aviat Space Environ Med, 1999, Volume 70, pages 548-555 British Airways flightdeck mortality study, 1950-1992. Irvine D, Davies DM. Abstract at http://www.ncbi.nlm.nih.gov/entrez/...ve&db=PubMed&list_uids=10373044&dopt=Abstract
 
This is exactly the cause of the rise in Light Sport, people saying screw it. This is also a by-product of modern databases having all kinds of stored information the FAA can access in seconds. In times past hand written records were a lot harder to search and you rarely heard of pilots having problems with their medicals.

You bet I am scared to go to the doctor. One subjective treatment code is going to cost me a lot to rectify. I believe this is a HUGE negative.
 
docmirror said:
Me to Doc: "What code are you putting in?"
Him to me: "coded as xxx.xx"
Me: "wait a sec, lets look that up"
Him: "It describes serious/debilitating pain, localized inter-cranial"
Me: "Um - no thank you"
Him: "What code would you like?"
Me: "something like general pain, non-localized"
Him: "I can do that"
Me: "Thank you"
Click to expand...
EXACTLY

I had regular BPs then a high one followed by a low one and caught my doc putting in 'uncontrolled HBP.' I got her to change it to another code, basically 'moderate HBP.' FWIW that one HBP reading was the only blip. You gotta watch doctors. They are there to put in the codes that get them paid!!! They are not there for your health care. That is a secondary result of their job.

And let me tell you that when I tried to see my doc for a pulled muscle in chest from lifting a suitcase up into the overhead....she would not see me. Made me go to the ER because 'my chest hurt' $3000 and a lot of tests later the ER doc told me what I said to him in the first 5 seconds of my visit. IT IS JUST A PULLED MUSCLE! ASSHATS!!! All of them!
 
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ScottM said:
And let me tell you that when I tried to see my doc for a pulled muscle in chest from lifting a suitcase up into the overhead....she would not see me. Made me go to the ER because 'my chest hurt' $3000 and a lot of tests later the ER doc told me what I said to him in the first 5 seconds of my visit. IT IS JUST A PULLED MUSCLE! ASSHATS!!! All of them!
Click to expand...

:confused::confused::confused:
So you call up your doc and give her every reason to think that you're having a cardiac event and now you're upset that she thought you were having a cardiac event?
 
Jay Honeck said:
Interesting. One would think that this avoidance of doctors would be quantifiable?

Are there any statistics on life expectancy of pilots?
Click to expand...

Great idea! I'm not sure though that the study you cite is making the right comparison to address the question at hand. There are all sorts of reasons to expect pilots to have a better life expectancy than the general public (especially if we exclude plane-crash fatalities from the statistics). Persons who are gravely ill, or who are destitute or very poorly educated, are largely excluded from the pilot population; and those excluded factors correlate strongly with reduced life expectancy.

So even if pilots have a better life expectancy than the general population, it's still possible that their life expectancy is less than what it would be if the medical requirements didn't sometimes discourage them from seeing doctors.
 
I would guess pilots having a higher life expectancy is related to SES and has nothing to do with being a pilot. Someone could look at the SES in the pilot sample and compare that to nonpilots with the same SES. Bet the life expectancy would be the same.
 
ClimbnSink said:
I would guess pilots having a higher life expectancy is related to SES and has nothing to do with being a pilot. Someone could look at the SES in the pilot sample and compare that to nonpilots with the same SES. Bet the life expectancy would be the same.
Click to expand...

Don't you love it when people post with obscure acronyms so they think they sound smart but no one knows what the f**k they're talking about?

http://en.wikipedia.org/wiki/SES
 
VWGhiaBob said:
So what's the lesson learned here? For me, it's "be careful what you tell your doctor, and don't get tests unless things are really bad."



I am extremely healthy, though technically I get a special issuance due to pre-diabetes that's now undectable. The FAA's policies make me think twice about reporting anything to my doctor.



Yes, I know my health is more important than flying. But whereas I always erred on the side of over-reporting before, now I think, "Should I mention this to my doctor, given the FAA will be right behind me questioning my health?"
Click to expand...


The lesson might be to give your business to doctors that are also active pilots. The doctor I use as my PCP is an active pilot and the AME I use.

It's a bit of a drive and I don't seek immediate treatment for every minor complaint. In fact I try to find home remedies for minor ailments.

I would never use any psychobabble practicioner, I view too much of that business as outright fraud (unexpected behavior is not a disease).




Sent from my iPad using Tapatalk
 
garyb said:
:confused::confused::confused:
So you call up your doc and give her every reason to think that you're having a cardiac event and now you're upset that she thought you were having a cardiac event?
Click to expand...
How is saying that I pulled a muscle giving her 'every reason'?

I told my doctor that I had been reaching up with a suitcase, pulled a muscle and now my chest muscles were now hurting and was asking if there was anything I could do more than the naproxen I was taking. As soon as she heard that I my chest muscle hurt she refused to listen to anything else. After I went to the ER and wasted an afternoon, we spoke and she apologized. She did acknowledge that she did not listen carefully. She even said her insurance would not have let her had any latitude. Since you were not there, you conclusion is not born out by the two people who were there.
 
I have to be half dead before I'll go see an MD. I'm less than fond of MD's in general (present company excepted of course) but my aviation activities make me even more so.
 
ScottM said:
How is saying that I pulled a muscle giving her 'every reason'?

I told my doctor that I had been reaching up with a suitcase, pulled a muscle and now my chest muscles were now hurting and was asking if there was anything I could do more than the naproxen I was taking. As soon as she heard that I my chest muscle hurt she refused to listen to anything else. After I went to the ER and wasted an afternoon, we spoke and she apologized. She did acknowledge that she did not listen carefully. She even said her insurance would not have let her had any latitude. Since you were not there, you conclusion is not born out by the two people who were there.
Click to expand...


I went through the same thing.

ZOMG! Chersts perns!!! Go 2 teh mergcy rm!!!!

Spend the day hooked up to an EKG, and a cat scan to find nothing, everything comes back negative, only to be told it's most likely strained cartilage between the ribs. Gee, maybe because I've been boxing and kickboxing, I might have over done it a little. But ooooooh no, any chest pain equals heart attack. Morons.
 
ScottM said:
EXACTLY

I had regular BPs then a high one followed by a low one and caught my doc putting in 'uncontrolled HBP.' I got her to change it to another code, basically 'moderate HBP.' FWIW that one HBP reading was the only blip. You gotta watch doctors. They are there to put in the codes that get them paid!!! They are not there for your health care. That is a secondary result of their job.

And let me tell you that when I tried to see my doc for a pulled muscle in chest from lifting a suitcase up into the overhead....she would not see me. Made me go to the ER because 'my chest hurt' $3000 and a lot of tests later the ER doc told me what I said to him in the first 5 seconds of my visit. IT IS JUST A PULLED MUSCLE! ASSHATS!!! All of them!
Click to expand...

Yep.

The problem is the way insurance companies work and the CoI for providers in getting paid vs correct diagnosis/patient care. FOr 99% of the patients, a single code for HTN (HBP) in the record will be meaningless. For pilots, a single code for HTN will require a significant amount of extra work-up and FAA reporting even if the diagnosis is incorrect. Worse if some ER doc puts that in the record ignoring other patient factors related to the visit.

Insurance companies pay on diagnosis code & treatment. You go for routine annual exam ("free" under the ACA rules), BP is slightly high for some reason (say, narrowly missing a wreck on the way to office), doc puts down a diagnosis to get paid even if the instructions are to "come back and get measured again". Boom. Now you gotta a perm. record of HTN in your records, and you have to deal with the FAA. But doc got paid for both the exam and diagnosis. And will get paid for the follow-up.

And the risk of errors persisting forever in electronic medical records is higher than folks want to admit.
 
wsuffa said:
Yep.



Insurance companies pay on diagnosis code & treatment. You go for routine annual exam ("free" under the ACA rules), BP is slightly high for some reason (say, narrowly missing a wreck on the way to office), doc puts down a diagnosis to get paid even if the instructions are to "come back and get measured again". Boom. Now you gotta a perm. record of HTN in your records, and you have to deal with the FAA. But doc got paid for both the exam and diagnosis. And will get paid for the follow-up.
Click to expand...

During an office visit, physicians don't get paid for each diagnosis made. They get paid for an office visit, that may vary in fees paid due to complexity of the visit. The physician gets paid for the visit, even in the annual exam (he/she does not do it for free even under ACA rules)

So, no incentive to add diagnosis to your chart. However, if there is not a diagnosis listed on your chart that the physician should have put there and provided treatment for, there is every possibility that the physician could be sued for NOT diagnosing a problem.
 
ScottM said:
And let me tell you that when I tried to see my doc for a pulled muscle in chest from lifting a suitcase up into the overhead....she would not see me. Made me go to the ER because 'my chest hurt' $3000 and a lot of tests later the ER doc told me what I said to him in the first 5 seconds of my visit. IT IS JUST A PULLED MUSCLE! ASSHATS!!! All of them!
Click to expand...
Wait... you went to an ER knowing that you weren't in an emergency situation, and then you call them asshats??? If I KNEW that it was a pulled muscle but my doctor wouldn't see me, I'd either find one who would, go to urgent care, or just live with it. NO WAY am I going to pay $3000 for unneeded medical care.

OTOH, if I wasn't sure what it was, then it's a whole different ballgame. Having been denied insurance coverage for a legitimate possible emergency (e.g. chest pain) because the ER determined that the condition was not life-threatening, I'm a little cynical when it comes to health insurance...
 
I had a serious event last year. I knew it was serious, I went to the ER cause I was out of town, and it was the right thing to do, even though my distress wasn't that big of a deal, it could have become a big deal.

Most people know when things are serious, or even deadly. Some don't and as has been said, not all turtles make it to the sea, and that's ok. Maybe I would have been fine without an ER visit, but really I needed to be seen by someone on a Sunday at 7PM.

That event dropped me out of the FAA medical system with no question from me. I got back in, but not without some serious work, which is how the system should work, if we are going to have a flight medical system.

Where things start to go haywire, is when the FAA begins to look at actuarials and life style situations and begins to forecast probabilities with ever increasing marginalization of the right to flight(yes, it is right). The sleep apnea, BMI, neck size BS is only the latest example. Many others are out there just waiting for the person to get tripped up like blood pressure.

Of course, this doesn't motivate people to lose weight in and of itself, it doesn't motivate people to lower their stress, eat better, stop smoking, etc. It motivates people to work around the system because they and I don't feel like changing our life style to suit the feds. Which leads to the ever popular and much discussed reporting avoidance, and may and I'm pretty sure does lead to MD advise or visit avoidance.

So the system is working, but not the way it should. Pilots should go to the MD for illness or events which would tend to make them unsafe to fly. But since the FAA is a take no prisoners, and evaluate while staying grounded kind of mindset, then people will continue to hide what can be serious medical issues. Remember when they cross-referenced the number of pilots with the people on medical disability? That was an eye-opener.
 
garyb said:
:confused::confused::confused:
So you call up your doc and give her every reason to think that you're having a cardiac event and now you're upset that she thought you were having a cardiac event?
Click to expand...

Really, if somebody calls a doctor and says "I pulled a muscle lifting something", that is "every reason" to suspect a cardiac event, without even an examination?

:mad2:
 
azure said:
Wait... you went to an ER knowing that you weren't in an emergency situation, and then you call them asshats???
Click to expand...
I had no choice. My doctor would not see me until I had gone to the ER. If I wanted medical care for what I was seeking the first hoop to jump through was the ER. Why do you think the American health care system is so F-ed up? Stuff like this!

azure said:
If I KNEW that it was a pulled muscle but my doctor wouldn't see me, I'd either find one who would,
Click to expand...
You obviously have never tried that. You do not just walk into a medical office and get an appointment. Far too many docs in private practice do not accept new patients. The ones that do require a full work up.

azure said:
go to urgent care,
Click to expand...
Mini-ER is what Urgent care is. Mostly in low income areas in Illinois and not near where I live. I have three ERs close by.

azure said:
or just live with it. NO WAY am I going to pay $3000 for unneeded medical care.
Click to expand...
It had been a week and was annoying. FWIW I did not have to pay the $3k, insurance did. Don't you love for profit medical care?

azure said:
I'm a little cynical when it comes to health insurance...
Click to expand...
Me too. If I would have had the time I would have made the drive to the VA hospital . But that would have killed about 6 or 7 hours because of the drive.
 
wsuffa said:
Yep.

The problem is the way insurance companies work and the CoI for providers in getting paid vs correct diagnosis/patient care. FOr 99% of the patients, a single code for HTN (HBP) in the record will be meaningless. For pilots, a single code for HTN will require a significant amount of extra work-up and FAA reporting even if the diagnosis is incorrect. Worse if some ER doc puts that in the record ignoring other patient factors related to the visit.

Insurance companies pay on diagnosis code & treatment. You go for routine annual exam ("free" under the ACA rules), BP is slightly high for some reason (say, narrowly missing a wreck on the way to office), doc puts down a diagnosis to get paid even if the instructions are to "come back and get measured again". Boom. Now you gotta a perm. record of HTN in your records, and you have to deal with the FAA. But doc got paid for both the exam and diagnosis. And will get paid for the follow-up.

And the risk of errors persisting forever in electronic medical records is higher than folks want to admit.
Click to expand...
For profit medical care is ruining American health care. Has been for a long time. The managed care made it even worse!
 
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