Before reading my med express form, and after having his side/nurse do the usual pee test, eye test, weight, bp, etc; my AME sat me in the end of the exam table and squeezed my knees.
That was the extent of my physical... Then he looked at my med express form and saw my drug list, commented on one. And said ah.. apnea... I'll go look.
He came back to inform me that I was being deferred...
This AME also did CDLs for every class including hazmat. In addition to bus drivers .
And, I know ATPs that tell their wives never to tell anyone they snore.... And don't have special issuances.
Do not tell me that the airman's medical system keeps pilots from circumventing issues.
In a perfect world, maybe.
Our docs here are an exception, of course. They make you "own your medical" tell you to do what it takes to get the issuance and to be honest.
I've talked to my medical provider about basic med. And I trust her to know me and my health well enough to be confident that I can and will self ground, and that she will not approve me if there is risk...
But, I'm confident I could, if I wanted, to find an AME to issue a 3rd class, even with issues down the road.
I won't do that.
Freedoms carry responsibilities. Even privileges do. Many will do whatever they want, regs or no.
Commercial rides in bush planes by private pilots comes to mind...