The Pilot and the Aviation Medical Examiner: An Important Partnership

By Brent Blue, M.D.

Sport Aviation, August 1997

The EAA Aeromedical Advisory Council has heard a recurrent theme from pilots at each forum the Council has held over the years at Oshkosh and Sun ‘n Fun - the mishandling by an Aviation Medical Examiner (AME) of a pilot’s FAA medical exam. There are strategies the pilot can use which will help prevent this problem and its inherent cascade of red tape.

If you are perfectly healthy and have never had a medical problem, it probably does not make any difference which AME you choose to perform your medical exam. However, if you have a problem with your blood pressure, have developed diabetes, have kidney stones, or any other medical problem, you had better be more selective. An uninterested or unknowing AME can cause grief beyond belief by mishandling the FAA paperwork for even minor medical problems.

My recommendation is to find an AME who also is a pilot. Only 50% of AMEs are pilots and even though they may not be the closest or easiest to get in to see, they will generally be more interested in keeping you flying than one which does not know the difference between a hangar and a hanger. Pilot AMEs can be identified by the "P" by their listing in the AME directory available from FSDOs and other sources such as the internet.

Being a pilot is not everything. Aggressive AMEs will usually be well known and recommended by local pilots. AMEs involved in local aviation organizations such as the EAA Chapter are a good bet. Physicians who have flying magazines in their office and decor which reflects their aviation interest are also signs of a positive attitude toward helping fellow pilots.

The most important point in obtaining a medical certificate after developing a medical problem is preparation and this is where an involved AME can make all the difference. Call your AME and ask what will be necessary to obtain, retain, or initially qualify for the FAA - given your medical status. If you are uncomfortable about talking with your own AME due to (usually unfounded) concerns about being "reported" - to the FAA, call another AME or check with one of your EAA AME Advocates. You can discuss the problem and how best to prepare for the exam by obtaining the right paperwork and having the correct tests performed. Also, the timing of the FAA - medical should be discussed to avoid "down time" resulting from FAA processing requirements.

Most all simple problems with FAA medicals due to new or ongoing medical issues can be solved by bringing a letter from your treating physician with you to your AME medical examination. The letter should state several things: - (1) You are under good control (if ongoing such as high blood pressure or recovered without difficulty if a single event); (2) results of your most recent laboratory tests; (3) that your medication, if any, is not causing any significant side effects; and most importantly, (4) you are "no more likely to be incapacitated than someone from the general population" due to the problem. This wording is the most effective.

By talking to your AME prior to the exam, you will find out if there are any other special requirements for your specific condition. For instance, some blood pressure patients are required to send in a copy of their most recent EKG and diabetics have to have current glucose testing. If you cannot get the proper preparatory information from your own AME, consider calling another. If that fails, call the EAA and ask for the EAA AME Advocate closest to your area or one who is verse in your type of situation.

In most situations, with a letter from your treating physician and proper documentation, the AME will be allowed to issue your medical right on the spot. In order to issue, the AME may need to call the regional Flight Surgeon or Oklahoma City. If the AME says he has to "defer" the application to OKC without calling, implore him or her to call. To defer without calling is doing you an injustice since once the file is sent to OKC, you enter a quagmire of bureaucratic paperwork that usually is not necessary!

(The AME has three choices when you apply for a medical - grant, defer, and deny. Denials are rare since most AMEs do not like to give the bad news to pilots nor write the mandatory notification letter.)

The EAA AME Advocate program was developed in response to the needs of EAA member pilots to get through the FAA paperwork morose. The Advocates are EAA - members who also are AMEs and knowledgeable with "problem" pilot medicals. More importantly, they have volunteered their time and extra effort these difficult situations can require. (An EAA AME Advocate will only charge if the member chooses to undergo their FAA - medical exam from the Advocate, but there is no charge for telephone help or any extra time involved in providing advice.)

If you are already stuck with a deferred or denied medical, call an EAA AME Advocate to see what can be done. Many times, the certificate can be salvaged but the pilot may now need to jump through many medical and bureaucratic hoops. Also, if something your AME tells you does not make sense, call the Advocate for a second opinion. Even well meaning AMEs can misunderstand a regulation or a requirement (goodness knows I - have!).

A word of caution at this point - do not contact a lawyer or your congressional delegation as your first point of appeal. Believe it or not, this usually slows the process considerably and causes the FAA - officials to be even more rigid since they will make sure to follow every regulation and ruling to the extreme. Most problems can be worked out more effectively and efficiently on an informal basis.

EAA wants you to be healthy regardless of your flying status. Passing your medical is one thing but being safe is another. Some pilots will never qualify for their medical after certain incurable or uncontrollable medical conditions occur. Doing what we can to stay healthy is important. Avoiding all tobacco products, keeping trim, and regular vigorous exercise are the three most important things one can do to stay healthy, promote longevity, and keep flying.

(Dr. Blue, EAA 377214, is Board Certified by both the American Board of Family Practice and the American Board of Emergency Medicine. He is a member of the EAA Aeromedical Advisory Council and the developer of the EAA AME Advocate Program.)