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On May 5, 8:40 pm, wrote:
On May 3, 5:21 pm, Frank Whiteley wrote: http://www.kilkennyadvertiser.ie/index.php?aid=5621 Frank, Before you run off and start demonizing a pilot LEGALLY excercising his rights, you should research the subject. The fact is that possessing a current Airmen's medical is not guarantee WHATSOEVER that the pilot is fit to fly on any given day. I just received a medical denial letter from the FAA because I was taking Trazodone for insomnia. Insominia is not by itself a disabling medical condition, but Trazodone is on their prohibited list because it is an old anti-depresent drug. ALL anti-depresents are prohibited. PERIOD. It does not matter what the condition is for which you are taking the prescribed medicine: medical denied, DO NOT FLY! Well, I am flying my glider while the paper work is being sorted out (I have a different, much more expensive, drug prescribed for the same IDENTICAL condition). By your reasoning, I AM UNFIT TO FLY. PERIOD, END OF STORY! because I don't have a CURRENT MEDICAL! Never mind that glider pilots DO NOT NEED A MEDICAL CERTIFICATE to LEGALLY fly!! My doctor DOES have a disabling disease; it is DIABETES. But he is LEGALLY able to fly his motorgliders WITHOUT an aviation medical. I am very confident in his ability to fly his motorgliders, to the extent that I have allowed my wife, my kids and my mother to fly with him. By your standards he should be GROUNDED!!! Once, while getting a 3rd class medical, the doctor remarked about my good health. By comparison, he pointed out another patient of his, to whom he had granted the 3rd class medical with the warning that he might not get it the next time, that had DIED within one year! That guy was LEGALLY fit to fly, but died shortly after getting the medical. What you apparently don't realize is the system is more about the FAA covering their respective asses than it is about protecting the public. The system TOTALLY depends upon self reporting of medical conditions; if you report you come under INTENSE SCRUTINY. Thus, the incentive is: DO NOT REPORT! The Inspector General did a study matching Social Security disability payments with certified pilots. They found nearly 10% held CURRENT MEDICAL CERTIFICATES while simultaneously receiving DISABILITY PAYMENTS! Only 40 of these cases were prosecuted because of limited resources (http:// flightphysical.com/FAA/FAA-Report-Falsification/index.htm). Another pilot I know once reported that he had an EKG performed that was negative. The FAA required him to take an ANNUAL EKG for no damn good reason, just to cover their asses! Tom Yo Tom, I wasn't demonizing anyone and if the pilot in the article wanted to come out and fly _his_ glider, fine by me, as I've stated before. However, I think he was flying a _club_ glider and clearly instructing and towing, at least one of those things he definitely should not have been doing. At some point, people need enough personal integrity to do the right thing, especially within a club framework, where responsibilities extend to the other members. (If you don't like it, don't fly in clubs). This chap didn't and that's quite simply stated in the article. I suspect if he had admitted the loss of his medical and loss of power flight privileges to the club, that body may well have banned him from flying club equipment and/or the national association may have prohibited him from instructing. I knew a youngish, at the time, BGA instructor that lost his instructor privileges due to a heart valve replacement. He was about 30 and hiked extensively as a second pastime, but a heart valve replacement may lead to a increase in the chance of clotting, hence the restriction. He was not banned from flying club or personal equipment solo. It's certainly a tough call if it has to be made. BTW, when the SSF does a safety audit of a soaring site, they do look to see if the operation is tracking pertinent information about their flying group, and suggests some internal audits to perform that are germane to this discussion. The FAA does all sorts of things. Heck, I know a man, at 79yo, that got his medical back from a US Senator following a quad by-pass. It took that sort of clout to stop the FSDO foot dragging and get the attention of the FAA Flight Surgeon. 79yo pilots don't like to waste time;^) He wanted to get back to test flying. Frank |
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![]() "Bullwinkle" wrote in message ... On 5/5/07 11:33 PM, in article , "Frank Whiteley" wrote: On May 5, 8:40 pm, wrote: On May 3, 5:21 pm, Frank Whiteley wrote: http://www.kilkennyadvertiser.ie/index.php?aid=5621 Frank, Before you run off and start demonizing a pilot LEGALLY excercising his rights, you should research the subject. The fact is that possessing a current Airmen's medical is not guarantee WHATSOEVER that the pilot is fit to fly on any given day. I just received a medical denial letter from the FAA because I was taking Trazodone for insomnia. Insominia is not by itself a disabling medical condition, but Trazodone is on their prohibited list because it is an old anti-depresent drug. ALL anti-depresents are prohibited. PERIOD. It does not matter what the condition is for which you are taking the prescribed medicine: medical denied, DO NOT FLY! Well, I am flying my glider while the paper work is being sorted out (I have a different, much more expensive, drug prescribed for the same IDENTICAL condition). By your reasoning, I AM UNFIT TO FLY. PERIOD, END OF STORY! because I don't have a CURRENT MEDICAL! Never mind that glider pilots DO NOT NEED A MEDICAL CERTIFICATE to LEGALLY fly!! My doctor DOES have a disabling disease; it is DIABETES. But he is LEGALLY able to fly his motorgliders WITHOUT an aviation medical. I am very confident in his ability to fly his motorgliders, to the extent that I have allowed my wife, my kids and my mother to fly with him. By your standards he should be GROUNDED!!! Once, while getting a 3rd class medical, the doctor remarked about my good health. By comparison, he pointed out another patient of his, to whom he had granted the 3rd class medical with the warning that he might not get it the next time, that had DIED within one year! That guy was LEGALLY fit to fly, but died shortly after getting the medical. What you apparently don't realize is the system is more about the FAA covering their respective asses than it is about protecting the public. The system TOTALLY depends upon self reporting of medical conditions; if you report you come under INTENSE SCRUTINY. Thus, the incentive is: DO NOT REPORT! The Inspector General did a study matching Social Security disability payments with certified pilots. They found nearly 10% held CURRENT MEDICAL CERTIFICATES while simultaneously receiving DISABILITY PAYMENTS! Only 40 of these cases were prosecuted because of limited resources (http:// flightphysical.com/FAA/FAA-Report-Falsification/index.htm). Another pilot I know once reported that he had an EKG performed that was negative. The FAA required him to take an ANNUAL EKG for no damn good reason, just to cover their asses! Tom Yo Tom, I wasn't demonizing anyone and if the pilot in the article wanted to come out and fly _his_ glider, fine by me, as I've stated before. However, I think he was flying a _club_ glider and clearly instructing and towing, at least one of those things he definitely should not have been doing. At some point, people need enough personal integrity to do the right thing, especially within a club framework, where responsibilities extend to the other members. (If you don't like it, don't fly in clubs). This chap didn't and that's quite simply stated in the article. I suspect if he had admitted the loss of his medical and loss of power flight privileges to the club, that body may well have banned him from flying club equipment and/or the national association may have prohibited him from instructing. I knew a youngish, at the time, BGA instructor that lost his instructor privileges due to a heart valve replacement. He was about 30 and hiked extensively as a second pastime, but a heart valve replacement may lead to a increase in the chance of clotting, hence the restriction. He was not banned from flying club or personal equipment solo. It's certainly a tough call if it has to be made. BTW, when the SSF does a safety audit of a soaring site, they do look to see if the operation is tracking pertinent information about their flying group, and suggests some internal audits to perform that are germane to this discussion. The FAA does all sorts of things. Heck, I know a man, at 79yo, that got his medical back from a US Senator following a quad by-pass. It took that sort of clout to stop the FSDO foot dragging and get the attention of the FAA Flight Surgeon. 79yo pilots don't like to waste time;^) He wanted to get back to test flying. Frank All, I think everyone here needs a basic course in FAA medical standards policy. I can't provide one here, but recommend you do some research, instead of just shooting from the hip. Start with the FAA Guide for Aviation Medical Examiners (available on the FAA website) and pay close attention to the "protocols" for various diseases. When you are surprised that someone got their medical back after a CABG (coronary artery bypass graft), or that it required a US Senator to intervene, or that the FSDO has any role whatsoever in the medical certification process, then you are seriously confused about the how system works. Recommend you also take a look at www.aviationmedicine.com . And if you have questions, call those guys. There are many, many airline pilots with valid first class medicals flying (on special issuance) for things like CABG, heart valve replacement, atrial fibrillation, ongoing use of anticoagulant medication, history of cancers of most types, diabetes controlled on oral meds, history of recurrent kidney stones, history of depression, etc, etc. It's all in how you approach the FAA. Frank, the suggestion that clubs start making independent medical certification decisions is ridiculous. The club should operate within the law, and let the pilots make the decisions they are supposed to make under the FAR's (61.53). Regards, Bullwinkle I've listened to this arguement for all my life and now I'm old enough that it may soon apply to me. In that time I've seen two sharply divided groups. One loudly proclaims their 'right' to fly as PIC with innocent non-pilot passengers until they are dead or incapcitated. They will 'game' the system as long as they can get away with it. The other will say that their medical conditions preclude accepting PIC responsibilities and continue to fly but only with a safety pilot. The former group outnumbers the latter by a significant margin. When the day comes, I intend to be in the later group. It is correct to say that the current state of medical science, at least as it is practiced by AME's, can't accurately predict the physical performance of a pilot once he has left the doctor's office. It is also correct to say that the pilot is in the best position to judge his physical condition. The problem is that pilots are often, understandably, in denial about the extent of their medical conditions. Responsibility for one's actions and concern for the safety of others should trump mere pride but sadly, it doesn't happen often enough. At some point organizations will have to deal with a pilot in denial. It should be done with respect, care and courtesy since we all will have to face that day - but it should be done. Bill Daniels |
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![]() "Bill Daniels" bildan@comcast-dot-net wrote in message ... I've listened to this arguement for all my life and now I'm old enough that it may soon apply to me. In that time I've seen two sharply divided groups. One loudly proclaims their 'right' to fly as PIC with innocent non-pilot passengers until they are dead or incapcitated. They will 'game' the system as long as they can get away with it. The other will say that their medical conditions preclude accepting PIC responsibilities and continue to fly but only with a safety pilot. The former group outnumbers the latter by a significant margin. When the day comes, I intend to be in the later group. It is correct to say that the current state of medical science, at least as it is practiced by AME's, can't accurately predict the physical performance of a pilot once he has left the doctor's office. It is also correct to say that the pilot is in the best position to judge his physical condition. The problem is that pilots are often, understandably, in denial about the extent of their medical conditions. Responsibility for one's actions and concern for the safety of others should trump mere pride but sadly, it doesn't happen often enough. At some point organizations will have to deal with a pilot in denial. It should be done with respect, care and courtesy since we all will have to face that day - but it should be done. Bill Daniels Bill, A few years ago an elderly pilot, who's ability to fly far exceeds mine, determined it was time to give up the sport. He had just completed an outstanding flight from Sun Valley, Idaho. During the after flight debriefing (you know, beer and "there I was, scratching the Bolders") he stated he wanted his memories of flying to be the great flight he and just finished and put his Mini-Nimbus on the market. Though we miss him when we fly, we all adminre his wisdom and judgement. Wayne HP-14 "6F" http://www.soaridaho.com/ |
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![]() "Wayne Paul" wrote in message ... A few years ago an elderly pilot, whose ability to fly far exceeds mine, determined it was time to give up the sport. He had just completed an outstanding flight from Sun Valley, Idaho. During the after flight debriefing (you know, beer and "there I was, scratching the Bolders") he stated he wanted his memories of flying to be the great flight he and just finished and put his Mini-Nimbus on the market. Though we miss him when we fly, we all adminre his wisdom and judgement. Wayne HP-14 "6F" http://www.soaridaho.com/ My father-in -law (now deceased alas) was driving cars well into his eighties. He was a very keen driver - he had learned on a Model T when he was doing his BS at Carnegie Mellon in the 20s. We used to lunch together from time to time and yarn (both of us were engineers with loads of stories). Normally I drove us to the lunch spot, but on this particular day he said he would drive. We had our usual jolly lunch and as I paid the bill he passed his car keys across the table to me and said ' The car's yours now; I'm not driving any more'. A very sensible decision by a man for whom I had enormous respect. I would hope that all pilots would be able to face facts as he did. There is no shame in flying with a safety pilot. When my time comes (soon) I will accept this gracefully. Alistair Wright |
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Alistair,
A pedantic correction - your father-in-law wasn't getting his BS in the 20s from Carnegie Mellon, he was getting it from Carnegie Institute of Technology. My class (1970) was the last to graduate from CIT, before they defiled a proud name solely because of naked greed. -John He was a very keen driver - he had learned on a Model T when he was doing his BS at Carnegie Mellon in the 20s. |
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![]() "jcarlyle" wrote in message oups.com... Alistair, A pedantic correction - your father-in-law wasn't getting his BS in the 20s from Carnegie Mellon, he was getting it from Carnegie Institute of Technology. My class (1970) was the last to graduate from CIT, before they defiled a proud name solely because of naked greed. -John He was a very keen driver - he had learned on a Model T when he was doing his BS at Carnegie Mellon in the 20s. Hi John, I was aware of the difference, I just didn't think anyone would remember. I am looking at Fred's Degree scroll as I write, and of course it is from CIT. You are not the only one to suffer this kind of thing. I graduated from the Royal Technical College Glasgow in 1954, an institution with dozens of famous alumni. It is now greatly altered and it has become the University of Strathclyde. They issued all us alumni with new degree parchments as well! I've kept my old RTC one though! At least C-M retains the Carnegie connection in the name. Fred attended a 50 year re-union of CIT graduates from his year in 1982. It wasn't pedantic in the least. You have every right to feel annoyed when people forget inportant things. Alistair Wright Melrose Scotland. |
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On May 6, 8:16 am, "Bill Daniels" bildan@comcast-dot-net wrote:
"Bullwinkle" wrote in message ... On 5/5/07 11:33 PM, in article . com, "Frank Whiteley" wrote: On May 5, 8:40 pm, wrote: On May 3, 5:21 pm, Frank Whiteley wrote: http://www.kilkennyadvertiser.ie/index.php?aid=5621 Frank, Before you run off and start demonizing a pilot LEGALLY excercising his rights, you should research the subject. The fact is that possessing a current Airmen's medical is not guarantee WHATSOEVER that the pilot is fit to fly on any given day. I just received a medical denial letter from the FAA because I was taking Trazodone for insomnia. Insominia is not by itself a disabling medical condition, but Trazodone is on their prohibited list because it is an old anti-depresent drug. ALL anti-depresents are prohibited. PERIOD. It does not matter what the condition is for which you are taking the prescribed medicine: medical denied, DO NOT FLY! Well, I am flying my glider while the paper work is being sorted out (I have a different, much more expensive, drug prescribed for the same IDENTICAL condition). By your reasoning, I AM UNFIT TO FLY. PERIOD, END OF STORY! because I don't have a CURRENT MEDICAL! Never mind that glider pilots DO NOT NEED A MEDICAL CERTIFICATE to LEGALLY fly!! My doctor DOES have a disabling disease; it is DIABETES. But he is LEGALLY able to fly his motorgliders WITHOUT an aviation medical. I am very confident in his ability to fly his motorgliders, to the extent that I have allowed my wife, my kids and my mother to fly with him. By your standards he should be GROUNDED!!! Once, while getting a 3rd class medical, the doctor remarked about my good health. By comparison, he pointed out another patient of his, to whom he had granted the 3rd class medical with the warning that he might not get it the next time, that had DIED within one year! That guy was LEGALLY fit to fly, but died shortly after getting the medical. What you apparently don't realize is the system is more about the FAA covering their respective asses than it is about protecting the public. The system TOTALLY depends upon self reporting of medical conditions; if you report you come under INTENSE SCRUTINY. Thus, the incentive is: DO NOT REPORT! The Inspector General did a study matching Social Security disability payments with certified pilots. They found nearly 10% held CURRENT MEDICAL CERTIFICATES while simultaneously receiving DISABILITY PAYMENTS! Only 40 of these cases were prosecuted because of limited resources (http:// flightphysical.com/FAA/FAA-Report-Falsification/index.htm). Another pilot I know once reported that he had an EKG performed that was negative. The FAA required him to take an ANNUAL EKG for no damn good reason, just to cover their asses! Tom Yo Tom, I wasn't demonizing anyone and if the pilot in the article wanted to come out and fly _his_ glider, fine by me, as I've stated before. However, I think he was flying a _club_ glider and clearly instructing and towing, at least one of those things he definitely should not have been doing. At some point, people need enough personal integrity to do the right thing, especially within a club framework, where responsibilities extend to the other members. (If you don't like it, don't fly in clubs). This chap didn't and that's quite simply stated in the article. I suspect if he had admitted the loss of his medical and loss of power flight privileges to the club, that body may well have banned him from flying club equipment and/or the national association may have prohibited him from instructing. I knew a youngish, at the time, BGA instructor that lost his instructor privileges due to a heart valve replacement. He was about 30 and hiked extensively as a second pastime, but a heart valve replacement may lead to a increase in the chance of clotting, hence the restriction. He was not banned from flying club or personal equipment solo. It's certainly a tough call if it has to be made. BTW, when the SSF does a safety audit of a soaring site, they do look to see if the operation is tracking pertinent information about their flying group, and suggests some internal audits to perform that are germane to this discussion. The FAA does all sorts of things. Heck, I know a man, at 79yo, that got his medical back from a US Senator following a quad by-pass. It took that sort of clout to stop the FSDO foot dragging and get the attention of the FAA Flight Surgeon. 79yo pilots don't like to waste time;^) He wanted to get back to test flying. Frank All, I think everyone here needs a basic course in FAA medical standards policy. I can't provide one here, but recommend you do some research, instead of just shooting from the hip. Start with the FAA Guide for Aviation Medical Examiners (available on the FAA website) and pay close attention to the "protocols" for various diseases. When you are surprised that someone got their medical back after a CABG (coronary artery bypass graft), or that it required a US Senator to intervene, or that the FSDO has any role whatsoever in the medical certification process, then you are seriously confused about the how system works. Recommend you also take a look atwww.aviationmedicine.com. And if you have questions, call those guys. There are many, many airline pilots with valid first class medicals flying (on special issuance) for things like CABG, heart valve replacement, atrial fibrillation, ongoing use of anticoagulant medication, history of cancers of most types, diabetes controlled on oral meds, history of recurrent kidney stones, history of depression, etc, etc. It's all in how you approach the FAA. Frank, the suggestion that clubs start making independent medical certification decisions is ridiculous. The club should operate within the law, and let the pilots make the decisions they are supposed to make under the FAR's (61.53). Regards, Bullwinkle I've listened to this arguement for all my life and now I'm old enough that it may soon apply to me. In that time I've seen two sharply divided groups. One loudly proclaims their 'right' to fly as PIC with innocent non-pilot passengers until they are dead or incapcitated. They will 'game' the system as long as they can get away with it. The other will say that their medical conditions preclude accepting PIC responsibilities and continue to fly but only with a safety pilot. The former group outnumbers the latter by a significant margin. When the day comes, I intend to be in the later group. It is correct to say that the current state of medical science, at least as it is practiced by AME's, can't accurately predict the physical performance of a pilot once he has left the doctor's office. It is also correct to say that the pilot is in the best position to judge his physical condition. The problem is that pilots are often, understandably, in denial about the extent of their medical conditions. Responsibility for one's actions and concern for the safety of others should trump mere pride but sadly, it doesn't happen often enough. At some point organizations will have to deal with a pilot in denial. It should be done with respect, care and courtesy since we all will have to face that day - but it should be done. Bill Daniels- Hide quoted text - - Show quoted text - Most of you are too young to remember that the CAA and the FAA has investigated the accident records of gliders extensively, thinking that medical exams would reduce the accident rate. All accidents in volve that aspect of investigation. The result of the years long study found that most injury accidents happened to pilots that had a valid medical. Almost no accidents happen as a result of pilot medical failure. Some do, and they get more attention. At my operation, I have a FAA rule that I preach...and apply to myself. Fred's air regulation #1.01 "If for ANY reason you don't feel like flying, then don't take off. Fortunately, glider pilots are under less pressure to fly under adverse conditions than other pilots. Before anyone should apply the factors of a single accident and propose rules, they should check all accidents to determine the overall cause or number of accidents related to the subject accident... For example, how do regulations stop a pilot from running out of fuel? I love the discussion. Fred Robinson |
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On May 7, 11:59 pm, fred wrote:
At my operation, I have a FAA rule that I preach...and apply to myself. Fred's air regulation #1.01 "If for ANY reason you don't feel like flying, then don't take off. ... how do regulations stop a pilot from running out of fuel? I love the discussion. I write as a power and glider pilot who's been an FAA-designated aviation medical examiner for 20+ years... This thread is interesting for several reasons, one of which is that it exposes on one hand the folks that are thoughtful and base their opinion on the best evidence they can find; and on the other had the folks whose own opinion is the strongest evidence, but only to themselves, that they are right. Medical screening of pilots was put in place due to the experience in WWI that something like 80% of the accidents were judged to be due to the physical inability of the pilot. The consequence is that we saw a change from no screening at all to unnecessarily strict screening, from which we have been unsuccessful in fully extricating ourselves. The chief usefulness of medical screening, it seems to me, is that it focuses the attention of the prospective pilot on his or her own physical condition and abilities, resulting in self-selection that is far more judicious and effective than the formal screening required by law. Yet there is an important role for formal screening -- to hinder pilots whose ambition to control an aircraft overwhelms good judgment -- and there are not a few of these, and as an enthusiastic pilot I fully understand. For example, a 28 year old airline pilot, whose life dream is being fulfilled, collapses in the ready room of his air carrier with an epileptic fit. The psychological blow and threat to him personally is incalculable. We physicians, sympathetic to him, expend every effort to prove whether or not this was truly epilepsy or simply twitching from a faint due to illness. But in the end, the existence of the formal process forces both him and us to the larger sympathy we owe to the safety of others. In this case, he did have epilepsy due to an old closed head injury in sport; he will never fly again; he would not have been able to make this decision by himself. The bureaucracy necessarily needed to put him into the paperwork corral. We medical professionals are often put in the uncomfortable position of trying to predict the future. Being required to do the impossible is a severe stress for any of us, and we decompensate as individuals and institutions in interesting ways when such is required. In this regard, the FAA aeromedical certification is viewed, by the FAA, as a statement that the pilot is *unlikely* to suffer sudden in- flight incapacitation for the duration of the certificate. We have reduced the impossible to a risk assessment. This assessment is always "wrong" in a sense, but the best we can do is to perform a thoughtful judgment based on the information at hand, about natural course of disease and about the pilot's current health status. We eventually die. Prior to death, we begin losing physical capability. For some of us, this is more or less gradual, and we have the opportunity to exercise good judgment and adapt to it. Or we have good judgment forced upon us by brave friends or an inexorable bureaucracy. For a few, death is sudden and calamitous, and occasionally this occurs while driving a vehicle or piloting an aircraft. In this regard I like to tell patients for whom I'm doing a cardiac stress test, "This test is pretty good at telling who's of the verge of needing bypass surgery, but it doesn't predict sudden death. You could pass this test with flying colors and drop dead on the way home -- but you might be stuck by a speeding semi, too." This is humorous, but makes the point about our inability to see the future. Hence, "self-certification." And hence our need to hold ourselves up to the light before each flight (and during it) and ask if it's *really* a good idea to go (or continue); and we must be brave and, gently or assertively, speak to our colleagues who seem to be risking themselves or others. It's hard, it's risky, and it's socially frightening. But we must do it. Dan Johnson |
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I've entertained a theory that if a pilot can assemble his glider solo, push
it to the end of the runway and strap in, then he has, in effect, self-administered a stress test sufficiently rigorous to indicate he is fit to fly that day. Bill Daniels "danlj" wrote in message oups.com... On May 7, 11:59 pm, fred wrote: At my operation, I have a FAA rule that I preach...and apply to myself. Fred's air regulation #1.01 "If for ANY reason you don't feel like flying, then don't take off. ... how do regulations stop a pilot from running out of fuel? I love the discussion. I write as a power and glider pilot who's been an FAA-designated aviation medical examiner for 20+ years... This thread is interesting for several reasons, one of which is that it exposes on one hand the folks that are thoughtful and base their opinion on the best evidence they can find; and on the other had the folks whose own opinion is the strongest evidence, but only to themselves, that they are right. Medical screening of pilots was put in place due to the experience in WWI that something like 80% of the accidents were judged to be due to the physical inability of the pilot. The consequence is that we saw a change from no screening at all to unnecessarily strict screening, from which we have been unsuccessful in fully extricating ourselves. The chief usefulness of medical screening, it seems to me, is that it focuses the attention of the prospective pilot on his or her own physical condition and abilities, resulting in self-selection that is far more judicious and effective than the formal screening required by law. Yet there is an important role for formal screening -- to hinder pilots whose ambition to control an aircraft overwhelms good judgment -- and there are not a few of these, and as an enthusiastic pilot I fully understand. For example, a 28 year old airline pilot, whose life dream is being fulfilled, collapses in the ready room of his air carrier with an epileptic fit. The psychological blow and threat to him personally is incalculable. We physicians, sympathetic to him, expend every effort to prove whether or not this was truly epilepsy or simply twitching from a faint due to illness. But in the end, the existence of the formal process forces both him and us to the larger sympathy we owe to the safety of others. In this case, he did have epilepsy due to an old closed head injury in sport; he will never fly again; he would not have been able to make this decision by himself. The bureaucracy necessarily needed to put him into the paperwork corral. We medical professionals are often put in the uncomfortable position of trying to predict the future. Being required to do the impossible is a severe stress for any of us, and we decompensate as individuals and institutions in interesting ways when such is required. In this regard, the FAA aeromedical certification is viewed, by the FAA, as a statement that the pilot is *unlikely* to suffer sudden in- flight incapacitation for the duration of the certificate. We have reduced the impossible to a risk assessment. This assessment is always "wrong" in a sense, but the best we can do is to perform a thoughtful judgment based on the information at hand, about natural course of disease and about the pilot's current health status. We eventually die. Prior to death, we begin losing physical capability. For some of us, this is more or less gradual, and we have the opportunity to exercise good judgment and adapt to it. Or we have good judgment forced upon us by brave friends or an inexorable bureaucracy. For a few, death is sudden and calamitous, and occasionally this occurs while driving a vehicle or piloting an aircraft. In this regard I like to tell patients for whom I'm doing a cardiac stress test, "This test is pretty good at telling who's of the verge of needing bypass surgery, but it doesn't predict sudden death. You could pass this test with flying colors and drop dead on the way home -- but you might be stuck by a speeding semi, too." This is humorous, but makes the point about our inability to see the future. Hence, "self-certification." And hence our need to hold ourselves up to the light before each flight (and during it) and ask if it's *really* a good idea to go (or continue); and we must be brave and, gently or assertively, speak to our colleagues who seem to be risking themselves or others. It's hard, it's risky, and it's socially frightening. But we must do it. Dan Johnson |
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