The medical check list for the pilot license

You know the drill…every few months or couple years, depending on your age and class of pilot license, you show up at your AME’s office. Usually this is not a happy event. You make sure you don’t overload on coffee or donuts before the exam, you shower and put on clean clothes, and despite the perceived denigration, you are on your best behavior. After all, you don’t want anything to prevent you from walking out with that certificate. And for sure, you do not want to tell the AME any of your health concerns. We all know that nothing positive ever comes from a flight physical….at best you can hope for no change, in other words, you walk in with a medical ticket, and you walk out with one as well.

I can’t imagine that any pilot actually looks forward to his or her FAA medical examination, nor do most pilots really think that this examination will benefit their health in any appreciable way. Many actually think that these examinations are not necessary for flight safety, because, after all, they should know if something is wrong with them! (Because they are pilots they are smarter than most people, and therefore would somehow intrinsically know that something is wrong, and by the way, what business is it of the government’s anyway?)

Back when I was an emergency room physician, I had to limit the number of complaints the patients wanted me to check out for them. I limited it to the most important 5 symptoms just because I knew I couldn’t solve any patient’s cumulative lifelong problems in one emergency room visit. Even at social events, I have never stopped being amazed at the willingness of strangers to tell me their most intimate medical problems…..all in the name of free medical advice. Of course, things are quite different in the AME’s office….it is amazing how pilots NEVER have anything wrong with them….they never have any medical concerns. Right? Right!

What many pilots do not understand is that the vast majority of medical problems are not issues that will adversely affect their Medical Certificate. Other than a few glaring showstoppers, such as seizure disorders and unstable cardiac diseases, very few medical conditions will actually prevent a pilot from eventually holding a medical certificate. However, a large number of medical conditions deemed not important enough to mention to the AME might affect a pilot’s health and perhaps lifespan! For example, on a daily basis I witness pilots who deny the fact that they have high blood pressure…”as long as it’s low enough to pass” they are often happy with the reading. The result is that they might get an FAA certificate, but they are shortening their lives by ignoring the obvious warning signs. Now would they treat their airplane the same way?

The FAA medical examination has to do with determining whether pilots are physically and mentally capable of operating an aircraft safely during the period that the Medical Certificate is valid. A pilot must be free of any disease or medical condition that could cause an incapacitating event while flying. (It should be pointed out that pilots are not held to any unrealistically high standards of health, they are actually compared to their own cohorts – age and gender – within the general population.) This means that the focus of the FAA exam is different than the health exam, and pilots should not confuse the two. Therefore, they should not blindly accept the FAA medical examination as an indicator of their HEALTH! In order for the AME to maintain greater objectivity in terms of flight safety, the FAA actually recommends that the AME not be the personal physician of a pilot. The drawback is that this perpetuates the tendency for pilots to avoid getting additional health examinations, often creating discontinuity within their recommended personal health maintenance schedules.

Pilots should use health checklists that are appropriate for their age as well as their personal and family histories. Unless the AME is unusually thorough, or the AME is also the aviator’s personal physician, these important items are not necessarily checked by the AME because the goals of the two examinations are so different. I would like to present a reasonable “medical checklist” for pilots to use, to assure themselves that they are getting good preventive health care evaluations. There are, of course, some differences between the genders, but beyond that, the checklist is pretty much the same for both men and women.

To focus on the differences first, I have found that women seem to be more in tune with obtaining regular examinations than men. Every woman old enough to hold a pilot’s licenseprobably knows she should be getting some sort of gender-specific preventive health examination on a regular basis. Every sexually active woman should be obtaining annual female pelvic examinations, and after the age of 18-20 should be obtaining pap smears at least every 2 years. After the age of 40, she should also be obtaining mammograms, the schedule of which is determined by her age, personal and family health history.

Men should regularly obtain prostate examinations after the age of 40, including PSA (prostate specific antigen) blood tests, again dependent on personal and family histories. A man in his forties can get by with such examinations probably every other year (unless there is a strong family history of prostate cancer at an early age) and after the age of 50, should be getting these examinations annually. Testicle examinations, especially in teenagers and young men, are also important, as testicular cancer can be fatal within weeks of discovery if the diagnosis is delayed. This delay in diagnosis is often caused by natural embarrassment on the part young men who are reluctant to tell anyone about a weird lump “down there”. And let’s not forget that men can have breast cancer, too!

Now that we have the gender-specific exams out of the way, let’s focus on those items on the checklists that the same for both sexes, specifically for those of more mature years. This checklist is not intended for individuals with known medical problems that need to be carefully followed, but just for routine health maintenance checks. And of course, depending on an individual’s personal, family and social history, this check list could change. Please keep in mind that ALL abnormal “lumps and bumps”, skin and mole changes, and unexplained pain should be taken seriously and evaluated by the appropriate health care provide!