“Suspected” Afib leads to Waste of $$$$ and Spec. Issuance

Discussion in 'Medical Topics' started by 422Phil, Jan 7, 2021.

  1. 422Phil

    422Phil Filing Flight Plan

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    Passing this along for anyone going through something similar. I’m over 40 with a 3rd Class Med. During a routine exam, my doctor wrote in my med chart suspected afib based on my relaying a time six months before when I felt like I had a rapid heartbeat that lasted for an hour or so. When I went to my AME to renew my Med Cert she found the note and deferred me and said I would hear from the FAA with a list of requirements. Keep in mind I don’t suffer from Afib symptoms, I’m not on any heart medications, and I stay in good shape. A couple of weeks later the letter from the FAA arrives, they need me to provide documentation of the following tests taken within the last 90 days: Echocardiogram, 24 hr Holter Monitor, Sleep Study, exercise Stress Test (with Bruce protocol), and Thyroid panel blood work. So I go to the local cardiologist’s office, find a nurse, and we read the letter together. She immediately says there is no way the doc is going to sign off on ordering all these tests. “They are not medically necessary.” I beg her to let me talk to the doc. Fortunately he agreed to meet with me even though I didn’t have an appointment. His initial reaction was “no way.” But, I pushed harder and said that flying meant the world to me and to please help. He didn’t want to do it, but in the end he ordered all the test and filled out the FAA Afib form. He also warned that my health insurer may not pay for the tests. $10,000 worth of testing later, we confirmed that I didn’t have any symptoms, and didn’t need any treatment. All of the test results were submitted to the FAA via overnight delivery service. 3 weeks later they were finally scanned into their system. Two months later I received a letter from the FAA advising I was approved for a special issuance Med Cert, but would need to submit to them annual update reports with a 24hr holter monitor re-test. The time, the money, the aggravation, all because I told my primary care doc that I felt like I had a rapid heart rate 6 months beforehand for a short period of time. Good Grief!! Why did I say anything????
     
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  2. PilotThumper

    PilotThumper Filing Flight Plan

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    You did the right thing as it could have been serious. However your doctor should have addressed it at the time and done any testing at that time.
    I would have a word with your doctor as things like this, if left open to interpretation, can cause some serious issues for a pilot. Not to mention are the reason why there are some who do not say anything at all as it could mean an end to there career.
     
  3. MountainDude

    MountainDude Pre-takeoff checklist

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  4. kmacht

    kmacht Pre-takeoff checklist

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    Why does your AME have access to the electronic medical records of your primary doc and since when is it’s an AMEs right to go through those records?
     
  5. Doctor Bob

    Doctor Bob Pre-Flight

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  6. bbchien

    bbchien Touchdown! Greaser!

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    Should only have done a 7 day ziopatch, then had the cardio testify: no evidence ever of AFib. Too late now.......

    ...and that is why you keep your AME separate from you PCP.
     
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  7. 422Phil

    422Phil Filing Flight Plan

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    My primary and AME work at different locations but are within the same medical group.
     
  8. MacFly

    MacFly Line Up and Wait

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    Classic FAA, not to mention a good example of medical record carelessness on the part of your doctor. A patient’s medical record is not a place for musings and “thinking out loud”.
     
    Last edited: Jan 8, 2021
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  9. Jeff Oslick

    Jeff Oslick En-Route

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    The is a very dangerous precedent. While the AME may have had the right to access your records within the scope of normal practice, I question whether they had the right to access those records without your authorization for the sole purpose of an FAA medical exam. The speed at which healthcare companies are being consolidated, you may not even know if one provider is in the same network as another. It may be worth a bit to consult with an attorney specializing in HIPAA rules.
     
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  10. Stewartb

    Stewartb Final Approach

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    Hello, BasicMed!
     
  11. Bill

    Bill Touchdown! Greaser! PoA Supporter

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    it would be wise to fix that. My AME for basic med and my PCP are in totally separate hospital networks.
     
  12. Aviator305

    Aviator305 Pre-takeoff checklist

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    It is absolutely necessary for a doctor to
    “muse” and “think out loud” in a medical record provided that appropriate qualifiers are included such as “possible” and “rule out.” Without such freedom, it would be difficult for one doctor to communicate to another doctor what is being considered in the differential diagnosis. A medical record is not the place for a doctor to shield his/her thoughts.

    Medical records a started fundamentally as a vehicle by which doctors record data about the chief complaint for a given visit, history of present illness, physical exam findings, past medical and surgical histories, medications, lab and (and now more than ever radiological) data and a general assessment and plan. The final diagnosis is rarely ever possible on the first or even initial set of subsequent visits, and it is entirely appropriate for a doctor to write down possible unconfirmed diagnoses (actually, this is often helpful if not required to justify ordering additional tests for the work up, and the insurance companies will not approve otherwise).

    As a physician, I am completely sensitive to this issue (and frustrated too), but the problem lies with how YOUR medical record is being used inappropriately by different agencies. Another case in point, one of my very good friend’s life was delayed by 8 years because of a “question” of a possible renal stone on an x-ray. If the radiologist in good conscience could not exclude a stone on a poor study and recommends a follow up, then the medical examiner should have followed up with the appropriate test before flagging him as not fit to fly. Instead of fulfilling his lifelong dream to fly for the Air Force, he had to go through a years-long drawn out process before he was cleared and thankfully is now flying for the Army.
     
  13. MacFly

    MacFly Line Up and Wait

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    Valid point. The FAA AME's source of health care information is supposed to come from the 8500-8 or the MedXPress form. They "shouldn't" be allowed to just cruise around in one's medical records and base their evaluation on that. The exception might be if the OP's doctor actually entered a diagnosis code of "atrial fibrillation".
     
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  14. MacFly

    MacFly Line Up and Wait

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    If a doctor is going to "think out loud" in the medical record, then he or she is obligated make a move to prove or disprove those musings. To just say "the patient's symptoms might be due to atrial fibrillation" and then not follow up with appropriate testing or specialty consultation in order to determine if that is indeed the case is inappropriate, bad medical care, and led to the pointless BS that the OP had to wade through.
     
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  15. Aviator305

    Aviator305 Pre-takeoff checklist

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    Absolutely correct, and that is in fact the standard of care.
     
  16. flyingron

    flyingron Touchdown! Greaser! PoA Supporter

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    Yes, with a differential diagnosis, you need to resolve one choice over another. Absent that, it's just "guessing."
     
  17. PeterNSteinmetz

    PeterNSteinmetz Pattern Altitude PoA Supporter

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    Perfect example of how the entire aeromedical requirements for private GA pilots are an expensive and time-consuming overkill.
     
  18. 422Phil

    422Phil Filing Flight Plan

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    I agree with many of the comments above with regard to the confidentiality/privacy of our med recs. But as pilots i think we have to relinquish some of those rights in exchange for the privileges of a Med Cert to operate our aircraft. All that said, if I was someone that suffered a heart condition and I was inclined to play hide the ball with the AME, then I’m putting everyone at risk and myself. I really don’t have a problem with my AME having open access to my medical records. In fact, I view it as a safety feature. I want my AME to make an informed decision and if necessary protect me from myself if I’m too stubborn to admit I’m not fit to fly. For me what it comes down to is the reaction by the FAA. The procedure should have been for the FAA to require me to meet with a Cardiologist and the cardio to review my records, order any tests the cardio deems necessary and then make a recommendation. What was frustrating is that the subject matter expert (ie, the cardiologist) was told by the FAA which tests he had to order and via the SI the FAA continues to require tests that are not medically necessary.
     
  19. MacFly

    MacFly Line Up and Wait

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    The OP wasn’t suffering from a heart condition.
     
  20. RussS

    RussS Pre-takeoff checklist

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    Unfortunately the FAA makes their own diagnosis’s independent from the rest of the medical community. I’m all for safety as well....but come on.
     
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  21. MacFly

    MacFly Line Up and Wait

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    In this case, the OP underwent tens-of-thousands of dollars of unnecessary medical testing because of an unsupported WAG that his doctor dumped into the medical record without followup tesing and which in turn ultimately came to the attention of the FAA based on the AME relaying information that she had no business having access to and probably represents a HIPPA violation.
     
    Last edited: Jan 8, 2021
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  22. X3 Skier

    X3 Skier En-Route

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    I always reflect on the absurdity of this type of action by the FAA when a person flying as a sport pilot only needs a drivers license or under Basic Med just a simple exam by a PCP:rolleyes:

    Cheers
     
  23. PeterNSteinmetz

    PeterNSteinmetz Pattern Altitude PoA Supporter

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    While protecting others is certainly an admirable goal, the trouble in the case of the FAA aeromedical system is that there is no good evidence that the requirement for a 3rd class medical to fly GA aircraft for recreation improves the safety of flight.

    The FAA argues that their experience with the HIMS program is indirect evidence that it helps and the data from Sport Pilot indicates no effect. Pretty weak evidence.

    So the serious question is whether such mixed evidence is a valid justification for forcing pilots to endure all this time and expense. I would argue that the overall experience with regulatory systems also bears on this point and suggests it is likely not worth it from any rational evaluation of the cost of accidents, both in terms of lives lost and money.

    The sort of problems you note here, an agency becoming overly intrusive, continuing unnecessary expenses, etc. are all typical problems with regulatory schemes to prevent bad outcomes. See Mises “Bureaucracy”.
     
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  24. hindsight2020

    hindsight2020 Final Approach

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    Yup. I won't give the OP my privately-held thoughts on the medical bureaucracy on open forum, as someone who feeds his kid by the fruits of a medical-dependent occupation. That said, I also don't really place much stock in morality purity-testing from hobbyists who at the end of the day don't have their livelihoods threatened by advocating a gratuitously naive approach towards the medical industrial complex.

    OP, you got railroaded because you approached the medical establishment with naive sincerity, and you got victimized for it. Nothing we can do for you now. That's a foul what the FAA, the AME, your PCP, and the mishandled weaponizing of your PCP records, all did to you in concert. Nevertheless, a lesson that life ain't fair and these people aren't your friends nor savior.

    If people insist on having their lunch eaten for the sake of being absolutist boy scouts, and choose to "fly unescorted" in this life, for the love of Zeus at least go BasicMed out the gate and help yourself not be the designated patsy at the poker table.
     
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  25. PeterNSteinmetz

    PeterNSteinmetz Pattern Altitude PoA Supporter

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    Of course you have to get that first medical certificate. Of course I guess the point may be, switch to BasicMed ASAP.
     
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  26. WDD

    WDD Pattern Altitude

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    Can you “turn off” your 3rd class medical and go basic med the day after you get the 3rd class issued? That way it can’t be revoked, terminated, or whatever else they can do.
     
  27. Eldorado

    Eldorado Pre-takeoff checklist

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    Thoughts...1) what caused the rapid heart rate that lasted for an hour, or do we know? 2) would a general cardiologist order the same tests for a typical 40 y/o patient versus a cardiologist(AME) clearing a pilot to fly? I don’t see the problem with either the first doctor, the AME, or the FAA. We all need to be careful when we enter the medical or FAA bureaucracy, but their obligations is different to each patient.
     
  28. hindsight2020

    hindsight2020 Final Approach

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    No need to. The way it works by stipulation is you let it expire and continue flying under basicmed.

    fwiw, they can revoke a certificate after the fact, and you would indeed lose basicmed eligibility overnight. In practice, as long as you let that thing expire (aka don't go fiddling with medexpress) and don't make contact with the wing-clippers, the certificate expires and you're free to fly around the Country as a basicmed guy, worry-free.
     
  29. Aviator305

    Aviator305 Pre-takeoff checklist

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    You have an answer in the original post. The cardiologist did not want to order those tests and resisted until there was begging involved.
     
  30. Jeff Oslick

    Jeff Oslick En-Route

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    I reflect on the absurdity of these situations every time I drive next to a large truck at 65+mph, driven by someone with a CDL. Medical concerns are the least scary part of driving near trucks.
     
  31. Jeff Oslick

    Jeff Oslick En-Route

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    Barista at Starbucks accidently put 4 shots instead of 2 in their coffee? Bad reaction to an energy drink?
     
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  32. WDD

    WDD Pattern Altitude

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    There isn’t evidence there ever was one. The OP said he felt like it was - maybe six months ago. How would the OP know? After $10k of tests you have a lot of evidence it never happened.

    For his doc to take that comment and declare it afib was crazy. Perhaps it was CYA. Time to get a new doc and basic med
     
  33. Lindberg

    Lindberg En-Route

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    Not to defend the FAA, but it seems to me the AME could have handled this better even after she felt the need to go fishing in the OP's record.
     
  34. Aviator305

    Aviator305 Pre-takeoff checklist

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    Not to take away from the absurdity and frustration of this situation, but to be sure I looked up the out of pocket costs for the four tests the OP mentioned. The sum total should be under $1k. Wondering if it was hyperbole
     
  35. Stewartb

    Stewartb Final Approach

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    Funny you say that. I have a permanent pacemaker. One of the attributes of a pacer is it provides the doctor a 24/7/365 EKG when the data is downloaded, which in my case is quarterly. During one cardiologist visit the doc mentioned I had a high heart rate event. I knew the date and time and told her. She asked what I was doing. I had been driving the 4 hours from daughter's house to mine after three cups of coffee with breakfast, a tall Starbucks latte along the way, followed by a big Dr Pepper a little later. That was the day I was told to switch to decaf. Never any danger. Easily explained because I had accounting of date and time. Watch that caffeine!

    BasicMed is a blessing for guys like me with minor cardiac treatments. My AME laughs that my heart is studied and maintained while the vast majority of you have no idea what your true cardiac condition is, yet I had to navigate the SI process like I was a ticking time bomb. That's far from the truth. FAA aeromed serves a purpose, but it shouldn't apply to private pilots. BasicMed isn't perfect but it's the best solution we have now. C'mon expansion of LSA!
     
  36. MacFly

    MacFly Line Up and Wait

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    An Apple Watch or a Kardia Mobil are very accurate and simple on-the-spot ways to distinguish a “high heart rate event” from atrial fibrillation. A cardiologist buddy recommended it as I was often hitting heart rates of 170-180 on my mountain bike.
     
  37. Lindberg

    Lindberg En-Route

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    Even if the sum total out of the OP's pocket was only $1k (and you don't know what kind of insurance he has), someone had to pay the rest. And insurance may refuse to pay anything for procedures that are completely unnecessary.
     
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  38. Aviator305

    Aviator305 Pre-takeoff checklist

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    Hence, why I said “not to take away..”. He should not have had to been placed in a situation to pay for any of this.
     
  39. LesGawlik

    LesGawlik Pre-takeoff checklist

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    And many CDL drivers just flat-out lie. I can't tell you how many medical records I see from CDL drivers who have been on opioids for chronic pain for years. The self-reporting form for the DOT physical doesn't mention a thing. The "examination" doesn't mention a thing. And the school bus driver leaves with her CDL.
     
  40. 422Phil

    422Phil Filing Flight Plan

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    Great point! The cardio also told me to use an Apple Watch to keep an eye on things.