Doctor unwilling to help with FAA request

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OregonDucks609

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OregonDucks609
Hi all - thanks for all the help thus far. My psychiatrist, who originally treated me for situational depression over a year ago, responded to my email showing him what the FAA requested in their letter to me and told me that he is "not able to assist me with the FAA letter." For context, this was the initial letter sent by the FAA asking me for records after I was deferred by my AME. I was hoping to get in to see him to fulfill the FAA request of doing the clinical examination, which would then allow him to write the letter (I was going to help with that process as much as possible to save him time). Specifically, the FAA requested "a current history and clinical examination from a physician regarding your history of situational depression. The report should be type-written on physician letter and must include..." and then goes on to list things such as diagnosis, mental health history, symptoms, treatment plan, prognosis, etc. I'm at a loss that my doctor won't work with me on this, although I do understand it's a lot to ask of a busy person. Also, to be clear, I firmly believe this is a bandwidth thing and not that he is unwilling to "sign off" or assist me in becoming a pilot due to safety concern or something like that. Any suggestions on best approach going forward? Can I find an FAA-familiar psychiatrist to review my records and perform the clinical examination to create this report? Does it have to be a psychiatrist (the letter simply says "from a physician" and does not specify what kind)? This was a roadblock I was not expecting, but I feel confident that someone on here has dealt with uncooperative docs before.
 
OregonDucks609 said:
Hi all - thanks for all the help thus far. My psychiatrist, who originally treated me for situational depression over a year ago, responded to my email showing him what the FAA requested in their letter to me and told me that he is "not able to assist me with the FAA letter." For context, this was the initial letter sent by the FAA asking me for records after I was deferred by my AME. I was hoping to get in to see him to fulfill the FAA request of doing the clinical examination, which would then allow him to write the letter (I was going to help with that process as much as possible to save him time). Specifically, the FAA requested "a current history and clinical examination from a physician regarding your history of situational depression. The report should be type-written on physician letter and must include..." and then goes on to list things such as diagnosis, mental health history, symptoms, treatment plan, prognosis, etc. I'm at a loss that my doctor won't work with me on this, although I do understand it's a lot to ask of a busy person. Also, to be clear, I firmly believe this is a bandwidth thing and not that he is unwilling to "sign off" or assist me in becoming a pilot due to safety concern or something like that. Any suggestions on best approach going forward? Can I find an FAA-familiar psychiatrist to review my records and perform the clinical examination to create this report? Does it have to be a psychiatrist (the letter simply says "from a physician" and does not specify what kind)? This was a roadblock I was not expecting, but I feel confident that someone on here has dealt with uncooperative docs before.
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I am a year plus into a similar situation. See a Psychiatrist or one you have seen in the past, get all old notes if they exist. Show them what the FAA letter requests, but also bring the FAR with you to show them what the FAA uses as definitions for your particular area of interest. Have them address each line item of the FAA letter...if there is no treatment plan necessary have them state so. Pro-tip: If there is no previous mention of alcohol use in your history, keep it that way!!! Take this information to your AME and have him complete his evaluation. They may say "WTF?" but have them do exactly what it says even if it is saying "You are fine". Submit all that yourself. They also might request years of pharmacy records, especially if you were ever on an SSRI. Preemptively look into acquiring them in case that is their next ask.
 
OregonDucks609 said:
This is helpful. Any suggestions on how to find one?
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I would start with your AME for suggestions. Some doctors don't want to deal with stuff like this, I think they may be worried about liability? Fortunately most are not like this. I would try to get all your records from your current doc. My former doctor was hesitant to sign a note saying my blood pressure was under control and there were no present plans to change my regiment. I explained that they were not approving me for flight, my AME and the FAA were doing that, they were just saying my blood pressure was under control.
 
PaulS said:
I would start with your AME for suggestions. Some doctors don't want to deal with stuff like this, I think they may be worried about liability? Fortunately most are not like this. I would try to get all your records from your current doc. My former doctor was hesitant to sign a note saying my blood pressure was under control and there were no present plans to change my regiment. I explained that they were not approving me for flight, my AME and the FAA were doing that, they were just saying my blood pressure was under control.
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Agreed. And if your treating physician knows them, even better.
 
This is unfortunate, but is a byproduct of the ACA’s allowable bill structure. :(. A so called”forensic” psychiatrist will run in the mid two thousands and will Be non-insurance..:(. NOTHING IS CHEAP……
 
In my opinion, a doctor who is reluctant to even write a letter is also unlikely to work with you on exactly what to write and more importantly what NOT to write. He is required to make his own records available to you, but the suggestion to leave the wordsmithing to someone who is clearly on your side is a good one.

In my own situation for other conditions in response to similar requests I've used the letter from the FAA to specifically address each requested item, looked at my own medical record for factual confirmation, then written the letter myself and given the letter in Word form for the doc to copy and paste on his letterhead, which he signs, returns to me and I send it directly to the FAA.

In your situation, with this kind of diagnosis, your own doc may be doing you a favor by not writing the letter himself.
 
dbahn said:
In my opinion, a doctor who is reluctant to even write a letter is also unlikely to work with you on exactly what to write and more importantly what NOT to write. He is required to make his own records available to you, but the suggestion to leave the wordsmithing to someone who is clearly on your side is a good one.

In my own situation for other conditions in response to similar requests I've used the letter from the FAA to specifically address each requested item, looked at my own medical record for factual confirmation, then written the letter myself and given the letter in Word form for the doc to copy and paste on his letterhead, which he signs, returns to me and I send it directly to the FAA.

In your situation, with this kind of diagnosis, your own doc may be doing you a favor by not writing the letter himself.
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Yes, I agree with this. At the end of the day, it may be a blessing in disguise. What’s interesting is, as you can see from my original post, is that they don’t even require a psychiatrist for this letter. It just says “physician,” so I think I may just get my PCP to sign off on a letter using your approach above. We will then see what the FAA comes back with. Does that sound like a workable/reasonable approach for you seasoned experts on here?
 
OregonDucks609 said:
We will then see what the FAA comes back with.
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If you're willing to take a chance that the FAA might come back with a denial, that might be reasonable.

I'm no expert, but we have experts on this forum such as Dr. Chien, who replied in post #14. You might want to contact him.


OregonDucks609 said:
...I think I may just get my PCP to sign off on a letter using your approach above.
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It seems to me that when the FAA is asking for a physician to write a letter about a psychiatric condition, they would expect the physician to be a psychiatrist. I doubt they're interested in an opinion from a PCP, a podiatrist, or a gynecologist.

If you were responding to an FAA query about a cardio condition, would you send them a letter from a psychiatrist just because he's also a physician?

Just a layman's opinion, and probably worth less than you paid for it.
 
I agree that you can't just use any "physician". So much depends on exactly what the request letter says but I also assume that if your psychiatrist won't write a letter you need another psychiatrist to review the original psychiatrists records and then write the letter according to the written request. I also would defer to Bruce Chien for guidance on this. A little prevention from a person experienced in doing this goes a long way towards making it as uncomplicated as possible. I wouldn't put it past the FAA to require a written statement from the original psychiatrist to confirm his refusal to write the letter.

The good news is that in many cases short-term situational depression is less of a hurdle than many of the other mental health hurdles.
 
FYI - I am currently working with @lbfjrmd, who is great, but I always like to try to get as much input from those with experience as possible. For what it's worth, he doesn't believe this needs to be a psych and can just be a regular ole doctor. That being said, you never know what nugget of information will make the difference. I cannot wait for the day I get through all of this successfully and can be a resource for others. Below is the request in the letter related to the situational depression. Let me know what you guys think.
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PaulS said:
I would start with your AME for suggestions. Some doctors don't want to deal with stuff like this, I think they may be worried about liability? Fortunately most are not like this. I would try to get all your records from your current doc. My former doctor was hesitant to sign a note saying my blood pressure was under control and there were no present plans to change my regiment. I explained that they were not approving me for flight, my AME and the FAA were doing that, they were just saying my blood pressure was under control.
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I had the same thing happen. Same issue, needed the letter from my PSC that my blood pressure was controlled. My doc closed his practice and turned over his patients to a group practice. First visit, no problem, doc did the letter.

Second time, she had left, and the current doctor either was clueless or deliberately dense, can kept saying that the letter was from the AME to the FAA and the AME should do it. I had all the previous letters in my file, and it was clear that it was from my PSP. Luckily, the nurse that day had been with my previous doc, so she gave me the contact info for the doc from the first visit to this practice. So I followed her to her new practice, even though, it was almost 45 minutes further away.
 
If your doctor is contracted with your insurance company, they can't charge you for services not covered. I ran in to this wanting blood work for low Vitamin D my insurance won't cover it even though I had a history of low D in the past I take one a day vitamin keeps it in the normal range. The contract stipulates the doctor is not allowed to charge the patient for non-approved tests. When a doctor tells you test isn't needed likely it's because of payment not really medical related it's all about the money these days I found it's even worse now because 2-3 large medical corporations are buying up all the small doctors' offices. It's all about the bottom line now. Psychiatry still has lot of them who are not contracted with insurance should be able to find one. If they were in network those are what I call pill mill psychiatrists, they spend an hour with a patient then write a script. After that they have the patient come in and spend 10 minutes renew the script. This is all designed by insurance companies, so they turn and burn 50-100 patient a day in a big office that's how they make money. It's why you only find a few of them contracted most are not taking insurance. I went through this trying to help a family member to find a good Psychiatrist have to pay out of pocket.
 
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