Personal Doc/AME?

Mike Smith

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I posted this over on the red board, but wanted to ask here also.
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What are the thoughts of the collective on having your personal Doc also be your AME? I find my self in the position of needing to find a new Doc and a new AME, there are a couple of options locally where I can get both. Good idea? Bad idea? Doesn't matter?
 
Conventional wisdom is don't so YOU can control information between the two.

I don't subscribe to that. I went for my first flight physical based on a recommendation from a friend. While I was waiting, I listened to the AME giving advice and chewing out a couple of folks for unhealthy stuff. I was in the market for a new doctor myself and he had a family practice. 11 years later I'm still using him for both. It has worked well for me because he can tell me what medicines I can and can't use to keep my 3rd class safe. And, more importantly, he's a good doc who keeps up with new stuff and is holistic.

John
 
Sounds like a bad idea to me.

As I said, that's the conventional wisdom. Please (you or anybody who can) describe what the problem is. Preferably with actual, personal examples.

That's all my data point is: my personal experience. My regular doctor is 1) a pilot and 2) my AME. For 11 years and 6 flight physicals it has worked well for me even with hypertension management and a heart attack scare (fortunately false).

John
 
Depends on who it is so I would say it's impossible to generalize. I have never had a doctor who is an AME. Pretty sure none of my doctors have even been pilots...
 
I have a doctor that I prefer for general care who happens to be an AME. He understands his two roles and it works just fine.
 
AME/Primary Care = two different sets of responsibilities.

The AME reports to the FAA, and works for FAA interests.

PCP reports to you, and works for your interests.

There are advantages if you have a PCP that's also an AME - he'll understand your questions and concerns better when it comes to diagnoses and treatments.

But, having a PCP that's also your own AME -- I would just prefer to keep those two jobs separate.
 
Can anybody cite an actual problem (as opposed to a hypothetical or just generally "it could be bad") that resulted from this relationship? I'm not trying to be combative, I'd really like to know.

John
 
Can anybody cite an actual problem (as opposed to a hypothetical or just generally "it could be bad") that resulted from this relationship? I'm not trying to be combative, I'd really like to know.

John
I can't think of any that I've heard of first hand.

Mainly, the concern is the possibility of putting your PCP into a conflict of interest. A "pure" PCP might treat something one way, and an "AME" PCP might treat something another way. Which way is better? Should he recommend a course of treatment best for the patient or easiest for FAA? Most of the time it probably isn't a problem at all.

But I'm interested too. One of the PCPs in my doc network is an AME, but I don't use him either as a PCP or AME.
 
I suppose I can see where there could be an issue where the PCP is adamant of reporting a diagnosis of (x) where you might "spin" it differently if you were just reporting to the AME. I guess I don't see the down side if you plan on being honest anyway. What am I not seeing?
 
AME/Primary Care = two different sets of responsibilities.

The AME reports to the FAA, and works for FAA interests.

PCP reports to you, and works for your interests.

There are advantages if you have a PCP that's also an AME - he'll understand your questions and concerns better when it comes to diagnoses and treatments.

But, having a PCP that's also your own AME -- I would just prefer to keep those two jobs separate.

Bingo.

As someone who flys for a living, I'm just flat out not messing with it.
 
I prefer to keep the two separate,I don't believe the AME needs to know all my personal business.
 
Two thoughts.

Separate providers- easier to control/conceal information if that sort of thing suits you.

Same provider- Easier to maintain treatments, procedures, and medications that don't cause FAA conflicts. That doc may be more willing to seek suitable alternatives so no concealment is necessary.

In either case a well informed patient can manage his own situation. It depends on the pilot and the doctor. But most DQ conditions require specialists anyway so in either case there's bound to be more doctors involved when dealing with a problem.
 
I would be willing to combine the two about the same time I become willing to allow a family member become my accountant, financial adviser and investment manager
 
I would be willing to combine the two about the same time I become willing to allow a family member become my accountant, financial adviser and investment manager

It would be more like hiring an IRS auditor to do your taxes.

It could work.
 
So still no specific examples.

Mine seems to have no conflict of interest. He wants me to be safe. He wants me to fly. Which sound like the same things I want...

Those are very powerful sound bites about family member as investment counselor and IRS agent as accountant. But how about some examples?

John
 
So still no specific examples.

Mine seems to have no conflict of interest. He wants me to be safe. He wants me to fly. Which sound like the same things I want...

Those are very powerful sound bites about family member as investment counselor and IRS agent as accountant. But how about some examples?

John

I really am open minded and want to make an informed decision, but I agree with this. I don't think I agree with the comparisons. Can someone give me a realistic scenario (even if made up) of how this would be bad? If I am flying legally and being honest, I cant see the issue, if it is there, I want to see it.
 
I really am open minded and want to make an informed decision, but I agree with this. I don't think I agree with the comparisons. Can someone give me a realistic scenario (even if made up) of how this would be bad? If I am flying legally and being honest, I cant see the issue, if it is there, I want to see it.

I'm guessing there will be very few real-life examples. Not many pilots have an AME/PCP combo, and probably not many actual bad situations will pop up. The numbers are probably so small it's more than likely just going to come down to having a personal preference.

I'd like to hear any real life bad experiences, too.
 
I really am open minded and want to make an informed decision, but I agree with this. I don't think I agree with the comparisons. Can someone give me a realistic scenario (even if made up) of how this would be bad? If I am flying legally and being honest, I cant see the issue, if it is there, I want to see it.

You come in for a routine physical but you're a bit dehydrated and last nights dinner was a bit salty. It was your favorite chinese place. This isnt related to an aviation physical.

Nurse checks your blood pressure which is normally 120/80, this time is 135/96. You know its probably just dehydration and the meal from last night, maybe you missed some sleep as well, the doctor knows this. But he makes a comment "Well technically now you're out of flying limits for your physical, we're gonna have to do several readings over the next week to see if you're still eligible for a class 3. "

Or better yet, your doctor who is a bit "straight edge", thinks you have a drinking problem because you admitted to throwing back a few beers on the weekend. Does he report that in his medical opinion you now have a substance abuse problem? Even though everyone else would see it as normal?
 
You come in for a routine physical but you're a bit dehydrated and last nights dinner was a bit salty. It was your favorite chinese place. This isnt related to an aviation physical.

Nurse checks your blood pressure which is normally 120/80, this time is 135/96. You know its probably just dehydration and the meal from last night, maybe you missed some sleep as well, the doctor knows this. But he makes a comment "Well technically now you're out of flying limits for your physical, we're gonna have to do several readings over the next week to see if you're still eligible for a class 3. "

Or better yet, your doctor who is a bit "straight edge", thinks you have a drinking problem because you admitted to throwing back a few beers on the weekend. Does he report that in his medical opinion you now have a substance abuse problem? Even though everyone else would see it as normal?

Scenario 1: Ok, I can see this even though I think that it is a very extreme chance. If this happened, Id get the readings done, go back to flying and get a new AME.
Scenario 2: First, can an AME write and opinion? I mean this would never happen to me anyway cause I don't drink, but I am questioning that the AME can write an opinion based on one comment?

Just to be perfectly clear, I don't disagree with you at all, I am just debating to get as much info as I can into my pea brain.
 
You come in for a routine physical but you're a bit dehydrated and last nights dinner was a bit salty. It was your favorite chinese place. This isnt related to an aviation physical.

Nurse checks your blood pressure which is normally 120/80, this time is 135/96. You know its probably just dehydration and the meal from last night, maybe you missed some sleep as well, the doctor knows this. But he makes a comment "Well technically now you're out of flying limits for your physical, we're gonna have to do several readings over the next week to see if you're still eligible for a class 3. "

Or better yet, your doctor who is a bit "straight edge", thinks you have a drinking problem because you admitted to throwing back a few beers on the weekend. Does he report that in his medical opinion you now have a substance abuse problem? Even though everyone else would see it as normal?

"Well technically now you're out of flying limits for your physical, we're gonna have to do several readings over the next week to see if you're still eligible for a class 3. "

Seems reasonable.

Maybe add the following: "And your insurance won't cover follow-up visits because it's outside a routine physical. But I'll make sure to keep all the copies of the paperwork necessary to send in to the FAA when you come in for your next medical. And don't forget you now have to report this separately because it isn't a routine physical anymore."
 
Scenario 1: Ok, I can see this even though I think that it is a very extreme chance. If this happened, Id get the readings done, go back to flying and get a new AME.
Scenario 2: First, can an AME write and opinion? I mean this would never happen to me anyway cause I don't drink, but I am questioning that the AME can write an opinion based on one comment?

Just to be perfectly clear, I don't disagree with you at all, I am just debating to get as much info as I can into my pea brain.

I'm not sure how they would handle #2, I just think there's too many possibilities for similar situations. Realistically, I think a lot of primary care folks would be realistic and okay, but in the situation of dual rolls, eventually someone will get the shaft in my opinion.

Similar to when my wife and I go married. her family is strict catholic so we had to do the catholic pre-marriage counseling. Her father was trying to get us to use one of his close personal friends. I objected and my wife agreed. We didnt want to talk about family planning, finances, etc with a close personal friend of the father.
 
[snip]
Similar to when my wife and I go married. her family is strict catholic so we had to do the catholic pre-marriage counseling. Her father was trying to get us to use one of his close personal friends. I objected and my wife agreed. We didnt want to talk about family planning, finances, etc with a close personal friend of the father.

Wow! I would imagine that would creep your wife out big time! It would've mine.

John
 
You come in for a routine physical but you're a bit dehydrated and last nights dinner was a bit salty. It was your favorite chinese place. This isnt related to an aviation physical.

Nurse checks your blood pressure which is normally 120/80, this time is 135/96. You know its probably just dehydration and the meal from last night, maybe you missed some sleep as well, the doctor knows this. But he makes a comment "Well technically now you're out of flying limits for your physical, we're gonna have to do several readings over the next week to see if you're still eligible for a class 3. "

Or better yet, your doctor who is a bit "straight edge", thinks you have a drinking problem because you admitted to throwing back a few beers on the weekend. Does he report that in his medical opinion you now have a substance abuse problem? Even though everyone else would see it as normal?
What makes you think your BP would be any better on a aviation physical? Are you not going out for Chinese the night before? Or are you saying that since you have more regular physicals you have more of a chance of an unusually high reading? I personally don't think AMEs are out to get you. In fact I've heard from various people how their AME will take additional readings if the first one is found to be a little high. They let them sit there and relax first.

But as I mentioned before, I think it depends on the doctor. We could come up with all kinds of hypothetical situations favoring one way or the other.
 
My BP is like that. Normally, its actually on the low end. Enough that I've set off alarms on a machine taking it. Lowest resting heart rate I've had recorded in a physical was 48 bpm, Lowest blood pressure I've ever had was 100/70 I think. They made me get up and jump around and retake it.

Now, If I dont sleep well, dehydrated, or anything off standard it all jumps up. I only know this because I specifically watch all that stuff regularly as I'm an ultra distance runner and pay attention to my cardiovascular system a lot.

I've had a large "less than ideal" dinner and a few drinks the night before a doctor visit (post race physical) and my bp was exactly 140/90.

That's strictly just me. Could be entirely different to someone else and you're right. We can dream up a thousand situations for either side.

I think if my primary care physician became an AME she'd probably roll her eyes and issue the cert for me in virtually all cases.
 
There is another angle. Are you going to be even less likely to get something checked out because your Doc is an AME? Easy to say when you are feeling fine, sure of course- health first, but if it means immediately tearing up(metaphorically) that little piece of paper?
 
There is another angle. Are you going to be even less likely to get something checked out because your Doc is an AME? Easy to say when you are feeling fine, sure of course- health first, but if it means immediately tearing up(metaphorically) that little piece of paper?

Very good point Greg.
 
There is another angle. Are you going to be even less likely to get something checked out because your Doc is an AME? Easy to say when you are feeling fine, sure of course- health first, but if it means immediately tearing up(metaphorically) that little piece of paper?

It isn't a flight physical until you take the steps to make it a flight physical. I wouldn't offer my physician access to my medical cert during a routine visit nor would he ask for it. If I exhibited a serious problem I think our focus would be on a solution, not my flight status. In finding the solution he'd likely try to find one that allowed continued compliance with aeromedical regs without my having to educate him. Advantage flight doc.
 
There is another angle. Are you going to be even less likely to get something checked out because your Doc is an AME? Easy to say when you are feeling fine, sure of course- health first, but if it means immediately tearing up(metaphorically) that little piece of paper?

My dr has a separate practice (and always has) for flight physicals. I have to hand carry records from one to the other (that may change now that they are in the same office). So he's aware, but keeps them strictly separate.

Now if i went to see him and had a condition which would make me unsafe to fly, he'd tell me. And I wouldn't fly. Safety first, right? If I then didn't report it at my next flight physical, he'd probably ask me about it. But still, safety first, right?

It seems to me the problems are if you're trying to game the system by not reporting something. Or, I suppose, if your doctor is a jerk and is out to get you. But I suspect that's a problem anyway. If you AME is playing "gotcha" you need a new AME.

Personally, using my doctor, I like not having to educate my doctor on what I can and can't do to keep my medical.

John
 
When I started flying, I found out that my doctor was also one of three AMEs in town. Kept using him, it was easier. Had a physical every year, on the old insurance plan. One year was just a physical, the next was my FAA physical.

Never had any conflict in the seven years before I relocated 600 miles away. Had the job not changed, I would still be using him for both.

Whenever there was a problem, I knew that he would take the FAA regs into account, and not do something stupid that would cause problems for my next physical. Also, I doubt that a single BP reading of 135/96 would be DQ, as I've been borderline for a couple of decades but am still med-free. Unless it happened during a flight physical . . . then there are still retest options that day. Maybe you're stressed from driving [typically causes 10-15 point rise]. Wait a while and retest. Once I had the pleasure of laying down and talking to a nurse for about 10 minutes before suitable readings came from the cuff, but I do not have a history of high readings so something unusual was happening on that day.

If your doctor suggests a new treatment regimen based on one event, find a new doc. Primary care, specialist, AME, surgeon, it don't matter--some things require actual thought, which is being systematically eliminated from many rules and regulations in this country [can you say "zero tolerance" in schools? I'm sorry, your 6 year old son made a bad drawing of a gun, he is suspended because we have a zero tolerance policy for violence. Since when is a drawing violent?]
 
When I started flying, I found out that my doctor was also one of three AMEs in town. Kept using him, it was easier. Had a physical every year, on the old insurance plan. One year was just a physical, the next was my FAA physical.

Never had any conflict in the seven years before I relocated 600 miles away. Had the job not changed, I would still be using him for both.

Whenever there was a problem, I knew that he would take the FAA regs into account, and not do something stupid that would cause problems for my next physical. Also, I doubt that a single BP reading of 135/96 would be DQ, as I've been borderline for a couple of decades but am still med-free. Unless it happened during a flight physical . . . then there are still retest options that day. Maybe you're stressed from driving [typically causes 10-15 point rise]. Wait a while and retest. Once I had the pleasure of laying down and talking to a nurse for about 10 minutes before suitable readings came from the cuff, but I do not have a history of high readings so something unusual was happening on that day.

If your doctor suggests a new treatment regimen based on one event, find a new doc. Primary care, specialist, AME, surgeon, it don't matter--some things require actual thought, which is being systematically eliminated from many rules and regulations in this country [can you say "zero tolerance" in schools? I'm sorry, your 6 year old son made a bad drawing of a gun, he is suspended because we have a zero tolerance policy for violence. Since when is a drawing violent?]
I think I am gonna call this doc and go in for a "consultation" and just ask him how would handle things as they come up, I am 50, things are going to come up. BTW, when are we going flying?
 
I really can't believe this thread. If the concept of "conflict of interest" pops into your brain, it is real. Just because you can't come up with a concrete example of that conflict in action is, IMHO, a poor reason to press on with mixing the two professional obligations of YOUR Doctor and the FAA's Doctor.
 
Martha Lunken, a Flying magazine contributing editor, DPE, retired FAA Aviation Safety Inspector, CFI and ATP says this about having your personal doctor also be your AME: "Bill is a physician in the very best sense of the word and would be my "real" doctor in a heartbeat except no pilot in his right mind combines both!" (link)
 
Here's my advice after 15 years of special issuance medicals. Ultimately it won't make much difference whether your doctor is your AME or you keep the two roles separate. The best person to maintain your medical cert is you and either way you go for the GP/AME that fact won't change. When you find yourself dealing with disqualifying issues and an SI you need to know the regs and know the process in your Regional Flight Surgeon office. At that point you'll have another doctor or two involved and it all comes down to assembly and administration of paperwork. Nobody cares about your files like you. So don't think your siding with one camp or the other makes you smarter or more successful than the next guy. When your medical qualification gets tested you'll forget all your old attitudes and you'll do whatever you can to secure your status. Even for everyday stuff, like you go to your non-AME doc for congestion and he gives you zyrtec. You need to manage your own situation and tell him you can't fly with zyrtec. Have him prescribe a suitable med. That's your responsibility. Escalate your condition to something serious and it remains the same. Your situation is yours to manage. That's my pirep for the day.
 
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It isn't a flight physical until you take the steps to make it a flight physical.
My dr has a separate practice (and always has) for flight physicals. I have to hand carry records from one to the other (that may change now that they are in the same office). So he's aware, but keeps them strictly separate.
Conflict of interest indeed. Do you have any idea of the conundrum you've put this guy in?

You don't understand what goes through a doctor's mind. His first priority is to take care of his family. He is not going down or is even going to take a hit to keep you healthy or keep you in the air, so no, if your health and your flying conflict, one will be at the expense of the other. I do not have an actual example, but I do know that the government is not your friend, the government has never been your friend, and these days, the government is your enemy.

If you feel you have to go to a guy who understands aviation, then go to a guy who is an AME, but get your physicals somewhere else.

... no pilot in his right mind combines both!
:yeahthat:
 
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Conflict of interest indeed. Do you have any idea of the conundrum you've put this guy in?

You don't understand what goes through a doctor's mind. His first priority is to take care of his family. He is not going down or is even going to take a hit to keep you healthy or keep you in the air, so no, if your health and your flying conflict, one will be at the expense of the other. I do not have an actual example, but I do know that the government is not your friend, the government has never been your friend, and these days, the government is your enemy.

If you feel you have to go to a guy who understands aviation, then go to a guy who is an AME, but get you physicals somewhere else.

:yeahthat:

Truth
 
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