Possible Insomnia and Anxiety Misdiagnosis

A

Anon

Guest
1st Class flying for Regional.

So, I’ve been visiting my new PCP for unexplained chest wall discomfort and pelvic discomfort. So far, costocondritis is the working diagnosis. Nothing on the pelvic issues yet.

1st visit, Nov 6, explained I have surface chest discomfort, impotence, as well as a little restlessness at night. Doc does basic routine, determines costocondritis, and hands me a sheet on sleep hygiene. Chest X-ray. Some blood tests for fatigue, impotence, chest pain. No meds prescribed. I call my AME and AMAS for all symptoms and they say I’m good to keep flying. Go on a trip.

2nd visit, Nov 19, explain that chest pain in improving but still there and sleep issues are fully resolved. However now have mild pelvic pain. He does an EKG and pelvic ultrasound for good measure. All blood tests, X-ray, EKG, everything 100 percent normal except for slightly low B-12. He asks if maybe anxiety is causing all this and asks if I want to be prescribed prescription pills. I firmly respond no, tell him I don’t have anxiety. He agrees. Since there was no significant change in medical condition save for the pelvis, go on another trip.

I come back from the trip, and I found out that the health clinic I go to has finally published reports of the visit. I pull it up to double check and make sure everything is hunky dory.

To my absolute shock I see the words Insomnia and Anxiety written in two parts of the documents, the former in Nov 6 and the latter Nov 19. I’m seeing him ASAP to determine if this was a diagnosis or simply an evaluation, but my gut is telling me more than likely it’s a diagnosis.

If in the event it’s a diagnosis, I’m grounding myself ASAP on extended disability to give myself the time and resources for potentially a massive ordeal with the FAA.

1) Is it worth asking for a clarification/elaboration on the terms, or if it’s a diagnosis to have it reversed? Or is it absolutely futile? He did not seem to go through DSM criteria when asking me about this and he never mentioned anything remotely about diagnosing me with either condition.

2) Not that I have a choice, but what happens when I file for disability, have to send the doc records, and they see the diagnostic date? Is it even worth arguing that I had no idea I was potentially diagnosed with these, or will the fact that he put in the electronic records screw me completely?

Really tired, broke after Hurricane Dorian, and just seeing if I will get through what could be an absolutely horrific ordeal.
 
You CAN have Anxiety and Insomnia without it being a diagnosis. Find out what codes, the clinic used to bill your insurer....
 
You CAN have Anxiety and Insomnia without it being a diagnosis. Find out what codes, the clinic used to bill your insurer....
R
Whoa... the legend himself! Thank you Doctor Chien for the prompt response. I hope you are enjoying the ,holidays. I apologize for the late reply, I didn’t know this thread got approved so soon.

It took some digging, but I found the SNOMED codes on a zip file. Advent Health makes it extremely difficult to get the raw files.

Anxiety - 48694002
Insomnia - 193462001

I plugged these into a SNOMED decoder and found out that anxiety is not a disorder code, just a finding. The insomnia might be though, depending on which decoder is used. So... some reassurance I guess.

Slightly off topic, but would an ASAP form help me in this circumstance? I want to make it painfully clear I would have NEVER flown if I knew I had been diagnosed with a disqualifying condition.
 
I logged into my mother’s doctor’s portal (I have her general and healthcare PoA) and to my horror she has been diagnosed with paralysis on the left side (she is not!), severe osteoporosis (she has mild osteopenia), diabetes type 2 (not even close - her A1c is 5.6) and “B12 anemia due to lack of intrinsic factor” (if true why has he not put her on b12 injections? Her B12 is 580, not sky high but hardly a diagnosis of pernicious anemia.)

I was gobsmacked. My sister lives in town so she printed this out and drove over there and talked to staff who said, “yeah that’s not right. We’ll get on it and fix it. We must have mixed her record up with someone else.” That was over a year ago and nothing has changed. That stuff is still in her record.

MY record says I have type 2 diabetes when I don’t, I have pre diabetes. My doctor deliberately coded it that way claiming they didn’t have a code for “pre” and they hadn’t updated their system. That was years ago, their system is updated but that diagnosis is still there.

I believe these doctors will never fix these things unless you get a lawyer and take action. But then, you are blacklisted. I found that out when we moved here. I went to a recommended doctor and asked for an appointment. She gave me an “application”, told me to fill it out and the doctor would decide if he wanted me as a patient. He did (I’m a good patient!) but I asked him what the application was about. He said they check up on wannabe patients for past legal actions against doctors, good insurance, and history of drug abuse.

Don’t get me wrong, if I were a doctor I’d discriminate against sue happy asshats, but in today’s impersonal digital world, a simple “correct my record” action may well be listed somewhere as a generic legal action, and doctors won’t bother to parse it out.

Seems the Seinfeld episode where Elaine gets blacklisted by doctors is true now. Maybe it always was but technology today is widespread and unforgiving and apparently, not correctable.

Maybe some is deliberate upcoding for insurance or Medicare money and maybe some is due to computer databases getting more easily mixed up than the old paper and pencil records but this is a huge problem. FAA medical certification is just one reason why. Life and long term care insurance companies look at your records. Weapons permitting requires certain health records. Some jobs require health assessment. Having stuff wrong in your record is one thing, but being completely unable to correct it is a whole new level of dystopia.
 
many airman visit their doctor for insomnia and stress. It's not an issue unless there are other issues, if your AME makes it one, or ... you do.
 
many airman visit their doctor for insomnia and stress. It's not an issue unless there are other issues, if your AME makes it one, or ... you do.

Whoa! Dr. Fowler! Another AME legend! Hope you had a good thanksgiving as well!

That’s a huge relief. I’m going into the doctors tomorrow for clarification, but this puts me further at ease.
 
I logged into my mother’s doctor’s portal (I have her general and healthcare PoA) and to my horror she has been diagnosed with paralysis on the left side (she is not!), severe osteoporosis (she has mild osteopenia), diabetes type 2 (not even close - her A1c is 5.6) and “B12 anemia due to lack of intrinsic factor” (if true why has he not put her on b12 injections? Her B12 is 580, not sky high but hardly a diagnosis of pernicious anemia.)

I was gobsmacked. My sister lives in town so she printed this out and drove over there and talked to staff who said, “yeah that’s not right. We’ll get on it and fix it. We must have mixed her record up with someone else.” That was over a year ago and nothing has changed. That stuff is still in her record.

MY record says I have type 2 diabetes when I don’t, I have pre diabetes. My doctor deliberately coded it that way claiming they didn’t have a code for “pre” and they hadn’t updated their system. That was years ago, their system is updated but that diagnosis is still there.

I believe these doctors will never fix these things unless you get a lawyer and take action. But then, you are blacklisted. I found that out when we moved here. I went to a recommended doctor and asked for an appointment. She gave me an “application”, told me to fill it out and the doctor would decide if he wanted me as a patient. He did (I’m a good patient!) but I asked him what the application was about. He said they check up on wannabe patients for past legal actions against doctors, good insurance, and history of drug abuse.

Don’t get me wrong, if I were a doctor I’d discriminate against sue happy asshats, but in today’s impersonal digital world, a simple “correct my record” action may well be listed somewhere as a generic legal action, and doctors won’t bother to parse it out.

Seems the Seinfeld episode where Elaine gets blacklisted by doctors is true now. Maybe it always was but technology today is widespread and unforgiving and apparently, not correctable.

Maybe some is deliberate upcoding for insurance or Medicare money and maybe some is due to computer databases getting more easily mixed up than the old paper and pencil records but this is a huge problem. FAA medical certification is just one reason why. Life and long term care insurance companies look at your records. Weapons permitting requires certain health records. Some jobs require health assessment. Having stuff wrong in your record is one thing, but being completely unable to correct it is a whole new level of dystopia.

I felt this status in my soul. It’s tough enough to deal with the stress weird persistent chronic discomfort, it’s another matter that trying to fix these issues will cost me my livelihood with very little chance of recovering financially.
 
So, quick update.

I talked me to my doctor. He did diagnose me with anxiety and insomnia. However, during the visit, he assessed me and found out that I was no longer suffering from either.

He changed the anxiety code into an adjustment disorder code with anxious mood and noted a resolution in both conditions. He also had me take a GAD test to demonstrate I wasn’t suffering from it.


My question is am I good to fly until my next medical appointment or should I still ground myself and ask for clarification from the FAA about needing further tests to return back to work?
 
you need to ask yourself: am i safe to fly? are my passengers safe to fly with me? what do my peer pilots think of my flying ability? what are my ratings and do i keep them current? no doctor or forum is going to be able to think for you.
 
My question is am I good to fly until my next medical appointment or should I still ground myself and ask for clarification from the FAA about needing further tests to return back to work?

One thing I wouldn't do is ask the FAA anything about it. Contact a qualified AME. The standard you are held to is "know or have reason to know" of a medical condition that would make you "unable to meet the requirements of the medical certificate". I think having a qualified AME review your actual records (as the FAA would) is the safest way to "know" what you need to know and then just report the condition on the next medical, once you're reasonably sure there won't be a problem.
 
Hey guys, thank you for all the tips.

So, the doctor confirmed he did diagnose me with anxiety and insomnia, but he switched the anxiety diagnosis to an adjustment disorder after I explained the circumstances.

I talked to my local AME and he said all he needed was a note from the doctor saying that ‘I had an adjustment disorder from date X to date Y due to etc.’

I bring this up to him and he says he doesn’t want to write that letter due to liability on his end. He also isn’t letting me review the notes he has taken during our office appointments.

I’m exhausted and tired. Just when I thought I had a chance this throws me under the bus. I’m in a tough spot at home and money is so tight it’s not even funny.

Any recommendations for an AME consult to review my paperwork and assess if I have a fighting chance of getting my medical without a deferral? If I do get deferred I will have no money to pay for the HIMS AME evals. At that point it’s best to switch careers early while I still have some money left.
 
Not a doctor so no doubt I am wrong, but I think sometimes doctors add stuff into the record knowing if they don't they won't get the tests they want approved by the insurance company. For example say you need an MRI or something so the doctor adds dizziness caused by the issue to the record. To the average person dizziness may not be a big deal in their record to an airman it might be.
 
some tests cannot be ordered with our pepper diagnosis codes. B12 level is a classic one. You need to use b12 deficiency as the dc to get test paid for- the dx in medical record can be easily deleted. It’s crazy what you have to do to get tests covered that you want to order. Otherwise ppl would be bitching about the 1000 dollar lab bill because you didn’t code to get tests covered. In past to order an a1c you couldn’t use prediabetes-no code for it. So you had to use dm2 code. You can use hyperglycemia or impaired fasting glucose tolerance (new phrases for antiquated ‘prediabetes’) now. But that has only been recent. Again big bill if not coded. Problem is emr remembers those codes. Can be cleaned up but takes someone the time to do it. You can elect to pay for tests the dr wants without codes. But that would get rather pricy. Mri 2k. To get tests done you have to have proper coding-or don’t get tests done. Sometimes providers need to wiggle to get coding correct so pts don’t get bills. Improper coding tests not covered plain and simple.
 
some tests cannot be ordered with our pepper diagnosis codes. B12 level is a classic one. You need to use b12 deficiency as the dc to get test paid for- the dx in medical record can be easily deleted. It’s crazy what you have to do to get tests covered that you want to order. Otherwise ppl would be bitching about the 1000 dollar lab bill because you didn’t code to get tests covered. In past to order an a1c you couldn’t use prediabetes-no code for it. So you had to use dm2 code. You can use hyperglycemia or impaired fasting glucose tolerance (new phrases for antiquated ‘prediabetes’) now. But that has only been recent. Again big bill if not coded. Problem is emr remembers those codes. Can be cleaned up but takes someone the time to do it. You can elect to pay for tests the dr wants without codes. But that would get rather pricy. Mri 2k. To get tests done you have to have proper coding-or don’t get tests done. Sometimes providers need to wiggle to get coding correct so pts don’t get bills. Improper coding tests not covered plain and simple.

Duly noted. Is there any way I can perhaps explain this to a AME? Would the diagnosis codes be a career-ender or because he needed these codes to get certain tests done I have some leeway?
 
Duly noted. Is there any way I can perhaps explain this to a AME? Would the diagnosis codes be a career-ender or because he needed these codes to get certain tests done I have some leeway?


If I understand you correctly, you would be asking a physician to state he falsified a diagnosis in order to defraud an insurance company to pay for certain tests.

Granted that this might not be an unusual occurrence, if a physician is stupid enough to admit it in writing I don’t think I want him to treat me.
 
If I understand you correctly, you would be asking a physician to state he falsified a diagnosis in order to defraud an insurance company to pay for certain tests.

Granted that this might not be an unusual occurrence, if a physician is stupid enough to admit it in writing I don’t think I want him to treat me.
Maybe there should be a diagnosis code for "FAA syndrome"?
 
Maybe there should be a diagnosis code for "FAA syndrome"?

In all honesty this should be an actual diagnosis haha. I’m still having health issues but I’m terrified of seeing a doctor in case the diagnose me with something that could rip my career away. Flying for a living seems to be awful for health.

I guess I’m really screwed with the SnoMed codes, I’ll message one of the head AMEs and see if there is anything I can do to save my career.
 
Demand the doc release your records to you. That should be simple.

You're a perfect example of what's wrong with the aeromedical system. You have an issue of concern but won't address it for fear of losing your flying status. That's crazy. Not you, but the rules. They encourage a less healthy pilot population in general but for 121 guys? That's absolutely stupid.

Find another physician. Try a naturopath. Take vitamin D. Best wishes for your future health and career!
 
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In all honesty this should be an actual diagnosis haha. I’m still having health issues but I’m terrified of seeing a doctor in case the diagnose me with something that could rip my career away. Flying for a living seems to be awful for health.

I guess I’m really screwed with the SnoMed codes, I’ll message one of the head AMEs and see if there is anything I can do to save my career.


"Oh, what a tangled web we weave, when first we practice to deceive!" (Sir Walter Scott, 1808).​

As a society, we do this all the time. Passing laws against entering the country (think corona virus), but no will to enforce them. Changing FARs by interpretation rather than by rule-making. Finagling dx codes rather than changing the insurance system or the FAA's requirements. It goes on and on... I wonder how many mom and pop businesses don't declare their true income, raising everybody else's taxes...
 
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