Using your AME as a PCP

midwestpa24

midwestpa24

Final Approach
Joined
Mar 4, 2016
Messages
6,218
Location
Iowa
Display Name
midwestpa24
What is everyone's thoughts on using your local AME as your PCP? I'm looking for a new PCP and my AME is accepting new patients. Just not sure if that is a conflict or concern?
 
If you want someone to be thoroughly familiar with your health history and have the ability to do FAA or BasicMed exams with confidence, I think that's great. Especially if you have any sort of complex history. They should also have the knowledge to avoid putting unfortunate diagnoses in your chart.
 
midwestpa24 said:
What is everyone's thoughts on using your local AME as your PCP? I'm looking for a new PCP and my AME is accepting new patients. Just not sure if that is a conflict or concern?
Click to expand...
It's definitely a problem if you want to dissemble on your medical application. If you want a PCP who really understands and is sympathetic to pilot's medical concerns, it might be a great idea.

Of course you could have it both ways by using an AME as your PCP, but using a different AME for your FAA medical exams.
 
Before I went BasicMed, I had some excellent AMEs. Heck, one of them probably saved me a lot of extra aggravation on a Special Issuance issue.

But I would not use any of them as both my AME and my PCP. Whether they are OK with it or not, I would not want to put them in a position where their obligations to the FAA (and none to me) wearing their AME hat might conflict with their obligations to me (and none to the FAA) wearing their PCP hat.
 
Several ame’s are being sued for malpractice and fraud right now. The common theme is the Ames claim they owe ZERO duty of care… and are whining the faa should actually provide legal services to assist them. Their malpractice insurance is saying nay since the alleged complaint is a deliberate action.

Food for thought.

It seems to me the best answer is to address this duty of care upfront and make sure everyone is on the same page.
 
Tools said:
Several ame’s are being sued for malpractice and fraud right now.
Click to expand...
Many more non-AME physicians are being sued for malpractice and fraud right now.
Tools said:
The common theme is the Ames claim they owe ZERO duty of care… and are whining the faa should actually provide legal services to assist them. Their malpractice insurance is saying nay since the alleged complaint is a deliberate action.
Click to expand...
Well, malpractice insurance would never cover fraud. What are the allegations?
 
I would worry about conflicting obligations and incentives. But I can see some pros to the arrangement also. Have a conversation with the doc and get their thoughts about how to balance the two roles.

I would make sure the AME is willing to do Basic Med if better for you at a particular point in time. Some are not.
 
Tools said:
Several ame’s are being sued for malpractice and fraud right now. The common theme is the Ames claim they owe ZERO duty of care… and are whining the faa should actually provide legal services to assist them. Their malpractice insurance is saying nay since the alleged complaint is a deliberate action.

Food for thought.

It seems to me the best answer is to address this duty of care upfront and make sure everyone is on the same page.
Click to expand...
Unless you are thinking of another one, the suits I've seen are pretty specific. Negligence (or bad faith) in fulfilling an obligation to properly report to the FAA. Examples include the Fries case, where a HIMS AME was found liable for attributing a positive blood test to the wrong pilot, and the currently pending Barnard v Kozarsky, in which the claim is that the HIMS AME misinterpreted the results of tests. In both cases the pilot's SI was revoked. What I haven't seen so far is something more traditional like an AME failing to diagnose a pilot's illness

@Lindberg, does this answer your question?
 
midlifeflyer said:
Unless you are thinking of another one, the suits I've seen are pretty specific. Negligence (or bad faith) in fulfilling an obligation to properly report to the FAA. Examples include the Fries case, where a HIMS AME was found liable for attributing a positive blood test to the wrong pilot, and the currently pending Barnard v Kozarsky, in which the claim is that the HIMS AME misinterpreted the results of tests. In both cases the pilot's SI was revoked. What I haven't seen so far is something more traditional like an AME failing to diagnose a pilot's illness

@Lindberg, does this answer your question?
Click to expand...
Yes, and that's kind of what I figured.
 
There’s a couple more where a poor diagnosis happened. Semi presumably due to a bias…

The common theme being this assumption and reliance on no duty of care. Whether or not that legally exists (a duty of care) is being debated in court right now.
 
During my career as an Army aviator, the general guidance was to only see the flight surgeon (aka AME), vice a regular Army doc, so they can take care of you and not give you a (mis)diagnosis that could be grounding or terminal to your career as an aviator. To put it differently, the flight surgeon’s job was to keep you IN the cockpit, as opposed for looking for reasons to kick you OUT of the cockpit.

My experience with civilian AMEs thus far has been the same, insofar as they want to keep you flying. So with that logic, a AME as a PCP could ultimately be advantageous, particularly if you fly for a living. Food for thought.

Or if you’re like every other pro pilot, you only see a doc once per year (twice if you’re over 40). And it’s the SAME doc, until one of you is dead.
 
Many moons ago when I switched AMEs, on my first visit my new AME specifically told me he was my aeromedical doctor and not my PCP. I've headed that wisdom ever since (for obvious reasons). I continued to use him till he retired.
 
Several are being sued for fraud because of a lawfirm seeking to make a big splash accusing HIMS of being fraudulent beucase it does not comply with DSM5. They've even put up a faux HIMS website and that's how they draw clients. But they are hiding the fact that in 2009 congress gave the FAS the mandate to write definitions of disease consistent with minimizing accidents.

Don't ask me to explain that whole thing but I suspect in the end it will just cost a lotta $$s and nothing will change.
I say PCP and AME should be separate, esp, when thing get complicated. Most PCP's don't know much about aviation.
 
My AME was my PCP for many years...great guy. No issues.
 
midlifeflyer said:
Before I went BasicMed, I had some excellent AMEs. Heck, one of them probably saved me a lot of extra aggravation on a Special Issuance issue.

But I would not use any of them as both my AME and my PCP. Whether they are OK with it or not, I would not want to put them in a position where their obligations to the FAA (and none to me) wearing their AME hat might conflict with their obligations to me (and none to the FAA) wearing their PCP hat.
Click to expand...
What about a BasicMed doctor? For many, it’s the same physician as their PCP. Does the BasicMed doctor have a conflict due to an obligation to anyone else, like passengers?
 
My eye doc is my AME, and he's a pilot and a great guy. I didn't plan it that way, but my last AME passed away, and my eye doc was an AME, so there you go.

So based on just my experience, I'd recommend it if your AME is also a pilot and a good guy. Meaning, someone that listens and genuinely seems to care about both your health and your flying. And this is all based on PPL. If I lose the ability to fly it doesn't cost me my job.
 
NoHeat said:
What about a BasicMed doctor? For many, it’s the same physician as their PCP. Does the BasicMed doctor have a conflict due to an obligation to anyone else, like passengers?
Click to expand...
I don’t see it, but MedMal is not an area I ever practiced in. Can you point to a case anywhere at any time in the US where a physician was successfully sued by a non-patient because the patient did something attributable to a medical error or misdiagnosis? Real cases, not hypotheticals.
 
midlifeflyer said:
I don’t see it, but MedMal is not an area I ever practiced in. Can you point to a case anywhere at any time in the US where a physician was successfully sued by a non-patient because the patient did something attributable to a medical error or misdiagnosis? Real cases, not hypotheticals.
Click to expand...
I haven't read the court's opinion, but this can't up on a quick search.


Here's another that may be more directly applicable.

case-law.vlex.com

Coombes v. Florio

Coombes v. Florio (Coombes v. Florio, 450 Mass. 182, 877 N.E.2d 567 (Mass. 2007)), filed at Supreme Judicial Court of Massachusetts
case-law.vlex.com case-law.vlex.com
 
Last edited:
Lindberg said:
I haven't read the court's opinion, but this can't up on a quick search.


Here's another that may be more directly applicable.

case-law.vlex.com

Coombes v. Florio

Coombes v. Florio (Coombes v. Florio, 450 Mass. 182, 877 N.E.2d 567 (Mass. 2007)), filed at Supreme Judicial Court of Massachusetts
case-law.vlex.com case-law.vlex.com
Click to expand...
Thanks. I looked at that one and a few others. Most seem to point to something fairly specific like the duty to warn of known drug side effects. How well they might apply to something far more generalized is a good question, even aside from problems of proving that the pilot's condition was the cause of the accident to begin with.
 
midwestpa24 said:
What is everyone's thoughts on using your local AME as your PCP? I'm looking for a new PCP and my AME is accepting new patients. Just not sure if that is a conflict or concern?
Click to expand...
My first concern with a PCP is top quality care. If you less than age 40, it probably isn’t a big factor.
 
midwestpa24 said:
What is everyone's thoughts on using your local AME as your PCP? I'm looking for a new PCP and my AME is accepting new patients. Just not sure if that is a conflict or concern?
Click to expand...
There’s a saying. You have two doctors. One to keep you healthy and one to keep you flying and they don’t know each other. Even with Basic Med it may be a good philosophy.
 
midlifeflyer said:
Thanks. I looked at that one and a few others. Most seem to point to something fairly specific like the duty to warn of known drug side effects. How well they might apply to something far more generalized is a good question, even aside from problems of proving that the pilot's condition was the cause of the accident to begin with.
Click to expand...
I think the really significant thing is finding that the doctor owes a duty of care to the third party, which these cases do. Once you pass that hurdle, the specific negligent act seems less interesting as long as the plaintiff is in the danger zone
 
Lindberg said:
I think the really significant thing is finding that the doctor owes a duty of care to the third party, which these cases do. Once you pass that hurdle, the specific negligent act seems less interesting as long as the plaintiff is in the danger zone
Click to expand...
Yes, theoretically. But exposure is a function of likelihood, and foreseeability a matter of proof. But it does explain the hesitance of some physicians.
 
midlifeflyer said:
Yes, theoretically. But exposure is a function of likelihood, and foreseeability a matter of proof. But it does explain the hesitance of some physicians.
Click to expand...
Yes, and as they say, that's what makes horse races. I wonder what the percentages are for motions to dismiss or summary judgment based on foreseeability and likelihood as compared to duty of care. Because that's what the insurance underwriters are more likely to care about.
 
Lindberg said:
Yes, and as they say, that's what makes horse races. I wonder what the percentages are for motions to dismiss or summary judgment based on foreseeability and likelihood as compared to duty of care. Because that's what the insurance underwriters are more likely to care about.
Click to expand...
I’m not using “likelihood” in any legal sense. Just as part of the personal exposure evaluation. You know, like we do when we evaluate our risks for a flight.

“Forseeability,” OTOH, is generally a fact question.

“Unforseeability” as a matter of law is rare. The general standard is that a result is unforeseeable only if it’s so remote or improbable that it’s beyond the range of reasonable expectations. If you want to do a little reading, see if you can find a discussion of the two Kinsman Transit cases. They are from the 1960s and involve the collapse of a bridge in Buffalo NY because some ships were not moored properly, loosened, drifted, and crashed into others, leading to the collapse of the bridge. There was also some negligence associated with the city not raising the bridge. In Kinsman I, property damage claims were found to be foreseeable. It’s one if those big cases studied in first year law school.

But I remember Kinsman II, which deals with denying a claim by a company that couldn’t deliver goods because it couldn’t use the collapsed bridge, more. In Kinsman II, the judge reminds the reader that in Kinsman I, he said that at some point the damage becomes too remote to become legally foreseeable, and basically says, “and here we are.”
 
luvflyin said:
There’s a saying. You have two doctors. One to keep you healthy and one to keep you flying and they don’t know each other. Even with Basic Med it may be a good philosophy.
Click to expand...
Who ever said this doesn’t understand the process. To keep flying you have to be relatively healthy. Your AME is present to simply determine you meet FAA standards, not to keep you flying or keep you healthy.

My current PCP for basic med is doing both.
 
Seems to me the AME system was created by, is governed by, and works for first and foremost the FAA to keep the skies safe. The AME system is to evaluate and judge. Think of AME's as your company's Human Resources Department. HR is not your friend. They are their to do what is best for the company, not for you.

The PCP first and foremost works for you to keep you healthy.

So yes, keep them separate.
 
Back
Top