AINsight: Tell the AME

 - June 11, 2021, 11:39 AM

Albert Einstein, the German-born theoretical physicist, developed the theory of relativity, which opines that mass and energy are interchangeable. In addition to his scientific brilliance (all of which is beyond my comprehension), many famous quotes are attributed to Einstein.

Two such quotes are relevant to today’s discussion: “The definition of insanity is doing the same thing over and over again and expecting different results” and “You never fail until you stop trying.”

I have spent most of my near-30-year tenure as an FAA aviation medical examiner (AME) trying to get pilots to give me a “heads up” regarding either new medical conditions that may have been diagnosed or medications that may have been prescribed in the interim between exams.

I explain at virtually every FAA medical exam I’ve done during these years that giving me some advance notice about circumstances that may have cropped up gives me time to provide advice and develop FAA medical certification strategy. Unfortunately, my feeble attempts at giving sage advice often are for naught.

Not giving the AME some time to plan strategy can lead to unpleasant surprises at the time of the next FAA exam, when the AME is put in the unenviable position of informing a pilot that his or her medical certificate cannot be issued. And, to rub the proverbial salt in the wound, I tell the pilot that, given some advance notice, I could have developed a strategy that would have permitted issuance of the medical certificate at the time of the exam or streamlined things so that any period of grounding could potentially have been minimized.

I don’t do this to scold the pilot, but just to make the point that, in the future, we can potentially work together as a team in a more timely and productive manner should new medical conditions arise.

At first glance, it might appear pointless to spend the time telling pilots at each exam to let me know if anything “interesting” happens before the next medical exam. This is the AME version of insanity, based on Einstein’s definition. However, being an optimist and idealist, and also typically being unable to “stop trying,” I keep at it. As Einstein said, you only fail when you stop trying. Fortunately, it sometimes works, so I keep at it.

While much of the time I do get blindsided at the pilot's next exam appointment with information that I wish I had known weeks or months earlier, to be fair I do have many pilots who indeed trust me enough to notify me in a timely manner of new medical problems or medications. Doing so often saves them several unexpected months of being grounded.

Not all new medical conditions can be approved “on the spot” by the AME, of course, but knowing about them in advance gives me time to start working on the strategy to potentially minimize any period of grounding.

In a future blog, I’ll give more tips on the best ways to notify your AME of medical conditions that have taken place since your previous exam, as well as how to report them on your next MedXpress application form.

That said, let me make a few comments now about medications. Medications can be used for many purposes, not always just for the condition mentioned in the gloriously expensive television advertisements that are designed to lure you with happy videos and music.

The point here is that when informing the AME of a new medication, please do not simply ask if it’s acceptable to take that particular medication. You must always tell the AME the reason why said medication is being prescribed. Sometimes the medical condition itself would require significant data submission and possibly a special issuance authorization.

At times, a certain medication might be approvable routinely for one medical condition, but the actual condition for which it is being prescribed is the bigger problem. And newer medications often are not approvable as soon as they hit the market, as the FAA wants to wait until they are out in mass use, with FDA approval, for at least a year before giving the greenlight to take them.

Regardless of any medication or medical condition that is “new” since your last FAA exam, and regardless as to whether you have or have not yet informed your AME, FAR 61.53 always applies. The AME’s opinion is only “regulatory” at the time of an actual FAA exam. It is simply advisory at other times.

The FAA puts much of the responsibility for determining the pilot’s airworthiness at all other times directly on the pilot. This is through the “self-assessment” required in an ongoing basis as per FAR 61.53.

Something that might appear self-evident, but unfortunately isn’t, is that if a pilot is seriously ill and the treating physician states that the pilot has a medical condition that must be treated immediately, that pilot clearly should not wait for the AME to state that it’s OK to be treated. One of my other personal cliches worth mentioning: “It’s easier for the AME to keep you flying if you are still alive.”

Therefore, in an urgent medical setting, don’t wait for any AME interface. Go ahead and get treated. You can interface with the AME later, after that urgent medical condition has stabilized.

Please also remember not to shoot the messenger when the AME has to tell a pilot that there could be some significant “homework” involved regarding new medical conditions and that possibly a period of grounding may result.

The FAA has the burden to provide an educated opinion regarding a pilot’s airworthiness, and sometimes there will be lots of documentation required, along with the requisite governmental pace of reviewing that data. While some of the more time-consuming evaluation processes can be frustrating, in reality over 99.9 percent of pilots who apply for an FAA medical certificate ultimately receive an approval.

It might be a mind-numbing exercise in patience along the way at times, but usually it works out in favor of the pilot. Not always, but way more often than not.

If you thought you were going to escape from this blog without a Covid-19 update, you were mistaken—sorry. But this update is a good one.

The FAA has recently issued formal guidance regarding Covid reporting, including as to when documentation might be required. In contrast to some of my earlier discussions, this new guidance streamlines and simplifies things just a bit.

For asymptomatic or mild Covid cases, even if the pilot may have been hospitalized or had a prolonged outpatient course of treatment, if that pilot has fully recovered the AME can issue the next medical certificate at the time of exam with no data submission required. The AME must explain the circumstances, of course, but there will be no waiting for the FAA to approve the pilot.

If, however, the pilot was seriously ill and when hospitalized required treatment in the intensive care unit, then the AME must defer the exam and send to the FAA all of the relevant treatment data for review.

If a pilot, regardless of where or how long the Covid treatment protocol was, is experiencing some of the “long-haul” symptoms of fatigue, shortness of breath, or other cardiovascular or neurological symptoms, for example, then the AME also must defer the exam and send the relevant consultation data to the FAA for review.

In the two circumstances that require deferral by the AME, if the FAA determines, after review of all appropriate data, that the pilot is doing well enough that he or she is not going to compromise aviation safety, that pilot will be approved. Even if the pilot is eventually approved, the FAA could, of course, ask for follow-up data at the time of the pilot’s next FAA examination.