BasicMed - FAA Private Pilot Medical abolished - not useful outside the US (merged)

My very wild guess, based on pilots I know or have known personally, is that 50% of UK pilots who stop flying do so due to a loss of the medical, although admittedly that event often triggers a re-evaluation of whether they still really enjoy going Shoreham to Sandown for the 150th time…

Sadly they don’t seem to provide that statistic in the link. Of those 50% would you think there are cases where it is a good thing they are “prevented” from taking it to the air again? I know of one in my history where someone kept flying, where I wondered about the suitability of that person to fly. Even when he still could pass a medical. His eyesight and ‘quickness of mind’ weren’t exactly where you’d necessarily want them. And he was an instructor…

Who is going to stop some of these guys if it isn’t the medical? I guess you’re the optimist stating that pilot’s are generally self-aware. I’m a pessimist stating that a lot of us are too passionate to give up what we’ve been enjoying for so long.

Look at elderly people being forced to give up driving a car. It gets personal!

Who is going to stop some of these guys if it isn’t the medical? I guess you’re the optimist stating that pilot’s are generally self-aware. I’m a pessimist stating that a lot of us are too passionate to give up what we’ve been enjoying for so long.

I think we are both right But what matters, from the AME POV, is whether the pilot is going to be incapacitated during a flight and cause a 3rd party damage or injury. The State has no business dictating an individual’s attitude to risk, otherwise they would ban scuba, mountain climbing, etc. The risk to 3rd parties is statistically tiny and the risk to 3rd parties as a result of pilot incapacitation is a tiny fraction of that risk.

And safety regulation should be based on the data. And the data virtually doesn’t exist.

Sadly they don’t seem to provide that statistic in the link.

They probably don’t have good data, because many will not submit themselves to the medical following some procedure which self-disqualifies them.

I once took an elderly gent up for a few circuits. I was practicing crosswind circuits and he had decided that it was too windy for him to fly. He confessed that he found my steep approaches alarming and said that he always used to do shallow approaches – because he couldn’t judge how high he was above the runway so used to keep the power on all the way down so that if he misjudged his very mild flare, things would probably still be OK. Which in one sense was very thoughtful.

A few other issues became apparent during an otherwise pleasant afternoon with him, I came to feel quite strongly that if he wants to fly himself, that’s fine. But the thought of him flying non-aviation minded people such as his grandkids around would have made me feel quite queasy. To my mind, ‘3rd party’ includes passengers as well as people on the ground. Or pilots under training if you’re an instructor.

Anyway, it seems that whatever his sensory/perceptual deficits are, they weren’t severe enough to be picked up by his medical.

pilot incapacitation is a tiny fraction of that risk.

I’m still not convinced sudden incapacitation is the only thing we should be talking about. Anything that decreases a pilot’s fitness is a threat to a good and safe operation. You could call it physical stress, impairment or other terms and it will affect your ability to concentrate, decision making, clarity of thinking.

Or are we saying now that flying requires the same (low) level of fitness as required to drive a car? To be honest I find that almost a bit of an insult and certainly not what we are taught in human factors. And by far not what I use as standard in my flying.

That makes the risk a little greater already and I think there is more to medicals than meets the eye. It’s also a discouragement policy once you become more and more borderline physically fit and able to fly.

I mean really a medical once every five years for the young is that too much? For the more mature it becomes every two years.

A middle road would be to increase the interval to say every 10 years and 5 for the older generation. It’ll be interesting to see what comes of it. Anyone know when it’s due to be discussed in the U.S. senate?

I’m still not convinced sudden incapacitation is the only thing we should be talking about. Anything that decreases a pilot’s fitness is a threat to a good and safe operation.

I’d agree – hence controversial moves to look at bmi/sleep apnoea for example.

Anything that decreases a pilot’s fitness is a threat to a good and safe operation.

Yes; I agree. But except in really obvious cases the AME is not well placed to check for that (e.g. reaction times). Nor is it within his/her official remit e.g. if a pilot owns or flies a TB20 does the AME check that the pilot can climb into one? I know for a fact that a significant % of “senior” pilots cannot get into a TB20 but they have PPLs and UK Class 2s. This is a difficult debate because it attracts criticism of being ageist, elitist etc. I don’t like car drivers who can barely see over the steering wheel any more than anybody else but…

I noticed in related browsing that there are already batteries of cognitive tests designed for the airline industry and for research into these issues. Probably you could have an ‘app for that’. One of the things I learned through model helicopters, which crash a lot, was how to judge my own mental state. I certainly learned not to fly them when e.g. I hadn’t slept well, even if I felt otherwise fine.

Inspired by Peter’s post above, you could incorporate it into the aircraft: an ipad linked to the door lock with a little battery of cognitive tests. If you can’t get into the aircraft, you’re not fit to fly it! (no, I’m not serious).

There is an effect of age on accident rates, though I’m sure there are lots of safe older pilots.

To be honest I find that almost a bit of an insult

Absolutely, to the car driver. If you’re daydreaming in an aircraft for a few seconds, nothing much happens, if you do that on a motorway, you’re quite likely dead. In aviation, people tend to call it a “near miss” if two planes pass by with half a mile separation, while on the motorway people drive with not much lower speed at a few tens of meters distance without the benefit of the third (forth if we include time) dimension.

certainly not what we are taught in human factors

No, we are taught priceless gems like the swiss cheese model. At that point I seriously started to question the mental sanity of what’s going on in aeromedicine.

I mean really a medical once every five years for the young is that too much? For the more mature it becomes every two years.

Yes, if there’s no evidence of any benefit. I haven’t found one, is there?

On the other hand, I know way too many persons who are completely safe pilots but who had a big fight to get especially the initial medical. One had to travel throughout switzerland and see different specialists, just because he had a very slight red/green deficiency, so slight that neither he nor anybody else had noticed before. Even my initial eye examination was very unpleasant even though I have no condition other than slight myopia.

I’ve certainly had to break the news to a 25 year old that he had effectively complete red-green colour-blindness of which he was completely unaware. He was from Mauritius if I recall correctly – somewhere where they don’t screen for it in childhood anyway. It wasn’t recognised as a condition until the 18th century despite being common – presumably before then, the vast majority of colour-anomalous people just assumed everybody saw colours the same way they did. Colour vision is a bad example because it’s been allowed to place artificial barriers to people getting e.g. an IR for use in the daytime only, but I think it’s false to assume that people always have insight into medical issues. Another example would be my deteriorating vision when I was an impoverished student. I didn’t bother having an eye check up for several years and didn’t notice a large, but gradual deterioration in my myopia. As I recall my vision was well below the driving standard, but borderline for cycling – which was all I was doing.

I now have what I would class as moderate but not mild myopia – I think my prescription is about 3.5/2.5 or thereabouts. I took a printout from the optician to my AME and it was a complete non-issue. And I didn’t think that colour-anomalous vision was an issue for a PPL unless you wanted a night rating. So it sounds as if medical requirements in your neck of the woods are rather more onerous than ours?

At a tangent, you can make a good argument that red-green colour-blindness should disqualify doctors (I know someone who missed the fact that someone was vomiting pure blood), before ubiquitous sats monitors it was important to be able to judge whether someone was cyanosed. But for some reason medicine doesn’t subject itself to the same scrutiny. A slight asymmetry there.

Yes, if there’s no evidence of any benefit. I haven’t found one, is there?

I’m sure there’s a benefit to aviation medicine. If I needed antihistamines, I’m glad there’s evidence as to which are likely to be safest. If I had a lung condition and reduced oxygen saturations, I’d be glad to have guidance as to how high it was reasonable for me to fly (hypoxia is another one that people don’t have good insight into). If I needed antihypertensives I’d like to have a cocktail/monitoring plan deemed suitable for a pilot rather than the choice that might be optimal for a non-pilot (i.e. more weight given to avoiding collapses, won’t make me pee every hour, little effect on cognition). I find quite a lot of the research into human factors very interesting – e.g. our (in)ability to detect aircraft on a collision course, Australian evidence supporting the loosening of colour vision requirements.

Whether there’s a benefit to frequent medicals I don’t know, and I’m not sure how easy it would be to prove either way. In medicine ‘randomised controlled trials of parachutes’ are a meme: the only evidence for parachutes is anecdotal and epidemiological (i.e. very weak forms of evidence). Yet we believe they work just the same. It’s fashionable to look for an evidence-base for everything we do, but in practice there are questions that are hard to address for ethical or practical reasons. The real dilemmas start when people generate poor quality evidence that goes against established practice.

I picked up a lady who was driving despite the fact that she knew she had a dense hemianopia and was blind down one side due to her stroke the week before. She was a retired professional, middle class educated. She’d figured that if she directed her gaze slightly to one side of the road this would compensate. Remember of course that you have very poor acuity outside of your central vision so if she succeeded at this strategy, she was probably directing her attention and detail vision from where it was most needed.

I later learned that in Holland she may well have been classed as ‘fit to drive’ anyway. There is epidemiological research purportedly showing that it’s a safe thing to do. But when I looked into the small numbers of drivers with this condition and did some sums, it seemed that they would need to be several orders of magnitude more likely to have a serious road accident before you could expect this to show up in the statistics.

Providing evidence that medicals prevent accidents is therefore quite a ‘big ask’ – and runs the risk of throwing up a false positive anyway. e.g. if you look at people flying on less restrictive medicals you may well find that they have higher accident rates, but is this due to differences in training (because they may have received less training) or other pilot characteristics.