One of my favorite quotes, generally attributed to Winston Churchill: However beautiful the strategy, you should occasionally look at the results.
This concept seems to evade European aviation regulators.
If the legal P1 is incapacitated anyone can legally fly to a landing.
It would be interesting to get a DGAC opinion, but perhaps unwise.
gallois wrote:
What exactly does an AME + Pôle medical bring to the table. Can for instance an AME see from the tests s/he does and even looking at all my dopplers, scans etc see that I am more likely to pass out at 2G than my cardiologist can?
Answering the latter part of the question… Very probably – though not necessarily by looking at your ECG. A cardiologist will undoubtedly be able to read an ECG better than the average AME, but these tests will probably tell you more about your risks of suffering an infarct or cardiac arrhythmia than of passing out at 2G. The other thing the AME will be able to do, is to make a risk assessment within a defensible legal framework. There’s no reason for your average cardiologist to be familiar with aviation specific guidelines, as he or she will probably only have a few patients who are pilots.
Most medical doctors will regularly look after frail elderly folk who feel lightheaded whenever they stand up, and will be good at adjusting their medicines to minimise the risk of falls. There are various tests and protocols (blood pressure lying and standing; tilt tables etc) to help diagnose and manage the issue. Throw them a relatively healthy person who doesn’t feel faint on standing, but nonetheless would benefit from antihypertensives (including some drugs such as Tamsulosin that are not billed as such), and they will find themselves in dragon territory (unmarked areas on the map where one is liable to be bitten). If you start someone on blood pressure medication or adjust their existing medication and they don’t collapse in everyday life then you can probably conclude that they won’t collapse when driving. But how sure can you be that they won’t collapse at 2G, even if they never feel lightheaded at 1G? Are there any protocols to determine this? Do you have to put them in a centrifuge or stand them against a wall taking their blood pressure every 5 minutes for an hour? Are there aviation-specific guidelines about which drugs are permissible for pilots? I’ve spent a while this evening looking the topic up, and I am fairly sure that 1) the standards seem to be more permissive than a non-specialist would probably expect and 2) it would likely be cheaper to pay an AME to come up with the answer than for the specialist to spend several hours reviewing the topic and 3) there are some drugs that are safer for pilots.
In other words, pay your cardiologist to decide whether you can fly, and I would expect you to pay more for a more conservative risk assessment and less useful advice than you will get from an AME.
Another thing your cardiologist probably doesn’t do is to ask you for your passport. You are on the same team as your cardiologist: you want to be as healthy as possible and your cardiologist wants to facilitate this. Why would you deceive your cardiologist? You’re not necessarily on the same team as your AME. Your AME will want to start by checking that you are who you say you are… This may be more appropriate for professional pilots, who may have compelling financial reasons to cheat the system, but in this adversarial context it makes perfect sense to do a quick and cheap check to prove that someone can see, even if they have a piece of paper to prove that they can.
when a specialist opthamologist says that your eyes are good to go for the next 10 years, using the latest high tech equipment?
If your opthalmologist truly believes (s)he is prescient, (s)he is deluded.
I fly with a PMD (i.e. the only medical I got was as a student pilot) and personally feel that this is a very proportionate approach to aviation medicine for private pilots. That said, I can think of medical conditions I might develop for which I would want to seek aeromedical advice. I would want to seek it in a less adversarial, bureaucratic and costly manner than the current system allows for, but I would still want to talk to an AME rather than to a generalist.
I wonder whether my viewpoint is partly a product of the British medical system, where most doctors have more work than they want and don’t want to take on private work that involves going off-piste as this would be medicolegally risky and require private indemnity insurance (most everyday work is covered by Crown Indemnity). On a medical forum that I frequent, there’s constant grumbling about people coming in for ‘fit to parachute’ or ‘fit for a triathlon’ medical assessments, then getting upset when their doctors don’t want to fill out the forms at any price. One of the undercurrents is that many forms come from overseas events where local doctors are apparently quite happy to fill them out in exchange for a fee – not unreasonably perhaps, as I imagine that for people who are already working in the private sector this work is probably easier and less risky than seeing people who are actually sick.
@kwif I don’t really complain about my AME and his cost €80 (recent increase) including ECG for an annual medical.
Having said that my cardiologist and my GP are paid for in my contributions to the French health system plus a top up insurance. So I pay nothing extra.
My AMEs surgery is a bit further to travel than most of my other medical examiners.
He is getting older and is due for retirement. The next closest AME is an hour away.
I still have to fill in the same form every year when nothing has changed and if it has changed in any significant way one is expected to have already informed the DGAC medical department. It is just a waste of paper. The form allows space to put that you have 1 glass of wine a day or 0 but does not allow space to put you have a couple of glasses every few months at a social event. So what is the purpose?
Thirdly this AME who is also a practicing GP has to send this form plus one he has to fill out on which he has to write whether or not I am a suicide risk plus the ECG tape to the DGAC medical department. Why? Either the AME is a specialist or he is not. How do AMEs discover if you are a suicide risk? They ask “have you ever thought about committing suicide?”
So what does all this red tape add in terms of safety? Does a PPL or LAPL (an AME is needed in France) medical class 2 mean you are any safer to fly than a PMD would be?
Here, nowadays, GPs usually do the medicals for triathlon athletes, golfers, rugby players etc.
Every large town used to have specialist sports medical centres where they could be done. Including BTW you aeronautical medical exams
(nowadays both Class 1 and Class 2).
The most anti risk group IMO are insurance companies and they do not seem to apply a greater risk to a pilot with a PMD to one with a Class 2. So who does?
With regards to my other question the DGAC have no problem with me acting as safety pilot.
Basically I am just a pilot passenger. But as he is a UK PPL in a G reg aircraft I would have thought it would be a matter for the UK CAA to approve me as safety pilot. The coditions attached to his CAA medical says must fly with a “safety pilot”.
gallois wrote:
plus the ECG tape to the DGAC medical department. Why? Either the AME is a specialist or he is not.
As kwif said, an AME is not a specialist in cardiologiy, (s)he is a specialist in aviation medicine. Why in your case the DGAC needs to see the ECG I can’t say, but I don’t think it is surprising that the AME is not allowed to make more involved cardiological interpretations. Indeed, the AMC to part-MED states that an “extended cardiovascular assessment” should be done by a cardiologist or by an Aeromedical Centre – not by the AME.
Here a GP which my AME is can and in my case is qualified to do an ECG. Most of my AMEs have been qualified as such. One or 2 are not and younger PPLs with no need for an ECG can have their medical exams for about €50.
@ Airborne_Again so what you are saying is that according to EASA an ECG must be done by a cardiologist. I know you added the word extended.So why does an AME do one when you get past 60years and every year at that. IMO EASA just add another layer of complexity to leisure flying for zero safety gain.
Why not cut out the middle man. The AME; get the cardiologist to email the results of your ECG to the NAA medical centre?
There is nothing on a resting ECG which will tell anyone, however specialised ,what is going to happen to your heart in the future. This has been written by cardiologists around the world in multiple medical journals. It tells what is happening whilst you are lying on the doctor’s couch. No more, no less.
gallois wrote:
Airborne_Again so what you are saying is that according to EASA an ECG must be done by a cardiologist.
That’s not at all what I said!
I know you added the word extended.
I didn’t – that word is already in the AMC to part-MED and it is there for a reason.
So why does an AME do one when you get past 60years and every year at that. IMO EASA just add another layer of complexity to leisure flying for zero safety gain.
Every other year from 50 actually – at least for a class 2 medical. The AME does the ECG to see if everything looks normal. If there is doubt, the assessment has to be done by a cardiologist (or an AeMC).
Thank you for posting this kwlf – neutral and well-informed.
Thank you. I try.
gallois wrote:
Why not cut out the middle man. The AME; get the cardiologist to email the results of your ECG to the NAA medical centre?
Isn’t that just reforming the service to make it more convenient? Not that there’s anything wrong with that as a goal, but it’s a different goal to e.g. moving to a PMD and doing without the service entirely.
gallois wrote:
There is nothing on a resting ECG which will tell anyone, however specialised, what is going to happen to your heart in the future.
It’s certainly true that people with heart disease can have normal-looking ECGs, but there are also diseases such as Brugada syndrome that you might pick up on a resting ECG. The other thing that you often see as you flick through a patient’s notes is that their ECG suddenly changes – e.g. they had an infarct last year but wrote it off as heartburn. Someone who’s already had a heart attack will be more likely to have another, and will be more likely to have cerebrovascular disease too. Whilst I think you can reasonably question the cost-benefit of doing ECGs for pilots, they do have the potential to show up some issues in advance.
Here, nowadays, GPs usually do the medicals for triathlon athletes, golfers, rugby players etc.
Here’s a British service that does something similar Almost all the events mentioned are outside of the UK.
Is a ‘golfing medical’ a real thing?! I find that idea very funny, but if so then the chances of getting an Europe-wide PMD must be close to zero.
AFAIK an AME is no more a specialist in anything than a GP. In fact most I have known are or were GPs. And GPs actually know very little, beyond standard stuff they see all day. Most of those I have encountered seemed to know astonishingly little. Their principal activity is management of people who struggle to even get there, dishing out pills and more pills, or less pills if somebody on 60mg of atorvastatin says he can’t walk due to leg pains, and generally act as a filter for those who really know stuff: the consultants. The result is those willing to pay contact the consultant directly and he gets the GP to authorise it 
And it will be basically the same in every country – except ones with a small and wealthy population.
No AME or GP I have come across can read an ECG properly. If the machine says OK that is OK. And AFAIK AME training is some exams, mainly, to do with how to understand the MED specifics.
Most medical doctors will regularly look after frail elderly folk who feel lightheaded whenever they stand up, and will be good at adjusting their medicines to minimise the risk of falls.
Without wishing to trivialise the job, that surely is what most of the job is. Pop into any GP waiting room and it is hugely obvious. People who have never done any exercise and spent their entire life eating crap. In some cases occupational damage. But most of these are not pilots, they would not get a Class 2.
I think what stops people getting a Class 2 is not the generally poor health / poor mobility which is most of a GP workload. It tends to be specific things which tick specific boxes. For example if your GP thinks that your feeling cold, sleepy, gaining weight, lipids rising, etc is due to hypothyroidism, he will test TSH (sometimes not even bother with T4) and stick you on thyroxine, 1ug/kg, and review in 6 months. You will function again but this buggers your Class 2. You will be required to go to a consultant endocrinologist and spend a few hundred there. In reality you will need a number of more closely spaced blood tests… Anything “cardiac” is straight to a cardiologist and goodbye medical until you spent a few k. The AME is not involved much.
“Aviation medicine” is mainly knowing how the system works and which conditions need consultant referral.
And underpinning all this is a big stream of €€€€€.
