If you haven’t (yet) filled out a new medical application, and are not (yet) applying for a new Medical, why would the AME you are paying for guidance have any obligation to anybody but you? The only legal issue anyway would be if you were still flying with an expired medical (assuming it’s not operations under Sport Pilot or similar, i.e. no current Medical required) or when you should be self-grounded. Presumably since that’s irrelevant to getting a new Medical nobody would need to discuss it.
That aside, I expect even a small company that specializes in helping pilots as paying customers could easily ‘firewall’ personal details from those who may under certain circumstances have an obligation to report them – as an AME does when he fails you. How would an administrator, attorney or non-AME medical doctor be required to report anything you told him to the FAA or CAA?
Peter wrote:
whereas in Europe an AME is an agent of his national CAA and – in the words of one European AME I spoke to years ago – there is no such thing as “off the record” chat.I’m not so sure this is true. My AME (for whatever reason) got a new ID in the computer records system (which I believe is an EASA system and not a specific Swedish system) and I had to give express approval (in writing) for him to access my records which were saved under his old ID!
Give me an example of a situation where one might want confidential advice but is not trying to game the system?
There are many areas where you may want to ask an AME a question – e.g. this sort of thing
The problem is that if the answer is “you are OK” then you are OK, but if it is “you are required to report this” then he is required to report it and you are instantly grounded until he has reviewed the matter 
Then there are cases where someone with an existing condition wants to find out whether he can embark on a PPL. If the answer is NO, or it is unclear, the AME is required to report that contact to the CAA, and it can be expected to appear on that person’s record for when he does apply for his initial medical, regardless of whether he still has that condition or not.
Another one I came across recently was whether you are required to report conditions to your AME if you are flying on the privileges of another country’s license (or in the UK the NPPL) whose medical doesn’t require the report. Apparently you are still required to report it because you are still a holder of a valid medical, even if you are not exercising the privileges. So a “silent downgrade to the NPPL” is apparently illegal; I am sure large numbers of UK pilots would be shocked to hear that. My question in that case was: what if on Monday you get a fresh medical, on Tuesday you get fed up with flying and abandon it for ever, and on Wednesday you get a cancer diagnosis? Are you still required to report the diagnosis to the CAA? Apparently you are because your medical was still current! So you committed a criminal offence. I find that totally bizzare because it means nobody could downgrade to the NPPL (and its medical declaration) until their EASA medical has expired!!
Many grey areas which can use confidential AME advice.
However from the AME’s point of view, probably everybody is trying to game the system
The AME’s access to your personal doctor’s records is a separate thing. This is rarely invoked anywhere, though I heard a rumour that the UK CAA (which always requires you to consent to the access, otherwise you will not get your medical) is now doing it automatically for initial Class 1. Obviously a lack of access (as in e.g. Germanwings) looks extremely prejudicial.
Are all AMEs in the UK full time AMEs Peter? My AME is mainly working as a family doctor (GP) and only occasionally does medicals. It’s more of a hobby for him, albeit paid. I don’t know any reason why he shouldn’tbe able to give me confidential advice if I ask for it. He certainly would need my permission in writing to forward anything to the LAB under German law.
Are all AMEs in the UK full time AMEs Peter?
No; some are normal GPs (general practitioners i.e. “family doctors”).
Sure a GP can give you confidential advice; he has a duty of confidentiality (within certain limits obviously). But if he is your AME then that duty is removed, in EASA-land. I am told by a well informed German pilot that this is true even in Germany (the Germanwings case involved the GP → AME information barrier, not an AME → CAA one).
This is why practically nobody who has one of these uses an AME who is also their GP 
It would be like doing personal banking with the same bank which your business banks with and which holds various loan guarantees signed by you
Most people won’t write about this stuff openly, for obvious reasons. One AME+GP said that when he works as a GP everybody tries to look as sick as they can and when he works as an AME everybody tries to look as healthy as they can. I am not bothered and I think it is informative
Peter wrote:
My question in that case was: what if on Monday you get a fresh medical, on Tuesday you get fed up with flying and abandon it for ever, and on Wednesday you get a cancer diagnosis? Are you still required to report the diagnosis to the CAA? Apparently you are because your medical was still current!
At the same time, I’ve never seen such a case in the list of CAA prosecutions so perhaps it’s not something they worry about or that we should worry about. I suspect the same is true for lots of old people in nursing homes who might not have changed the address on their driving license as they are supposed to.
Going back to the original question… and bringing up the example of depression – I’m still failing to see how a confidential discussion about this might not be seen as gaming the system. Take the question ‘I have really severe depression. My GP wants me to try antidepressants but I’ve heard this will make it harder to renew my medical – can you tell me whether this is true?’
First of all, the AME isn’t going to want a death on his/her conscience so the advice is going to be to make looking after the depression the priority. Secondly, whether or not you’ve taken antidepressants is probably being used as a soft marker of the severity of the depression (sometimes doubtless unfairly, as someone seeking treatment is probably safer than someone bottling everything up) so if you choose whether or not to take antidepressants on the basis of whether or not it affects your medical then this, to my mind, would be an example of gaming the system.
As another example, ‘I have high blood pressure. Can you tell me which of these tablets will be least likely to make me woozy or perhaps even make me faint at the yoke?’… This seems to me to be a reasonable, honest question, but why try to discuss it confidentially? Perhaps I’m being naïve. But there’s likely to be a reasonable solution and probably everyone will go home happy (AME will feel useful; pilot will get helpful advice and continue to fly).
If the problem is ‘My heart stops for 5-10 seconds at a time – I keep fainting even when I’m sitting’… well good luck, you won’t be flying any time soon but neither you nor the AME have anything to gain by discussing it confidentially and the AME is going to be pretty miserable if you discuss it confidentially but don’t declare it officially…
I would tend to be honest with an AME, if for no other reason than if your medical is invalid your insurance is probably invalid and I have a view that the truth will out… at least if you have a sufficiently significant accident. As I’ve said before I’m ambivalent about the need for medicals, but the lack of a venue to discuss confidentially whether or not you should declare something officially seems a losing proposition all round.
I lost my medical and timed out on all my ratings because of bureaucracy – both FAA and CAA – simply because I disclosed a (fully cleared up) case of Pneumonia in the questionnaire.
I had had if a few months earlier, of course did not fly (nor do much else, for that matter) while I had it and until I had recovered.
Instead of the sensible reaction – had pneumonia, clearly healed now, there’s your medical – it went to formal doctor’s records and reports going to both authorities and with some process delays I was with no medical when all my ratings expired.
Lessons learned: While having all revalidations together with the medical in the same month helps with remembering to do it all, it does not help if anything goes wrong. The AME apologetically said he had to follow procedure – “you are obviously fine, but…”
Action taken: I will have different dates for these expires in the future. That means I need to make more of an effort to remember the various days. Sadly, as my total memory capacity is limited, it means that I am now less likely to remember that I had some cleared-up illness, especially when I have to fill in forms.
Cobalt wrote:
Sadly, as my total memory capacity is limited, it means that I am now less likely to remember that I had some cleared-up illness, especially when I have to fill in forms.
That’s the way to go. Amnesia. If it leaves no scars…
The FAA medical grounding conditions are widely published. A self-evaluation here is in order. Case in hand – I have a friend doing his PPL. A few years back he was on a low dose of Zoloft for anxiety and now faces SI and psych eval. It will take his AME to coordinate with his regular doctor, probably a psychiatrist and prove that he hasn’t been on the stuff for months or years. A royal pain in the a*se that will take tons of time and money, for very little benefit to safety. All it does is open up an unnecessary world of rectal pain. Obviously if you’re still on it, nothing can help you.
But more importantly, you need to be in the hands of an AME that know the system, knows the FAA/CAA and can see things through but also has the trust of the issuing body. There are not that many of those around. Most of them will just follow the published guide and defer any thorny conditions to the FAA and make things worse, generally. Then you’re in the system forever and looking at SI’s indefinitely. As an example, here in LA, a major city by all standards, there are only 2 AME’s I would consider (after consulting with the professional pilots I know). And if you have a really thorny thing that needs lots of guidance to pass through the system, there are just about only 2 AME’s in the whole of the US who could do that.
