My point was that flying when you are known to have a medical contra-indication is different from flying with one that is unknown
In the modern world, general medical care and personal health awareness is so much better and more comprehensive than anything produced by a pilot medical certificate that I find the idea of an additional contribution from that source somewhere between unlikely and ridiculous. Maybe its more likely for Russian pilots who for the last 30 years have started their day off with a shot of vodka to get ready for flying, and visit their doctors once every 5 years whether they need it or not :-) it is certainly an unlikely scenario for anybody I know... flying anything from a Pietenpol to a PC12.
On the other hand I've known several people flying with no Class 3 medical for years - the punishment would be to take their pilot certificate away, which is not exactly a major deterrent!
Also, am I right that in the UK, nowadays, the CAA obtains your GP records for issuing a medical, so your GP has no duty of confidentiality to you anyway.
You have to consent to the GP supplying your data to the CAA but if you don't consent then you won't get the medical
Where did you hear this?
When I got my Class 1, I'm fairly certain that the AME at Gatwick asked about my medical history, but at no point was I asked for permission for them to contact my GP.
I don't believe that the AME I go for renewals has access to my GP records either. He always asks if I've seen my GP, but maybe he's checking to see if I'm telling the truth or not.
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Far from your assertion that the majority of pilots are therefore relatively young, they are in fact generally older PPLs who have downgraded to self declarations because they cannot meet class 2 standards!
From everything I have read about the NPPL, that's true (and a disappointment for those who drove the NPPL project, who tried to make flying more accessible as a whole) but you are undoubtedly still looking at a pilot population who risk-compensate i.e. if they have chest pains they are not going to go flying.
That compensation will always exist, which is why aviation medicals can appear to have no value. Even if say 10% of pilots don't compensate, the stats will still get skewed to support that assertion.
No doubt this is why, in the USA, the Sport Pilots don't show any bigger in-flight incapacitation. Pilots tend to be above-average intelligent / educated / wealthy and those people are above average health-aware and probably take a bit of care about themselves, not drinking Coke and eating MacDonalds etc. Because of this skew, it may well be that aviation medicals have no value. I think this is what Silvaire is getting at. But it probably wouldn't work for the general population, whose health is often really bad.
Where did you hear this?
When I got my Class 1, I'm fairly certain that the AME at Gatwick asked about my medical history, but at no point was I asked for permission for them to contact my GP.
When I got my CAA Class 1, c. 2008, it was a condition that I signed a form authorising my GP to supply the medical records.
It is probable that this doesn't happen on the Class 2 because my son did his about a year ago and didn't have to do it. But he was only 16.
Certainly, years ago you could get a Class 1 without GP contact and there were cases of airline pilots not disclosing "stuff" and I think that after this made the media, the CAA tightened up.
I never asserted it; I just argued that I expected it to be the case... If I'm wrong, then so be it.
Still, you're arguing that older pilots with an NPPL are less likely to be medically incapacitated than younger patients with a PPL. I would still argue that all that implies is that the populations are in some way different.
For the record, I tend to agree that for PPLs, regular medicals are unlikely to be of much benefit, though I haven't looked into it in any great detail. I can see more value in there being AMEs with whom to discuss medical issues as frankly your average GP is unlikely to have a good handle on what's likely to be significant and what's not - unless it's something obvious. Even though I have medical training I'd find a lot of questions hard to answer.
For example if I met a pilot who suffered from mild longstanding vertigo (the feeling that the world is spinning - not a fear of heights) should I forbid him from flying? Perhaps I should forbid all pilots with vertigo from flying - which is the obvious answer. Or perhaps I should only forbid IFR pilots from flying, because VFR pilots can see where they're going and overcome any sense of vertigo. Or perhaps I should only forbid VFR pilots from flying, because IFR pilots are trained to ignore sensory conflicts. Or perhaps they need further assessment and may or may not be fit to fly depending on the result. Perhaps they can fly unless their vertigo makes them feel sick. I don't know, and I'd wager the average GP doesn't know...
In the modern world, general medical care and personal health awareness is so much better and more comprehensive than anything produced by a pilot medical certificate that I find the idea of an additional contribution from that source somewhere between unlikely and ridiculous.
I'm not an AME, but when I had my medical I thought I could glean a fair idea of what they were looking for. If you go and see your AME their main concern is that you're not going to be suddenly incapacitated and that you don't have any sensory or psychiatric issues that will preclude you from being a safe pilot. They're not directly concerned about whether, on a wider scale, you're well. They look to see whether you have rare heart abnormalities. They don't look to see whether you have rare but potentially treatable cancers.
If you go and see your GP (family doctor; whatever...) they may have the results of more sophisticated tests that you've had in the past, but they're really only interested in whether you're well in wider terms, and in whichever medical issue you've come to see them about on the day. They won't be particularly interested in whether you're likely to be suddenly incapacitated or have psychiatric or sensory problems that should prevent you from flying, and probably won't be in a great position to make good judgement calls on such issues anyway, without consulting an AME.
As an example of bad decision-making, a relative of mine was told by his GP that he could go scuba diving on his honeymoon despite having epilepsy and the fact that the antimalarial interacted with his epilepsy medicines to make him more likely to have a seizure and despite the fact that both the antimalarials and epilepsy medicines may potentiate narcosis at depth... Clearly his GP was out of his depth, and didn't know it. If I have to see a doctor regarding flying, I'd personally rather see a specialist.
OK, looking at the CAA statistics, older pilots are over-represented amongst NPPLS relative to PPLs.
However, there are only 548 NPPL licences issued in all. Crashes aren't terribly common. I'd like to see the figures, but it seems unlikely to me that you're going to be able to make any statistically meaningful statements about accidents due to medically incapacitated pilots in such a small population.
If you go and see your GP (family doctor; whatever...) they may have the results of more sophisticated tests that you've had in the past, but they're really only interested in whether you're well in wider terms, and in whichever medical issue you've come to see them about on the day. They won't be particularly interested in whether you're likely to be suddenly incapacitated or have psychiatric or sensory problems that should prevent you from flying, and probably won't be in a great position to make good judgement calls on such issues anyway, without consulting an AME.
As I mentioned above, my FAA class 3 medical is a near-trivial formality. The level of care that I get on every level from other doctors of my choice is better. They work for me, pay attention to what I ask, and if they think I could do better with a specialist in answering my needs and questions, they recommend I see one. There is no value added by a formal medical certificate or process in my case, and today I think that's true for the majority of pilots today, at least in the US where I fly.
Responding to Peter's observation about the socio-economic status of pilots, I think they are spread pretty widely, but they are generally responsible people. Those at the bottom tend to be younger and healthier, not needing much health care either way, and those at the higher end tend to be older and get good health care for themselves.
Clearly his GP was out of his depth, and didn't know it.
Sure, there are bad GPs out there. But on the other hand I've had some very good ones.
What makes you so sure the AME actually knows what he's doing? A GP is working for you, if he's out of his comfort zone, he will try to offer you a solution, like giving you the address of a specialist, or inform himself. If an AME is out of his comfort zone, he will most likely try to cover his backside, read he will just say no. And then it's up to you to fight for your rights, costing you even more time and money the whole circus already costed you. There's lots of anecdotal evidence for bad AME decisions, too.
Other than the diving story, the post wasn't intended to be GP bashing. If you're a GP you have broad knowledge of a number of specialties such as paediatrics, obstetrics etc... that do not include diving medicine or aviation medicine.
Half of medicine involves with dealing with things you know about - such as a patient coming in with textbook appendicitis. You know exactly who to contact and what to do. The other half of medicine is about dealing with the unknown - which is where a modicum of common sense guided by basic scientific training comes in to play. If you don't have any basic scientific training in areas related to aviation medicine or diving medicine then your common sense is inevitably going to be impaired. I don't doubt there are AMEs who have made poor decisions (we all do, from time to time) but you would hope that they would make fewer poor decisions than people with no aviation experience or training.
The problem with the GP who made the diving decision wasn't that he was out of his comfort zone; it was that he didn't realise that he was out of his comfort zone.
They work for me
No, a doctor is also working for him or herself and (in the UK) also for the wider community. I spend lots of time documenting decisions, people contacted... for which the sole reason is to protect myself if something should go wrong in the future and a claim be made against me. Sadly even in the UK, lots of tests are carried out more for the sake of the doctors than the patients. I also have a responsibility to tell people not to drive if they are unfit, and if I later see them driving, a legal duty to report them.
On one of the medical fora at the moment there's some fuss about medicals for parachutists, with one of the medical defence unions stating that doctors may not fill out a particular pre-jump assessment form which has been poorly worded. The MDU states that doctors filling out the form will not be insured, which in the UK is a legal requirement. Conversely the parachuting center will not accept people without the form, as in this case they would not be insured.
A lot of GPs said that they would not fill out such a form anyway, as they do not know enough about what parachuting involves. In the UK this leaves you in something of a quandry as it would be a real hassle to find a GP who would see a patient from another practice solely for the purpose of filling out a parachuting form. Having the option of seeing AMEs who by definition are happy to see pilots who are not their regular patients, avoids such impasses. Over the next few years I would imagine that there is likely to be more work for AMEs, as the number of older pilots with more complex medical histories is likely to increase.
but you would hope that they would make fewer poor decisions than people with no aviation experience or training.
I personally know way too many people who had to fight bad AME decisions (and in the end won, so their case had some merit) to believe that the bad AME problem is fairly widespread
Do you think that GPs with no training would be more or less conservative in making decisions about something that they know relatively little about?
