Current status of medical concessions

But you said an AME can’t necessarily be expected to be able to read an ECG.
Or at least you quoted @kwif as saying that.

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.

So I return to the point of why does an AME do and ECG if s/he can not be expected to gain anything meaninful by it?
In some countries in Europe it can really push up the price of a medical. That reduces the flying budget. IMO an hour actually flying adds far more to safety than an ECG for an AME.
Many people I ask why they are going to ULM rather than LAPL or PPL answer that they just can’t be bothered to go for an annual medical.
For the young the answer is they just can’t be bothered with booking a rendezvous with an AME which is usually a few weeks into the future, they want to start flying then and there.

gallois wrote:

But you said an AME can’t necessarily be expected to be able to read an ECG.
Or at least you quoted @kwif as saying that.

I did neither of these things. Actually I did not say anything about what an AME is “expected” to do, only what they are allowed to do. Obviously they both can and are allowed to do basic interpretations of ECGs. That does not necessarily mean they are qualified or allowed to determine to what degree every anomaly pose a potential problem or not.

Peter wrote:

What is “aviation medicine”?

Oh, come on. Now you are just being stubborn.

https://en.wikipedia.org/wiki/Aviation_medicine

And some links relating to the UK in particular

https://www.jrcptb.org.uk/aviation-and-space-medicine
https://www.kcl.ac.uk/short-courses/basic-course-in-aviation-medicine

But you said an AME can’t necessarily be expected to be able to read an ECG.

That’s not quite what I said. Any doctor should be able to see the most common abnormalities on an ECG, but there can be subtleties that only a specialist might reasonably be expected to pick up on. The issue is that if your patient drops dead 5 years hence, it’s probably the specialist who will review the ECG and quite possibly crucify the generalist for the missed subtle finding.

If a patient twists their ankle and has an X-ray, the doctor who sees the scan the first time round will see most fractures and treat them today, but we still get a second report as it’s accepted that even experts sometimes miss something obvious. It’s just one of my little bugbears that we don’t do the same thing for ECGs.

Few of us will drop dead on the way to buy milk, but all of us slow down as we get older. For a few this happens at 50. For a few it happens at 95. For most of us, it happens somewhere in between.. The scenario I always have in mind when it comes to wondering whether AMEs are necessary or not, is to imagine an older pilot walking into an AME’s office a little bit more slowly and unsteadily than last year… Slightly blunted affect and intelligence compared to last year. A GP AME is actually going to be very good at picking up on these clues (early Parkinson’s disease; hypothyroid..? B12 deficiency..?) Sometimes patients have insight that there is something wrong, but not always. I’d be very curious to hear from an AME, what proportion of people make good judgements for themselves when it comes to hanging up the headset and what proportion need a nudge or a push to make the right decision. Certainly when it comes to driving, I have had hard conversations with a taxi driver with poor vision, a lorry driver who had a seizure, people with mild dementia; an elderly lady who was driving despite her dense hemianopia (something that I detected by talking to her then waving my hands around, with no expensive medical equipment whatsoever).

The broader issue that pervades all of aviation, is that whenever you put professional people in a position of taking responsibility for somebody else’s actions you are forcing them into a cycle of ostentatious back-covering and over-cautiousness. There are situations where very strict regulation is necessary, but my current feeling is that to fly a single-seater aircraft or a two seater with another pilot for their own pleasure, the main concern should be that the pilot is of sound mind and has access to information and resources they need to make sensible decisions (and the sensible decision for some might be to ask a doctor). Ditto when it comes to maintenance. I very much like the SSDR programme, and when I next buy an aircraft it may well be one.

@kwif I don’t disagree with.some of what you say. Here for instance an HGV driver has to have a medical, each year. That is carried out by a GP who probably has never driven an HGV.
I don’t necesarily disagree with a special medical for professional pilots.
But as to when to recognise when to hang up our headsets or to stop for a while, well surely that is what the “human factors” training and exam was introduced to do. To give pilots who many claim to be intelligent people the information to recognise when physically or physchologically aren’t quite right and they should seek medical guidance.
This sort of self assessment has been recognised in other leisure activities for years. What makes leisure flying so different.
If I wanted to drive at Le Mans for instance, I would expect to get a good medical checkout by specialists in their field and one of those fields would not necessarily have anything.to do with driving cars.
If I did aerobatics I would expect to get a good medical checkout by specialists who deal with the various challenges my mind and body would expect to take during aerobatics. This is not part of an AME exam.
I have a chum who was an astronaut. He was a pilot before he trained to be an astronaut. The exam carried out by AMEs for his pilots licence and those carried out during astronaut training bore little relationship to each other.
In fact rumour has it (and I can put it no better than that) that at least one well known American trainee astronaut and several fast jet jockeys have been sent for further tests by AMEs. Tests which have already been carried out during their training and showing they.have no problem.
I simply find it ridiculous that following a series of tests a cardiologist has declared someone perfectly fit and goes on record that someone is fit to fly. The next day an AME, who as is admitted here is probably not a heart specialist, can then demand you have the same tests again and /or additional tests and to determine that those tests which the cardiologist has carried out and the additional ones, now need to be carried out every year, when the cardiologist and the specialists responisble for those tests say they are only needed once every 2, 3 or even 5 years.
On top of that, this dossier of tests goes off to a committee who decide that further tests are needed. And perhaps you should not fly for a year and when you do perhaps you should have a safety pilot for another year.
If it is a problem of the medicines that are allowed or not. These can be published eg beta blockers, or anti coagulants are perhaps no fly medicines. This is not just in aviation. All types of sport have certain forbidden medicines and those sporting bodies and the people who do the sports simply ask their specialists to give them alternative medicines which are allowed.
@Peter is quite right to ask “what is an aviation medical”?
I ask if it is necessary for the type of flying we do and is it fit for purpose? What is worse it is far more bureaucratic than it was and getting more so IMO. Which of course pushes the cost up.
And of course its not just cardio system where these problems arise. There is opthamology and the auditory environment where problems which today can be put right, once and for all, by specialists, can lead to pilots needing either unnecessary time off from flying or the necessity for a “safety pilot”.
This is despite medical problems which were once thought of as extremely serious which advances in surgery and pharmaceuticals have made not serious at all can still exclude someone from flying for leisure outside of the PMD/ULM world.
And so I ask again is there evidence, after many years now that a PMD or similar is any less safe for leisure flying?

And so I ask again is there evidence, after many years now that a PMD or similar is any less safe for leisure flying?

Apparently not less safe, see page 5 of Julian Scarfe’s document in post 6.

As to ‘cardio issues’, my personal experience how this is handled in Spain is positive. The AME thought she spotted something awkward on my ECG and ordered me to go to an ‘Aero conversant’ cardiologist they work with. Proper investigation; scans, treadmill measurements and a 24 hr BP monitoring. Absolutely nothing found wrong. AME accepted this of course, case closed. Important to note that I was permitted to continue to fly during the whole process. Actually glad I had a good check-up.

Also cardio related; rumors are that over here AME’s are becoming quite strict on BMI compliance. One person I know lost his medical, another one given some time to lose weight.

Although this is not a concern to me personally, it could be for many others; how does this work under PMD/FAA self declaration or French UL exception rules? Is it not a parameter anymore for someone to consider? Or is one supposed to submit BMI data on some sort of form?

how does this work under PMD/FAA self declaration or French UL exception rules? Is it not a parameter anymore for someone to consider?

FAA Sport Pilot does not require any ‘declaration’ or any forms or any examination so BMI is not an issue.

For the FAA 3rd class and up, BMI over 40 is considered an issue in relation to the likelihood of sleep apnea, but in and of itself is not a disqualifying issue. I’d personally have to be 60% over my current weight to reach a BMI of 40 and would be physically unable to get in my plane at that weight. I can’t imagine a lot of people are affected.

The obsession with ECGs in Europe for pilots having no known cardiac issues is particularly unnecessary, and eliminating it would be a good first step. No routine ECG testing ever been required for any US pilots unless needing a 1st Class medical to carry passengers for hire.

Airborne_Again wrote:

Obviously they both can and are allowed to do basic interpretations of ECGs

I Asked my AME about that several years ago. I asked him what he could read from that printout. He answered he didn’t read anything out of it. What he did was to send it to the “HQ”. The main thing they did was to compare new ones with older ones and look for changes over time. This could have changed with more EASA into the picture, I don’t know, but I can’t remember he studied the ECG at all the last time either.