AdamFrisch wrote:
By not eating for 48hrs before, you can easily drop 10 points.
Taking note of that for next year’s… the 10 day hibiscus – no booze cure did not help a bit. Barely passed despite not being affected by the white blouse syndrome.
Low rest BPM ?
Top athletes often have a dodgy ECG, but there aren’t many top athletes in GA 
You can also get a dodgy ECG by not eating. One AME told me that young applicants often have this problem.
A pity European AMEs never post online, isn’t it? But as agents of the CAA they feel they can’t, even under a nickname. FAA AMEs can and do although not European based ones.
Another thing to consider if you have trouble losing weight (and feel cold, lose hair, etc) is hypothyroidism. This is nasty, leads to heart damage (via cholesterol elevation), but is easily tested for and easily and safely fixed. In the UK, Medichecks will flog you a £60 fingerprint test kit so no AME needs to find out.
For those attached to meat, try King Oyster mushrooms. Texture quite similar to fillet steak
I have had issues on the day because of cardiac reasons.
For a while I was superfit, resting BPM 41. The ECG machine didn’t like this at all, the nurse said it regarded anything below 48 BPM as serious heart disease. She had me do situps (I was lying down on the table with all the leads attached to me at the time) until my heart rate went into the 50s, at which point the machine was happy. But before it finished recording, my heart rate dipped below 48 again and the machine said nyet. Had to do this a few times until we got a recording we could use.
Also, the automatic blood pressure machines don’t always work in this case, not sure how they are calibrated. The one the nurse was using tried to tell me I had a BP of 150/90. Was redone manually by the AME and he got 117/60.
The next ECG a couple years later flagged up something else. Overshoots and undershoots were out of parameter and had to be referred to cardiology. AME’s opinion was that this was a combination of fitness level and body morphology. He said he was going to sign the medical off because he was a 100% certain that the cardiologist would pass it.
Yep. Resting 42 bpm. So I get the ‘get down and give me 20’ and then I have to keep my feet off the bed. Not always first time, but it’s not a drama.
It feels great to flex and say that we are too fit to pass a medical.
But this doesn’t help the OP who is feeling down about his experience with his medical.
I often fly with a good friend who by the sounds of it has the same shape as the OP. He was made to do a fitness to fly test – had to get signed off by an instructor that his belly wasnt interfering with the controls. He knows he needs to slim down, but a lifestyle change is hard for some people.
On the other hand it shows how silly this whole pilot’s medical thing is. You need an ECG to fly a Cessna 172, possibly the most boring plane ever made, in class G. But any idiot can buy a Ferrari or Range Rover and drive wherever they want. No matter how many pies they have eaten.
Look at it from the AMEs perspective: 1/100 of his or her class 2 customers is going to expire in an aircraft crash, with or without taking somebody else with them. Whenever that happens – and it will for any AME with a decent sized practise – the customer in question is liable to get an autopsy, blood tests and people will be going through the AME records with a fine toothed comb.
There are two ways for the AME to deal with the risk: one is to be absolutely meticulous and ‘by the book’. The other is not to take on that responsibility at all i.e. self declaration medicals.
Personally I feel that the self declaration is great initiative – as far as I’m aware there aren’t PPLs raining to the ground all over the UK. I assume somebody is monitoring this.
The issue is that I do see a need for access to aeromedical advice. If I were prescribed blood pressure tablets, I wouldn’t want to do any aerobatics without knowing whether they would lower my threshold for blacking out. Ditto for some other less obvious medications.
will be going through the AME records with a fine toothed comb.
Sure, but what can they prove he did wrong? For criminal proceedings, the AME is innocent until proven guilty BRD, and they cannot prove that he did not examine the pilot’s left testicle. I guess the CAA can just give an AME a hard time (by repeated inspections of his paperwork) and force him to retire. I am pretty sure I know of one such case; regulars here will know exactly who I am talking about. But that AME was an excellent and diligent one, and the CAA probably did not like that he was not lazy so as to walk away from difficult cases.
Self dec works and there is a huge amount of data from the US, and more recently from the UK. The problem is that AMEs don’t like it – obviously.
In Europe there is a particular problem: you cannot discuss something with an AME. He “is the CAA”. He is not your agent. In the US it works differently and much better. So there is no access to aeromedical advice because the AME is required to disclose any conversation. In practice he might not, of course, but you never know.
Look at it from the AMEs perspective
With respect, why? The AME is providing a well paid service and in doing so should give the customer what he actually needs, not what makes himself feel good. He isn’t paid to make himself feel comfortable and risk is part of his job, and the rules that guide his job. If he doesn’t like doing his job in a reasonable way he should quit.
Self dec works and there is a huge amount of data from the US, and more recently from the UK
Yes. I have no interest in doing anything with aviation medicine other than the absolute minimum that’s legally required. If I were to need medical help in relation to flying, I can get it without going through a pointless military style charade every so often.
Other than in cases where getting a 3rd class is super easy (i.e. no medical record and a common sense AME) I don’t know why any US pilot would deal with even the relatively simple FAA medical system versus BasicMed, assuming they’re flying under 18,000 ft, flying something smaller than a Cessna 340 etc. It’s archaic and irrelevant for private pilots, no value added.
Likewise if I was in the UK and not flying elsewhere I wouldn’t for one moment consider subjecting myself to the self perpetuating, manipulative nonsense described here.
Peter wrote:
Sure, but what can they prove he did wrong? For criminal proceedings, the AME is innocent until proven guilty BRD, and they cannot prove that he did not examine the pilot’s left testicle. I guess the CAA can just give an AME a hard time (by repeated inspections of his paperwork) and force him to retire.
Something that always amazes me is how little documentation you get in aviation compared to medicine. In the medical world it’s rammed into everybody that ‘if it isn’t documented, it didn’t happen’. My inspector inspects my aircraft and spends an hour pulling and tugging at everything that can be pulled and tugged and writes ‘I have inspected this aircraft and am satisfied that it is fit to fly’ (or something similar). If a doctor did it, you would end up with something like…
‘I first examined the propeller. None of the bolts were obviously loose and all of them were safety wired correctly. I could not check the torque myself, but the owner is aware of the need to adjust bolt torque seasonally and confirms that he adjusted them last week on Tuesday. The propeller leading edges showed some mild abrasion to the varnish coating over the polypropylene, but there were no defects overlying the woodwork. There are no splits. The propeller was horizontal when I arrived. I then inspected the cowling and found that the fasteners were all in good condition. There were some mild chips in the gel-coat…’
and you would probably get to several pages of typed A4. Seriously. If after the accident the left testicle was found to be missing and you’d documented that it was examined and in good working order, you’d have some explaining to do – even if the pilot died during low-level aerobatics. In fact, on the subject of testicles I’m aware of a case in a hospital far from my own where a patient came in with vague abdominal pain. The doctor examining asked to see his testicles, and explained that this was because testicular can cause abdominal pain in the same way that a heart attack can cause pain in the arm. The patient didn’t feel that this was necessary and said that his testicles were fine thank you very much. The patient’s father who was present might have intimated paedophilia. The testicle had twisted and cut off the blood supply, and by the next day it was unviable and had to be removed. The doctor had documented that examination of the testicle had been declined, and that he had explained that abdominal pain might indicate a disease of the testicles such as testicular torsion but he had not documented that he had explained to the patient the importance of prompt treatment of testicular torsion – which at this point in time was only one of a million possible diagnoses. The patient replies that ‘If only you had explained to me the time sensitive nature of the management of testicular torsion, I would have consented to be examined. Your negligence resulted in the loss of my testicle.’ and the case is settled for a significant sum. The doctor doesn’t pay any of the sum from their own pocket, but does have to spend huge amounts of time answering questions from the patient complaints team, and the acrimony not to mention the guilt and self-doubt when somebody comes to harm can be very draining.
I have tweaked some details in this story but I feel that it is in essence ‘true’, and a common enough issue that if someone reading this happens to think ’that’s my story exactly’, then they ought not to jump to the conclusion that it is their case that I’m referring to.
That’s the culture of fear outside of the Aviation Medical Examination environment at least. I don’t know what it’s like to be an AME as I’m not one, but I would anticipate that there would be some carry-over from general medical culture to aviation medical practise. If a pilot did something stupid and turned out to have a brain metastasis from a testicular tumour, it wouldn’t surprise me one jot if the lawyer asked the AME in court why he didn’t examine the pilot’s testicles.
I don’t know, but might anticipate that a thoughtful AME would see private pilots as being a bigger risk for less reward than airline pilots. If you have 200 class 2 medicals on your books, then the probability is that several of your pilots will die in plane crashes. When it comes to airline pilots, even though the stakes are higher, the probability is that none of them will die in plane crashes.
Has anyone heard of an AME being sued or otherwise brought to account after an aircraft accident, as a result of the AME previously issuing a medical certificate as a government function?
