Welcome Cem !
Emir wrote:
Welcome! My impression is that average age of forum participants is such that we’re more and more interested in medical topics
Pilots are interested but not open to talk about in front of an AME, let’s keep it high level 
I had no idea this thread existed until it’s most recent incarnation a few days ago, so for a very belated introduction;
I’ve had my professional licences (CAA & FAA) for forty years and flown piston twins, turboprops, Gulfstreams and jet airliners in a professional capacity. My current employer is a bit sensitive about social media but if I said I was a Captain on Boeing’s biggest twin jet based out of LHR you could probably figure it out.
I keep active on the GA scene co-owning a Cirrus SR22, flying taildraggers (mostly supercubs), occasionally flying gliders and very very occasionally (thanks to a well connected friend) Warbirds. Since the lockdown all of my GA flying has been around the UK of course but prior to that I enjoyed flying around Europe, the USA and Canada.
Flying and aviation generally is inescapable in our family, my Wife and Brother are also Captains on Boeing’s biggest twin for the same outfit, my Father had a successful business outside of aviation so just stuck to PPL flying but he still has his medical at 83, Brother in law has just retired as a training Captain from Easyjet and still teaches gliding/tugging/MCC, Father in law flew Meteors and Canberra’s in the 50’s, Mother in law edited sailplane and gliding magazine for 27 years, lastly my eldest Son is a training/fleet Captain for a new US airline. Difficult to believe I know but when we have a family dinner we hardly ever talk about flying!
When I’m not flying I own a precision engineering/manufacturing business that mostly deals with the film industry (putting cameras on anything that goes fast for films like James Bond, Mission Impossible, Fast and Furious sort of thing) along with motorsport and some aviation parts – reverse engineering parts that are no longer made or impossible to get hold of etc.
I enjoy this forum because for the most part the discussions are calm, fact based and open. Of course everybody has an opinion and I don’t always agree with other posters but I’m equally happy consider that I might be the one who has not considered a different point of view – or I could simply just be wrong!
Thank you for all of the warm welcomes and also welcome to Xlr8tr (even thought you probably have been here longer than I have).
I am not sure how to link other posts into my post so I hope you can follow my train of thought.
I am happy to talk about medical related issues or general health related issues.
Happy to share my contact info if anyone wants to have a private chat.
I am a UK based AME. Up until Brexit I could issue EASA medicals but since Brexit I have not registered with a EU state yet.
This is because I currently only do Class 2 medicals and have not really had the level of demand to warrant registering with an EASA state.
I wanted to get some experience under my belt before moving on to Class 1 medicals.
I work as a General Practitioner so I took my time and almost 4 years in practicing as an AME I feel ready to progress to Class 1 and I am waiting for the universities to run the course in Advanced Course in Aviation Medicine.
In fact there is a course in Germany which I am hoping will have a space for me, just so I get to visit Germany as I have never been.
My main role as a doctor is General Practice but I am hoping to dedicate more hours to AME work. Just need more pilots :)
Like I said, if there are any medical questions – aviation or general health related, I am more than happy to have a go at helping.
Just bare in mind that it can be difficult to give advice on line, having a face to face conversation is one thing but doing it on line is a completely different ball game when it comes to communication.
Also, confidentiality is a big issue, so please bare in mind what you are about to post and I need to be super careful to try not to break confidentiality as a doctor. Your private business needs to stay private. Once you put it on the forum it is out for the public to see.
Also, not sure how secure it is to share any personal information over the forum (no disrespect to the forum or admins who put all of the effort of running it). Being GDPR aware and compliant is also very important.
I am happy to help guide and give my opinion but please do not hold me liable or pull me into an argument with another health professional or any Aviation Authority who is actually in charge of your heath or medical.
If I am not sure of something or I do not know, I will say so. Please don’t be disappointed if I do not have the answers you are looking for.
Also, if I do not feel comfortable answering a question or contributing to a discussion, I will not do so. I hope this is acceptable.
I have just read back on what I have written above and it seems like I am putting up lots of barriers. Please try not to be put off by them. These are some of the things doctors need to think through before even talking to a patient.
For example and this is a true story. I met a really nice pilot for the first time who came for renewal of his class 2. Very pleasant gentleman. He mentioned that he had a friend Mr X (lets call his friend) who also needed a medical and he would be calling Mr X to recommend me. I thanked him and said I would be grateful for this recommendation. What he did not know was that Mr X had already called me and we already arranged for a medical between us. I got a call about an hour later from this very pleasant gentleman (honestly he was really nice and I was telling my family how nice he was when he called) and proceeded to tell me he just got off the phone from Mr X. He may have been some what frustrated with me to start off with as he let me know that when he did tell Mr X about me and recommended he books in for his medical with me, Mr X replied by saying something along the lines of what an earth are you talking about? I already have an appointment with him. I swiftly apologised for not disclosing Mr X and I had already communicated and arranged for a medical. But if I did so I would have broken confidentiality. He was very understanding once he heard why I did not tell him Mr X already had an appointment with me in the first place. As you can see these things can be tricky at times.
I look forward to reading posts on the forum and hopefully taking part in discussions.
Thanks again for the warm welcomes.
Welcome to EuroGA, Gem
There is a lot of advice which can be posted in general terms. We’ve had loads of threads where somebody asked a straight question, which should have a straight answer. And there is potential advice on strategy especially in more complex areas like the cardio flow chart where you can have multiple ways to approach something. Cardio is huge and based on pilots I know may be the biggest single factor behind medical loss. And most give-up cases are pointless; if the pilot got himself sorted out he could fly on and he would benefit generally in terms of health, quality of life, etc. It can however be a wallet-emptying process.
Confidentiality is an interesting topic.
One UK AME told me he has no duty of confidentiality to his client, because he is working for the CAA. Accordingly, no “off the record” discussion is permitted and he is required to report everything to the CAA. Obviously, in reality, some will be more reasonable…
However, in FAA-land, this is different, and the AME can legally advise the client of what needs disclosing and what doesn’t need disclosing. And a lot of them are working as consultants, advising pilots on how to get difficult medical situations sorted out.
One FAA AME I know is unaware of this and told me that he is required to report everything to the FAA. I suspect he is not the only one who is misinformed
The systems are also different. The FAA publishes around 20 “self grounding” conditions. There is a lot of stuff which grounds you if you have it but it does not need disclosing to the AME until the next medical. In EASA Part-M (and the UK system is probably identical, due to the Withdrawal Act which absorbed EU law into UK law on 31/12/2020) there is no such thing and in theory everything must be reported to the AME. Obviously this does get bent e.g. you probably don’t declare a positive pregnancy test 
In any medically-regulated endeavour they have never really squared the circle of a doctor’s duty to his/her patient vs the fact that he/she is acting, to some degree, as a regulator. I don’t think they can be both without compromising the doctor/patient relationship, so:
For myself, I view ‘my’ AME strictly as a government employee / regulator and I don’t consider there to be a doctor/patient relationship. They are not ‘my doctor’ and there are no circumstances under which I will communicate with them outside of the process necessary for renewing my medical, which unfortunately is now every two years rather than five.
Thank you Peter, Graham and RObertL 18C.
You raise some very interesting point here and I am glad you have. I find this whole process fascinating so I think I have a lot to gain from these discussions, hope you feel the same way.
With regards to confidentiality, I was thinking of pilots confidentiality vs rest of the world, not just Aviation Authority.
With regards to the UK CAA, yes all of the information we collect, we do so on their behalf. So information collected is always put on Cellma and shared with the UK CAA. I am unable to comment on other Aviation Authorities. So, in short yes, if you disclose something it goes on your Cellma record. I imagine the uncertainty from the pilots point of view is will it mean they will be grounded and if so will they be able to fly again. And when flying is such a big part of your life and in some circumstances your personality I imagine it can be difficult to think objectively as emotions and desires can also impact on our judgement of the circumstances. This is one reason why doctors do not treat themselves or their own family. My advice is always disclose (easy for me to say I know) and I do not say this lightly, but ultimately your safety and well being and safety of all those around you when flying is priority. I am sure no one here skips on safety checks and if something is out of place they do not turn a blind eye to it.
When it comes to what happens when something is disclosed and it means grounding and investigations and reports and referral to the CAA. This can be straight forward and quick (some times) and can also be slow, convoluted, complicated and as you have already pointed out very costly indeed. The money spent on specialist opinions firstly is a good investment in your own health and in return your own quality of life. Secondly the investment is on your hobby or career. This is the view point I take, of course if may not seem this way to everybody else. That is if you are able to afford spending all this money as well. When going down this route a thought goes out to pilots from me as I personally money is spent flying and enjoying yourself but again following UK CAA guidance and ultimately pilots well being and safety takes precedence.
With regards to the first point Graham raised. That is an interesting one. Yes, as an AME I will follow the guidance and advise pilot accordingly. So, I suppose this is the regulatory side. However, whenever I do a medical I do also mention that medicals are a golden opportunity for a health check. We literally go from head to toe. And I do ask if it is OK to give health advice if appropriate. I have not had anyone decline this. I cannot see why the two cannot go hand in hand. I am happy to told otherwise or may be this can be elaborated further. I will give one example from my practice. A gentleman who just retired presented for a C2 medical. He paid off the mortgage, children all grown and sorted, now retired he wanted to make time for himself and learn to fly – something which he always wanted to do. He had no medical history, not on any medications, always been well and had not seen a doctor in decades. On examination he had a heart murmur – leaky heart valve. So as far as progressing with the medical was concerned we absolutely could not proceed and he would have to see a cardiologist as per UK CAA guidance. But putting all that and flying to one side, I advised this gentleman that primarily this needed investigating and sorting out for his well being at first. Once this is done we can always focus on flying again. This is what I mean by taking an interest in the persons health as well. Yes, I may not be the treating clinician but surely it is OK to give advice on what findings during the medical may mean on flying as well as general health.
As a GP I also follow local and national guidance when investigating and also treating patients. These guidelines can never be one size fits all and cover for every eventuality. So whenever there is uncertainty or the patient is not happy with the guidance followed GPs also act as patients advocate and contact the local CCGs to see if there is another way of helping the patient. I think as an AME if the pilot hits a barrier or a wall during their medical and wonders if there is another way, there is no reason not to communicate with the CAA. I am not saying we will always find a way but there is no harm in asking. So form regulatory point of view there may be times where I cannot see a way forward but if it seems like a grey area why not ask to see if there is a sensible solution that will allow the pilot to progress. I never felt this interfered with the Pilot/AME or Patient/Doctor relationship. Again, I am happy to hear otherwise.
Overall, that is the way I try to treat pilots. Not just an assessment of are you fit to fly but also bit of health advice if appropriate, e.g. it would do you a world of good if you can stop smoking or your BMI is not 35 so UK CAA obesity guidance does not apply but losing some weight will help your overall health. As a gentlemen (apologies to ladies) do self examine regularly. Have you thought about asking for a PSA test? For ladies (again I do not mean to be inappropriate) are your smears up to date, if not I definitely recommend going for them. Easy for me to say go for it as a man and as men we cannot imagine the discomfort of having one done but the screening programme saves lives for sure.
Looking at flow charts together and discussing them should not be an issue. And we can do hypothetical situations and take a flow chart and try to work through it together. I think it would be interesting. We do not need to use any real cases here. I hope Admins do not mind me saying this but there is another forum where I share information about medicals and what goes on in them and why we do certain things. I appreciate this may seem like advertising but I write them out of my own enthusiasm and with the hope that other people enjoy reading them too. Happy to share links etc if deemed appropriate or can share links with individuals if interested and if this is more acceptable with the forum rules.
Thanks again for your comments, I have enjoyed reading them and I will reflect on them.
’ We’d also love you to get involved in the forums. Why not visit the Hangar Talk forum and introduce yourself? ’
Got the line off my email confirmation upon registration and am a tad lost what is expected exactly?
My name is Michael, or Micha, 47, Pilot, now only private but former airline transport, now flying mostly FAA LSA aircraft.
Welcome to EuroGA, MichaLSA
That line is in the automated welcome email which has been there since we started 10 years ago, and you are one of the very few people to actually do this
Well, semi-automated, because with around 30% of signups being malicious, there is a manual approval step.
Peter wrote:
around 30% of signups being malicious
I must be very unworldly but why sign up to something like this forum with malicious intent? What is to be gained? So pleased you are working very well to stop them, it must take quite some effort.
