AircraftOwner Online

    I was shocked to hear that I was only one of two physicians in the small community of Jackson Hole that admit their own patients to the hospital. The other doctors admit to the “hospitalist” which means the patient is taken care of by someone they probably have never met and that person changes every day.

    Now why is that important in an aviation medicine article? The biggest problem is these dedicated “in hospital” physicians have no vested interest in your privileges to fly. Plus, once you are discharged, you are no longer their problem.

    Since the hospitalist never knows your detailed history, they also order more testing and imaging studies than you probably need. The problem with more tests is the risk of false positives which are frequent.

    So let’s say you have pneumonia with some chest pain—not an uncommon associated symptom. The hospitalist, in the name of being complete (and liability, and easy, and produces money for their hospital employer), orders an echocardiogram. They echo comes back with a “hypodynamic wall motion” abnormality which is not an uncommon finding in normal folks but “could” mean a cardiac problem.

    When you go for your next FAA medical and report the echo results, regardless of whether you are a competitive 30 year athletic or a 70 year old smoker, you are going to have to show the FAA you do not have a heart problem which will involve more testing. And the cycle goes on. Trying to unravel false positive results can be an expensive and time consuming proposition.

    Although physicians will imply that you do not, you do have a choice. You can refuse testing. You can ask for a second opinion. You can call your primary care doctor. You can call your Aviation Medical Examiner (AME).

    Over diagnosis and over prescribing is rampant in profit driven medicine. Aside from the inherent problems with this medical culture, it can wreck havoc with your medical certificate. It is not unusual to have pilots come in on high blood pressure medications only to find that their blood pressure was high normal and the doctor “just wanted to make sure it did not go higher.” There is no data to show this is appropriate medical care and will force you to provide information to the FAA to show you are OK!

    Sometimes, even explaining why a person had a specific test can be problematic. A classic scenario is the person who has stomach problems that gets a cardiac cauterization to “prove” it is not a heart problem. Then you get into explaining to the FAA the abdominal pain which was stated as “chest” pain in the medical record to justify the cauterization to the insurance company.

    Modern medicine can be a valuable tool in preserving health and prolonging life. It also can cause side effects and premature death with unnecessary treatments. Being a discerning user of the health care system is extremely important. Asking the question “why?” and “what are the options” and “what if I do nothing?” will produce valuable information. If a doctor ever refuses to answer those questions, change doctors.

    The more informed you are, the better but beware of where you get your information. The Internet has lots of information and much of it is tainted by the pharmaceutical industry and other vested interest. Just because it is on line, do not trust it as fact.

    To pilots, our medical certificates are very close to our heart and soul. Obviously our health is primary but there is no reason not to consider both when making health care decisions.