AOPA Pilot Magazine - February 2021 - 24

FLIGHT MD

I wish I had not said that

BY DR. BRENT BLUE

And other nonflying pilot errors
" I HAD A HEART ATTACK " is what the pilot put on his

DR. BRENT BLUE is an
ATP with more than
9,000 flight hours,
and a senior aviation
medical examiner.
He helps members
through the AOPA
Pilot Protection
Services program.
aopa.org/pps

online FAA Form 8500 medical certificate application.
I asked him to tell me about it.
" Well, I had chest pain, " he said. " They had me all
wired up and did a lot of tests and let me go. "
" Wait a minute, " I said. " You mean they discharged
you from the emergency room that same day? "
" Yes, and just told me to follow up with my primary
care doctor if it happened again. " This pilot has unnecessarily entered the FAA medical certification " hurt
locker. " He did not have a myocardial infarction, commonly known as a heart attack, which is an obstruction
of an artery that supplies blood to the heart tissue itself.
He would have been admitted to the hospital and had
tests and medical interventions to reduce the severity,
and prevent recurrence. This would take a couple of
days to a couple of weeks if he required bypass surgery.
The problem for the pilot and me was to prove to the
FAA that the pilot did not have a myocardial infarction.
What he had was chest pain, and tests in the emergency room that ruled out a heart attack. Chest pain
lands people in the emergency room for multiple reasons, including indigestion, strained chest wall muscles,
or inflammation of the lining of the internal chest wall.
These noncardiac issues do not disqualify a pilot from
receiving a standard medical certificate.
To provide information for the computer file to be
sent to the FAA, I must request and review medical
records from the emergency room. If the record shows
another reason for the chest pain, I can document the
findings and the problem might end there. However,
the FAA may decide it wants to see the record and the
agency will be less forgiving. For instance, if the emergency room physician states in his dictation that the
pilot has some " skipped heartbeats " in the past, even
though these are common in normal individuals, the
FAA may require additional testing.
In the old paper system, the 8500 form was filled
out in the aviation medical examiner's (AME) office, so
the pilot could ask the AME how to answer questions
on the form. Since pilots now fill out the form online,
if they have a question, they should call their AME for
advice before submitting the form. The FAA does not
want to review records that do not fall into special issuance categories any more than the pilot wants to send
them. A simple phone call to an AME or to AOPA's Pilot
Protection Services can prevent these problems.

24 | AOPA PILOT February 2021

Misdiagnosis or assumed diagnosis by a physician
also can create problems with the FAA. I was diagnosed with rheumatic fever when I was 5 years old. It
was 20 years later when I was in medical school that
I realized that I never had it. When I asked my pediatrician about it, he said " close enough, " because he did
not know what else to call it. Since rheumatic fever may
have cardiac implications and affect insurance rates, I
worked months to have my medical record corrected.
Many times, physicians will not realize the implications of a casual diagnosis. Physicians may put a patient
on an antidepressant when they are going through a life
trauma such as a divorce; being put on one can have devastating effects on a pilot's medical certification. Once
placed on an antidepressant medication, even if it was
discontinued, the pilot may have to prove he or she does
not have depression nor need medication.
In the nonmedical world, a bad headache is often
called a migraine. However, in the medical world,
migraine is a syndrome that includes headache but also
may have visual and neurological symptoms. If a pilot
puts " migraine " on the 8500 form, this will require documentation to determine if it is true migraine syndrome
or just an occasional bad headache.
I am a proponent of pilots getting a BasicMed signoff
if qualified and appropriate for their type of flying.
However, the pilot must understand the important distinctions between BasicMed and the third class medical.
If the pilot fills out the 8500 form online, it does not go
anywhere until the submission number is given to the
AME. If there are any questions about data on the 8500
form, ask your AME before you give your number. Once
the AME has the number, the 8500 history page must be
sent to the FAA whether or not you complete the exam.
If there is a problem on the 8500 form, whether or not
you complete the AME physical exam, the FAA may
deny your FAA medical-which would make you ineligible for BasicMed or sport pilot privileges. The pilot
certainly can fill out both the BasicMed form and the
8500 form prior to going to the AME's office. Once he
discusses any issues with the AME, the pilot can decide
which way to proceed, but only before the submission
number is given to the AME. If the 8500 form online is
not entered into the system by the AME, it is deleted
after 60 days without being sent anywhere.
AOPA
EMAIL brentblue@wyoming.com


http://www.aopa.org/pps

AOPA Pilot Magazine - February 2021

Table of Contents for the Digital Edition of AOPA Pilot Magazine - February 2021

Contents
AOPA Pilot Magazine - February 2021 - Intro
AOPA Pilot Magazine - February 2021 - Cover1
AOPA Pilot Magazine - February 2021 - Cover2
AOPA Pilot Magazine - February 2021 - Contents
AOPA Pilot Magazine - February 2021 - 2
AOPA Pilot Magazine - February 2021 - 3
AOPA Pilot Magazine - February 2021 - 4
AOPA Pilot Magazine - February 2021 - 5
AOPA Pilot Magazine - February 2021 - 6
AOPA Pilot Magazine - February 2021 - 7
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AOPA Pilot Magazine - February 2021 - Cover3
AOPA Pilot Magazine - February 2021 - Cover4
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