Basically Bad

Rear cockpit.

25
BasicMed is a great program, but like any option it has its pros and cons. One of its strongest advantages is it allows the pilot much greater leeway selecting the physician they want to work with.

Last month this column was full of low-skill derring-do; this month I’m back with another blood pressure raising potboiler, this time more of the bureaucratic bent.

My precious memory got things started by letting my BasicMed lapse, if only by two or three weeks. We had a Young Eagles rally coming up at my local airport, and while reviewing my paperwork as requested by the Supreme Eagle, I had that funny feeling it had been a long time since I had taken that online refresher. And yes, a close look at the paper revealed it had been a while and I needed the blessing of a medico, pronto.

Naturally this was Thursday night and the Young Eagle rally was Saturday. That left one day—Friday—to get close with the medical profession. I needed to impress my family doc’s stethoscope and tongue depressor, not so easy to do as a walk-in on a Friday. But I tried and didn’t impress the receptionist one bit. “You need an appointment.”

Reminding myself that a mistake on my part didn’t constitute an emergency for my doctor, I said thank you and wheeled over to the Urgent Care dugout. We used to have our own hospital in our village, but like the family-owned pharmacy, Ford dealership, bowling alley, movie theater, clothing stores and wonderful family-owned hardware store, the horse pistol is long gone, turned into a druggie’s halfway house. That’s all thanks to the overnight sprouting of 150,000 houses just over the hill by the great land developer machine. Traumatize your bod in my small town these days and you get a long ambulance ride in gridlocked SoCal traffic to the big hospital over the hill. Get bit by a dog—or overlook your medical—and you get Urgent Care.

Turns out the sole Urgent Care in town is staffed by pleasant people, none of whom, alas, is a “state licensed physician.” So, no possibilities there.

Airshow coverage sponsor:

Retreating to the airport intending to talk my hangar partner into flying the Young Eagles and thus not abandoning the Supreme Eagle, it was suggested I go to the big city over the hill and see a certain AME. A brief finger trip on the cellphone revealed said AME had an opening that afternoon, so I took it. Sure, an AME is overkill for a BasicMed check, but at least I wouldn’t have to explain what BasicMed is.

It said in the fine print that I’d receive a confirming email. Never did, so I called four times to listen to the answering machine during office hours. Hmm, do I really have an appointment? No choice but to sit in the afternoon traffic and get to the big city to find out in person. Glad I don’t have a real job anymore and can devote so much time to such things.

“Why yes, you’re on for 3:30 p.m.,” was the answer upon arriving at the chrome-and-glass palace. Ah, some good news. “That’ll be $285.” Geez, life in the big city. Credit card returned to wallet, I got taken to the back for a vitals check, along with reading that ever-shrinking eye chart, looking for the red line through the musical note, reading the numbers in the colorblind dot-fest and all that. “Strip down to your shorts and sit on the exam table. The doctor will be right in.” Some basic exam.

The usual mind-wandering wait and then the door burst open and the doctor was present, all white lab coat, gray hair and clipboard. More erupting than speaking, his clipped, snarling opening was, and I quote, “Umm, yes, I’m Doctor XXXX and what the hell are you doing wasting my time on a Friday afternoon when I could be at home or doing something else instead of a stupid BasicMed?” He certainly has a command presence, I remember thinking while stumbling out why I was in for a quick BasicMed, but he cut me off. “Look, no one comes to me for a BasicMed unless they’ve got something to hide. And you’ve got something to hide and I’m going to find it.”

Are You for Real?

It had already been a long day and was definitely getting longer. I don’t enjoy being called a liar, particularly when it isn’t true, and if I had then fully understood how BasicMed works I would have put on my Levi’s and walked out. But Cub Scout that I am, my focus was upholding my Young Eagles obligation and naively thought by dint of my superior physical state I could push aside doubt and walk out with the coveted signature.

There followed some rapid interrogation regarding why was I there…then the cursory flashlight in the eyeball bit, followed by grilling on why I had gone to my regular physician twice in the last three years as I had noted on the form. Well, if you really have to explain a skin rash, then I guess you do. The other was for a pain that had gone away and an ultrasound that had shown nothing. But to Dr. X that was the sturdy peg to hang his weighty suspicions on. In the meantime he warmed his stethoscope on my back. “Nice and clear,” he mumbled. Then the heartbeat; no comment.

Again he asked why I was there, made another rude comment I won’t repeat here, and in what I thought seemed getting desperate told me to bend over and touch my toes with my fingers. Luckily I had been riding the dirt bike lately and was about as limber as I get anymore (not very), so I managed the task with the slightest of knee bend. Then he told me to squat down like a baseball catcher, then stand up again. At 67 that can be a lot to ask of a guy who’s been sitting at a desk for 40 years, but again the dirt biking did me proud and I made sure to not use my hands or arms at all when standing up. “Get dressed and see me out front.”

Out front he said he was going to hold my paperwork and I was to get a letter from my regular physician—on his letterhead—explaining that bit about the long gone pain. “When you can do that I’ll feel more comfortable about signing you off. Sorry you can’t fly tomorrow.” And I was out the door.

My hangar mate flew my Young Eagles and I was put on the PA system. On Monday I was back at my regular physician’s looking for a letter. No letter was forthcoming without an examination, said the receptionist. “We’ll call you after I talk to the doctor.” About four hours later I received a phone call and was told to get blood drawn for a panel and make an appointment with the doctor when I had that. The next possible date was two weeks out.

And BasicMed is all about making flying easier and less expensive, I mused. Here I am, grounded for at least two weeks if I’m lucky. Counting the driving I’m already $300 lighter and just getting started. Most troubling was the AME’s attitude. It was beyond obvious he had a burr under his blanket about BasicMed. In other remarks not repeated here, regarding how BasicMed had come to be, the doctor made it clear he thought BasicMed was a bad idea but never said why. He also had the bedside manner of a pissed off traffic cop. Certainly a disagreeable personality—which is unfortunately not a breach of the regs but would seem a liability for a doctor in a capitalist society—the AME was exceeding his mandate for a BasicMed exam in his zeal to find something wrong when all evidence was to the contrary.

The two weeks passed, I got the blood work, and after a brief exam my family physician gladly signed another BasicMed form I thought to bring with me, and the episode is behind me. That’s possible because, as I was reminded after the first exam, unlike Class l, ll or lll medical paperwork, BasicMed forms don’t go to the FAA; they stay with the pilot until the Feds want to see them. That’s one check against overzealous physicians—if you run into a stinker you can try again elsewhere.

Lessons Learned

I must say, experiences such as mine are what teach pilots to never mention anything to an examiner, as the punishment for honesty can be vexing. I can also advise avoiding any AME if wanting a BasicMed sign-off, a sentiment other AMEs have since confirmed. An AME represents the FAA during a Class I, II or III check; your physician represents you during a BasicMed exam. There’s a distinction, and some AMEs thus don’t do BasicMed exams. They don’t want to work both sides of the runway as it were. For a pilot there’s no upside in dealing with an AME for BasicMed, just the chance of meeting up with a prick, so don’t do it.

Then there is the whole thing about BasicMed not looking as good to the insurance industry as a Class III medical, but that’s another topic for another time.

In a larger context, the episode reminds of how dangerously close we are of drowning in practically unaccountable officialdom. Any number of administrative law types stand nearly unassailable in getting things done today. Pilots are one step away from a rogue AME, while elsewhere fire marshals, building inspectors, DMV clerks and so on have the power to impede. It’s all for buildings that don’t fall down or explode, pilots that don’t keel over at the stick and all that, which is a heck of a lot better than riding out an earthquake in some third-world paradise where a $100 bribe got the contractor past any inspection. But at some point there needs to be a check on those checking.

Ultimately, maintaining good health is easily the best medical policy. It’s attention-getting to contemplate not flying again, even over a paperwork scare, believe me. It’s also good to review the practicalities of how medicals and BasicMed work and understand your options. Being in a rush doesn’t help either.

25 COMMENTS

  1. I’d be willing to wager a large sum of money that the AME made all sorts of doom and gloom predictions about BasicMed when it first passed into law. Planes would fall out of the sky without his anointed hands to dictate who could and could not fly. I’m sure that with 6+ years of BasicMed and literally zero evidence to support his claim has surely added piss to his vinegar.

  2. My father, a decorated WWII vintage career aviator, stated “you bet your wings every time you go to see the Flight Surgeon…and the best you can do is break even.” As my flying now is strictly personal, I have moved off FAA Medicals and onto BasicMed. My personal physician knows all there is to know about me, shortcomings and all, and feels comfortable signing her name stating she knows of nothing that would impede my ability to pilot an airplane.

    Some AMEs get it and are pro-BasicMed for those who don’t have to have an FAA Medical.

    Given that we have to have a medical of some sort unless you are Sportpilot LSA or glider driving, it just makes good sense to preplan this mission to the Doc as if your flying life depended on it. It sounds like Tom’s “Getmedicalitis” got him on thin ice and he dodged a bullet.

    My BasicMed date is written on the hangar board, right next to my airplane’s annual date. And, OBTW, unlike the FAA Medicals which are good to the end of the month, BasicMed expires four years day for day after your Doc’s date of signature.

  3. Geez, should have just gotten a Class II from Dr. Prick; probably would have cost the same.
    And WTH were you thinking getting a mystery pain; The ‘good’ Dr. probably contacted the FBI to alert them about your situation.
    🙂

  4. All of that and more are the reasons I went sport pilot rather than private. That said, I set reminders for myself to prevent expiration of drivers license, passport, professional licenses and so on.

  5. All of these rants, I mean issues, have nothing to do with BasicMed and all to do with leaving it all for the last minute.

    • My thought exactly. Not that I’m unsympathetic, especially regarding the AME, but it’s basic– don’t let these dates pass you by.

  6. Basic MED is more time consuming more expensive; so unless you don’t have an AME close (for Class 3 med) then I would never do a Basic MED.

    • I have had a type of reactive arthritis since 1992. It was disclosed to the FAA at the time and was referenced on every Class II physical I had after that. Suddenly, in 2016, my condition became a major concern for a desk jockey in Oklahoma City despite the fact that my AME had signed me off.. A letter from the FAA Medical boss indicated that I was not eligible for a regular medical, but if I provided a bunch of extra paperwork from a series of doctors, I might qualify for a special issuance (SI) medical. Once the SI was issued, I was required to return to my AME annually, provide bloodwork and submit a detailed report from my rheumatologist to keep my FAA medical (now a Class III). That was a LOT more expensive and time consuming than getting Basic Med coverage that only requires a doctor visit once in 4 years (covered under my insurance as my annual physical at no cost to me). Yeah, I have to run through an online checklist at the end of 2 years, but the cost and time commitment are WAY less than what the FAA required for a Class III Physical. I’m just flying for pleasure now, so there is no downside to having Basic Med, and a LOT of upsides. There is absolutely no reason to deal with the FAA on medical issues again for me!

    • Simply not true. I get my basicmed done by my personal family physician when I do my yearly checkup, and she doesn’t charge me any extra. You shouldn’t make a blanket statement about like that.
      If you prefer going to an AME for a Class 3 have at it. Don’t criticize things you are not familiar with.

  7. Please file a complaint with the FAA. If this happened to me, I would also be sure to tell every local pilot I know about what happened to prevent anyone else from going through something similar. Drs like that should have their AME credentials revoked.

  8. Basic Med is a Failure as the evidence has proved a Class 3 Medical provides no safety to the public nor private pilot. Only a Drivers License Medical should be required for a Private Pilot License.

    • I agree, light sport pilots have done it for many years now. we’ve had Basic Med for years now, and still the leading cause of accidents is still pilot error.

    • Basic Med is a Failure?

      It was for me but that’s because for the longest time I couldn’t find a doctor that was willing to sign their name on a FAA government form stating that I’m safe to fly.

      Seriously, why would anyone with little knowledge of flying sign up for that liability? For me the basic medical questions and the whole process still seems excessive… Sans digital exam of my prostate?

      However, saying Basic Med is a failure is dismissive of the roughly 200,000 pilots who fly safely under Basic Med.

      My thinking is we should go back to the paper pilots license combined with a valid driver’s license. Now that the data is in this seemingly should satisfy a third class medical without all the hassle. Toss in two hours of ANNUAL FAA medical based continuing education for those of us over 65 and I’m guessing the statistics wil continue to indicate safety is not compromised… If you can figure out a government website you more than likely can fly a plane… Right?

      PS My optometrist says my vision is correctable to 20/20 but my flight surgeon’s eye chart says I’m borderline every time. I’m scolded to get a good night’s sleep, drink lots of water and avoid caffeine before my exam which surprisingly helps. Also some how in all my training I missed that a 3rd Class Medical doesn’t require 20/20 correctable vision… I’m glad that I’m still able to learn after all of these years!

  9. “Ultimately, maintaining good health is easily the best medical policy.”. That, and don’t get old. Aviation insurance for example, becomes near impossible to obtain once you reach a certain age, even if you’re healthy and still feel like a kid that wants to play with his flying toys. It’s as if you’re suddenly decrepit and incapable of flying safely. Never mind that you can drive an SUV at highway speeds while someone comes at you from the opposite direction while he’s busy texting or on the phone and passes you within a few feet.
    Your treatment by that doctor was terrible. He was quite rude and disrespectful and expensive!. Having a Basic Med doesn’t make you less qualified to aviate than having a class medical.

  10. When I moved from northern Virginia (Primary Care Physician handling BasicMed) to northern Georgia (new, large multi-discipline physician group), my PCP didn’t feel comfortable signing anything associated with the FAA. Luckily I found a nice, low key AME. When I explained why I called on him instead of my PCP, he just nodded and we went ahead with things. No hoorah.

  11. Basic med isn’t designed to make it easy to get a complicated medical, it’s only for those that go through in flying colors.
    For us others there is lsa.

  12. Tom
    Your experience mirrors my own in dealing with bureaucracy here in Oz.
    About the time I turned 60 I had an unexpected medical issue present requiring diagnosis and appropriate treatment. This I received promptly from my local Dr, a friend of 20 years. He also referred me to a specialist who confirmed his judgement. Both Drs assured me of my safety to fly, in response to specific questions from me regarding that issue.
    A few weeks later I had to go for my biannual medical, as required by CASA to maintain my private pilots license. The DAME who I consulted assured me I was fit to fly. I was happy. Then the paperwork hit CASA and some officious prat deep withing CASA wrote to me grounding me until i was off medications or at least to a very minute level.
    It took 3 letters to get a direct answer as to what the concern was for CASA. When I finally did receive the explanation it was self evident it was not a cause for grounding. By this time I was able to jump thorough the hoops required to comply and thus regain my medical certificate. However it was for 1 year only and that meant that 12 months later i had to go through the whole fiasco again. You guessed it, they gave me a one year medical again. This is not an inexpensive affair as you note and I have heard many similar stories of others, both here and in the USA. Given that I’ve been a very active outdoors person all my life I am far fitter than the average person my age, if a bit battle scarred form a very physical lifestyle. I am back to 2 year medicals now but it all taught me some expensive lessons. The biggest are that the bureaucrats are more interested in bureaucracy and avoiding issues than solutions or an individual’s welfare and while you should never lie to a Dr you should be very careful how much truth you pass onto people who don’t care about you and who have the power to ruin your career or pursuits.
    The bigger issue however is one for the regulators, be that the FAA or CASA. When bureaucrats are so bloody minded (as these instances show) it builds a huge barrier between the regulator and the aviation community. This works against improved safety outcomes.
    We should be working together for mutually beneficial safety outcomes.

  13. Your experiences with Basic Med and AME’s pretty much mirrors what I’ve seen out in the field. AME’s resent basic med since it costs them money from lost applicants. The only challenge I’ve run into is finding a doctor to do the basic med exam. My last one was with a chiropractor who did DOT physicals for truck drivers, but also basic med exams. His license is legal to do those exams in my state. I love the 4 year time frame for basic med.

  14. I feel you Tom.
    I have a bi-annual check-up with my cardiologist and no big deal. In the past he supplies a Fit To Fly Letter I use for my Basic Med
    Exam with my PCP. This time he says I haven’t had a Nuclear Stress test in 3 years so he orders one. I have the test and he calls me himself the nest day and says it’s not clear enough to determine if I have any issues. ( I did the treadmill for the required time, etc. for my age (83) and had no problem completing. So now he wants me to have a PET Scan/CT and the earliest available is the day after I’m scheduled to depart to volunteer for OSH. I put my name on a cancellation list but no joy so far, so I rescheduled for the week after I return. So much for treating patients like more than a revenue source. And don’t get me started about the VA.

  15. I am a licensed physician and was the director of a residency training program (the way physicians become specialists) for twenty years. One of the primary competencies that all physician trainees must demonstrate is “professionalism”. The physician you saw was about as unprofessional as humanly possible. If one of my trainees did such a thing, there would have been trouble. I am appalled by what you described.

  16. Tom, I love your articles about airplanes and flying. This one, not so much. I’m certainly sympathetic to your bad experience with someone who should have brought more professionalism to the interaction. It sounds awful and I’m truly sorry it happened. BUT…

    Blaming “unaccountable officialdom” for the outcome of your lack of attention and planning; it’s classic. You even throw in the obligatory “DMV clerks.” Almost a parody. When do you start shaking your fists at clouds and screaming at kids to get off your lawn? 😉

    “But at some point there needs to be a check on those checking.” Well, to use your phrase “in a larger context,” that check is called BasicMed, which exists in part to give you options beyond going to an AME.

    To repeat, I am very sympathetic to the frustration arising from your awful treatment by a supposed professional. It should have never happened…for a lot of reasons.

  17. Basic Med was a godsend when you have a special issuance. Much cheaper tgan annual renewal via the FAA. Since retiring I get an annual physical anyway so my basic med gets renewed annually. One question from
    my doc is, “what does examining the seventh planet from the sun (Uranus) have to do with flying?” Answer, its a key indicator of a difficult landing or recent dealings with the FAA. Basic med is a stepping stone of ( hopefully) expanding the LSA allowances.

  18. I had never had medical problems, Class III passed easily, but then had a melanoma, completely excused with negative sentinel nodes. AOPA said Basic Med was the way to go. But no one would do one. Primary care physician, who is excellent,would not, something about liability. Several AME wouldn’t, said their insurance carrier wouldn’t allow. Urgent care,nope. Other primary care, nope. Finally found an AME a hundred miles away who would do Basic Med, no guff, no problems. But that is not the way it should be

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