Five reasons why it’s called a medical—but isn’t.

Many pilots believe that their aviation medical is, as the name suggests, akin to an actual medical. Let me disavow you of that notion, for although both use the same word they are markedly different.

In The Phaedrus, Plato reports a dialogue between the titular character and Socrates. One line states, Things are not always as they seem, the first appearance deceives many.” And my topic today is self-deception, how many pilots believe that their aviation medical is, as the name suggests, akin to an actual medical. Let me disavow you of that notion, for although both use the same word they are markedly different. A regular medical is focused on maximizing your health and longevity, identifying emerging problems and nipping them in the bud. An FAA exam, on the other hand, compares you to a regulatory standard. “Don’t trust everything you see or hear – even salt looks like sugar” (Maryum Ahsam).

And the purpose of drawing this to your attention? Simple really – please consider ensuring that evaluations of your health, and not just the AME visits, are a regular part of your life. This message is largely aimed at the men out there; we certainly constitute the majority of pilots, but women are much better at looking after their health prospectively – so ladies, please encourage the men in your life to follow this mantra, because I am sure you already do.

Let’s look at some examples where the two divaricate.

  1. The biggest threat to a healthy and long life is obesity, which is at catastrophic levels in America. I recently flew from Iceland back to the Midwest and the only obese people I saw at the Reykjavik airport were Americans – three of them airline pilots. Landing in the Midwest? I was surrounded. Obesity has been covered extensively in AOPA Pilot magazine, in this communique, and in the general press, but as a refresher it considerably shortens life expectancy and increases risk for diabetes, cardiovascular, musculoskeletal, and many other diseases. Your personal doctor would counsel you to lose weight, having evaluated what problems were already present and which were around the corner. A diet and exercise program would be suggested and a monitoring regime instituted. Your AME will check for diabetes and possibly signs of sleep apnea. He or she may make some disapproving noises. That’s it. I know it’s a heavy topic, but please weigh your options and consider taking action. Now.


  2. An FAA eye exam ascertains if you can read the chart to the standard required, whether your pupils dilate and constrict appropriately, a quick visual field test, and a brief retinal inspection. A full eye exam that might detect early glaucoma, macular degeneration, and signs of other diseases such as tumors, would include pressure testing, retinal photography, and a detailed ophthalmology review. Can you see the difference?


  3. An FAA ear exam consists of a quick peek with an auroscope and ascertaining if you can hear whispered comments. A full ear inspection includes full auditory range testing and tympanic membrane (ear drum) function that might deteriorate with age and cause troublesome symptoms, but is potentially fixable. Additionally, as balance is in part mediated through the ear, a dedicated exam might look for early signs of impaired static (standing) or dynamic (walking) balance. This can be critical for an aviator. Am I coming through loud and clear?


  4. Hidden diseases are, by definition.....not obvious. Things like asymptomatic heart disease, lurking aneurysms, and colon, throat, or thyroid cancers. In most GA singles, the gear are “down and welded” so nowhere on a Cessna 172 checklist are you asked to look for “three greens.” Nowhere on an FAA medical checklist is the AME advised to exclude occult problems. But they can kill you just the same. Maybe the parallel here is that you are looking to pilot a Cessna Citation with a 172 checklist. In this analogy, you are the Citation and I presume you want a smooth flight.


  5. For every case of carotid artery disease picked up by an astute AME – and there are many of them, my own included – there are countless airmen inappropriately feeling reassured because they have that piece of paper. We can do better than that! There were those who felt that BasicMed would lead to a reduction in the health of the pilot community, but I see this as a golden opportunity to remind pilots that they self-certify their health every time they act as PIC. Additionally, maybe it will help create some separation in thinking. BasicMed or an AME exam is a tick box to keep flying; a proper regime of medical checkups is a tick box to keep living.


So, continuing the literary thread, I will finish with a quote from Henrik Ibsen, the nineteenth-century Norwegian playwright: “A thousand words will not leave so deep an impression as one deed.” So ignore my 800 or so words and schedule a medical to look at your health. That way, you will guarantee more time in that wonderful left seat we all cherish. Fly well!

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.

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