donnak

Maybe this is the wrong forum but I have a question. Everyone is talking about the self-report aspect of this industry and I get that. And this isn't a question about whether psychological exams should be required. But in the case where a doctor has deemed a pilot unfit for duty (for whatever reason), is there not a requirement to report that to the patient's employer? I am told that if a doctor is aware that someone drives a commercial vehicle and they find they are not fit to drive, they must report it to the state Motor Vehicle Department. If that is true, why does not the same hold true for pilots?

points_maniac

Not in Germany. The co-pilot went to doctors unrelated to the airline and they are bound by the doctor-patient privilege. He may not have even told them his profession, he could have claimed he is an office worker.

donnak

I see. I know the doctor was not related to the airline, the more precise question is this. If the doctor knew he was a pilot and found him unfit for work, does that doctor have an obligation to notify the aviation authorities?

Randyk47

No.

jphripjah

I hope the answer to his is no -- in Germany, the US, anywhere. What's next, should doctors contravene the physician-patient privilege and report health issues to the employers of other patients who could kill people on the job, like air traffic controllers, school bus drivers, nurses, police officers, surgeons, truckers, nuclear power plant workers, train conductors, taxi drivers, construction workers, etc.?

satman40

My Internist can not tell my wife about any medication, or any related medical conversation, without my permission,

Jack M. Rice

It's the duty, ethical and often legal, of a practitioner to report any patient, not just a pilot, who he or she reasonably believes will physically harm others. Patient confidentiality is always trumped when the danger becomes public, i.e. beyond the practitioner/patient.

Yes, that includes, pilots, police, fire, emt, etc. etc. Of course the belief must be specific and related to the nature of the job or domestic situation. it's a judgment call which I think practitioners are capable of making, and I don't think it happens so much as to make it impractical or excessive.

invisible

That will change for sure.

CDTraveler

Some U.S. states have very detailed regulations on what type of medical problems doctors should report to the state authorities issuing driver's licenses and what conditions can cause a license to be revoked or suspended. For example, a person with uncontrolled diabetes and episodes of hypoglycemia should be reported, as should someone with a degenerative neuromuscular disease likely to impede their ability to control a car.

I would not suggest that doctors start reporting problems to employers; making a determination of fitness to perform is not the role of the employer. But doesn't the public deserve some type of protection when an individual is diagnosed with a physical or mental condition which renders them unfit to drive a car or fly a plane?


FWIW I lost a good friend on Silk Air Flt. 185, which was suspected of being a case of pilot suicide, so you might say I'm kind of biased on this question.

Boggie Dog

But isn't it true that doctors are required to report physical abuse, especially against children, to police?

Randyk47

But that's a law at the state level that requires the reporting not a Federal law and the reporting requirements vary from state to state. Maybe it's coming as a surprise to some that doctors aren't required to report on pilots but then again if a pilot is deliberately going "out of system" to get treated with the intent to hide the treatment or illness how is the doctor supposed to know what the patient's profession? I can tell my doctor I'm a whatever and they'd know no difference. Now other than a few commentators on TV and the discussion here I can't say I've heard of a huge ground swell of public outrage and demand for closing the reporting loophole.

RandomNobody

Although it's different for Germany, in the US, to get a medical certification for all 3 classes (3, 2, and 1), you give the FAA Aeromedical Branch permission and proxy to gather any and all medical info on you every time you go to your local Aviation Medical Examiner to get re-examined.

They do regular audit sweeps, and regularly catch people who haven't disclosed stuff on their applications/Exams.

Mats

No.

The only exception would be if a patient expresses clear homicidal or suicidal intent, specifically stating a plan, intent, and means. Even then, it would require collaboration and legal clearance to disclose anything to an employer.

Most actively suicidal patients keep their cards close to their chests, and would not disclose an escalating risk for violence.

MSPeconomist

If you're paying yourself rather than using employer provided insurance, is it possible to see a doctor under a false name? If you have a prescription, do you also need a photo ID for psychiatric medications? For other drugs that would be forbidden for pilots (and which would supposedly be checked for in blood and urine during the pilot's mandated periodic exam by the official aviation doctor)?

In the past, it was at least an urban legend that people with HIV/AIDS were being tested and treated anonymously.

Mats

Although some medical practices ask for a photo ID, most do not.

So if you are a self-pay patient, it would be hard to get caught if you used a pseudonym. I worked in multiple free clinics and sexual health clinics where many patients used pseudonyms.

It is both common and legal to test for HIV and other sexually-transmitted diseases anonymously. At a clinic here in Israel, they never ask for a patient's name, and they actually require a pseudonym.

Things change if a patient has a positive result. Gonorrhea, syphilis, and HIV fall under mandatory reporting laws in the USA (only HIV in Israel, and Chlamydia is reportable by some local health departments in the US.)

So if a patient tests positive, I am required by law to tell the government. But they do not get any information about where that patient works, and they do not know if he or she is a pilot. There would be no way for the FAA or any employer to find out.

And it shouldn't matter. Unless a patient had the rare occurrence of neurosyphilis, or if he or she developed cognitive deficits from HIV, there would be no reason to restrict someone from flying.

One does not ordinarily need identification to purchase prescription medication. The exception might be if you were using a credit card, or certain pharmacies or states who might require identification for tightly-controlled medications, the so-called "Schedule II" drugs. Antidepressants are not "scheduled" drugs, and would not be subject to such laws.

The drug tests used for pilots do not screen for ALL drugs, just drugs of abuse. So one can take antidepressants or antiretrovirals, and it would not show up on an FAA drug screen.

About a decade ago, I remember seeing a patient for a DOT medical exam. He had HIV, and I remember wondering what I was supposed to do with the paperwork. I was able to set it up so that the employer only got the section saying that he had an unrestricted license. The rest remained strictly confidential.