Flight md: I wish I had not said that

“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.

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.

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