BASIC MED QUESTION

[Hank]

13 minutes ago, ilovecornfields said:

Brilliant rebuttal of the points I made. Thanks for contributing. I guess I was the only one making assumptions on this thread. Or maybe just the only one being explicit about it.

You were certainly the only poster attacking others rather than rebutting their points. It's called a Straw Man Argument, Google it. It's under Logical Fallacies, and is not a way to win arguments, discussions or friends. 

[carusoam]

Has anyone had their cognitive abilities tested to demonstrate ability to fly or drive... without actually flying or driving?

There are plenty of cog tests... once you pass them all.... you still get invited to demonstrate that you can put it all together on the road.... and in the sky.

I would assUme... 

PP thoughts only, not a cognitive therapist....

Best regards,

-a-

[ilovecornfields]

1 hour ago, carusoam said:

Has anyone had their cognitive abilities tested to demonstrate ability to fly or drive... without actually flying or driving?

There are plenty of cog tests... once you pass them all.... you still get invited to demonstrate that you can put it all together on the road.... and in the sky.

I would assUme... 

PP thoughts only, not a cognitive therapist....

Best regards,

-a-

Having at one time possessed the necessary skill and abilities to do something and currently possessing those abilities are two different issues.

The original issue presented in this thread was the (in)appropriateness of a physician with whom you have no previously established relationship asking you to take a cognitive test prior to certifying that you have no known deficiency which would interfere with safety of flight. 
I’ve met plenty of people (and we all have) who at one time we’re excellent drivers and now lack the faculties to safely drive a car.

Safely piloting an airplane is a nontrivial action and can require substantial cognitive demands. If I sign a 70 year old off on basicmed and next month he crashes his plane into a school because of fuel starvation and the NTSB investigator finds the fuel selector set to the empty left tank instead of the full right tank would I expect some questioning into how I arrived at my conclusion? Absolutely! It’s disingenuous to suggest otherwise.

I gave a physician’s perspective (my own) on why some might be hesitant to sign off basicmed for someone with whom they have no previous established relationship. I also mentioned my PCP had no problem doing it. I’m sorry people didn’t like my answer but I don’t see how the self-declared “experts” here are providing and useful information.
 

But I guess potty humor will always prevail.

Edited May 22, 2021 by ilovecornfields

[kmyfm20s]

For all of us that don’t know the big words. Traits of a Narcissist, copied and pasted.

• People with NPD expect to get special treatment.
• They exaggerate their own smarts, success, power, and looks. 
• The lack of empathy leads them to take advantage of people, with no regrets. 
• Narcissists may be extremely jealous and ultra-sensitive. 
• Because they tend to be very thin-skinned, they may angrily lash out at any criticism or push-back.
• Narcissists also may lash out when they feel like they’re not getting special treatment. 
• Underneath all of these traits is a deep sense of insecurity. 
• And — no big surprise, when you consider all these traits — narcissists may find it super-difficult to have healthy relationships, and have loads of trouble at work or school

[carusoam]

56 minutes ago, ilovecornfields said:

Having at one time possessed the necessary skill and abilities to do something and currently possessing those abilities are two different issues.

The original issue presented in this thread was the (in)appropriateness of a physician with whom you have no previously established relationship asking you to take a cognitive test prior to certifying that you have no known deficiency which would interfere with safety of flight. 
I’ve met plenty of people (and we all have) who at one time we’re excellent drivers and now lack the faculties to safely drive a car.

Safely piloting an airplane is a nontrivial action and can require substantial cognitive demands. If I sign a 70 year old off on basicmed and next month he crashes his plane into a school because of fuel starvation and the NTSB investigator finds the fuel selector set to the empty left tank instead of the full right tank would I expect some questioning into how I arrived at my conclusion? Absolutely! It’s disingenuous to suggest otherwise.

I gave a physician’s perspective (my own) on why some might be hesitant to sign off basicmed for someone with whom they have no previous established relationship. I also mentioned my PCP had no problem doing it. I’m sorry people didn’t like my answer but I don’t see how the self-declared “experts” here are providing and useful information.
 

But I guess potty humor will always prevail.

So... my question is related to the initial post...

Somebody asked him to take a cog test...

I have never heard anyone specifically getting tested for this... in aviation...

And we often discuss flying octogenarians... hoping to be flying nonagenarians...

 

I have worked with many non-pilots that have gone through this... with the goal of a road test... to prove they are safe to drive.

Our cog test for aviation comes in the form of a BFR... demonstrating cog skills and physical skills...

 

 

I went with assume, mostly because I didn’t want to discuss how much I know about the subject... and where that knowledge comes from... I have had the honor of working with people that are in the recovery mode... unlike getting older where things may be declining...

Best regards,

-a-

[ilovecornfields]

@carusoam, I think the issue is a little more complicated than what you stated. Yes, a BFR is required to act as PIC, but so is a medical (or basicmed). If they accomplished the same thing they wouldn’t both be required.
 

Flying with someone for an hour and spending an hour on the ground talking about cloud clearance requirements and what not isn’t the most demanding cognitive task. Most of the BFRs and IPCs that I’ve done over the last 30 years have been nothing compared to flying hard IMC at night in bad weather at the end of a long day. Being able to safely do one doesn’t necessarily mean you can safely do the other (as the accident statistics show).

When I was doing geriatric medicine I had a 90 year old anesthesiologist as a patient that was still “passing gas” and sharp as a tack so I understand that age alone is not the sole indication of cognitive ability. I can name at least one person on the board (but I won’t) who I’ve met in person, is a couple of decades older than I am, and way sharper than I am so I agree that age isn’t the only factor

I’ve also seen some 60 year olds with significant cognitive decline and, unfortunately, many were affected in such a way that they had poor insight into their impairment. I don’t think it’s inaccurate to say that after a certain age, on average, cognitive ability seems to decline. I understand it’s not the most popular thing to say, but it happens to be true. A physician assessing an older patient for cognitive ability using a standard test like the MOCA isn’t being unreasonable, just taking his responsibility seriously. If you can’t do well on that test, you probably shouldn’t be flying. It’s not a very challenging test and if you’re afraid to take it then you really should take a moment to consider how objective you are being in evaluating your fitness to act as PIC.

My wife competed a fellowship and is board certified in geriatric psychiatry and although I know much less about the subject than she does, this is a field in which I know something about and we discuss regularly. I know it will offend some people, but I probably know more about it than the average person who’s spent a few hours “researching this on the internet.” Some will still argue that despite this my opinion isn’t any more valid than anyone else’s but the rest will demonstrate some degree of common sense. 

With respect to @kmyfm20s comments I would humbly suggest that he consider reading “The Death of Expertise” as the author specifically addresses his concerns. Hopefully he will sleep better at night knowing that I own a paper copy of the DSM-V and am quite familiar with the contents. 

[skykrawler]

On 5/18/2021 at 9:19 PM, thomas1142 said:

What?????
 

I just “renewed” mine. All that was required was for me to complete two pages of the four page (two you fill out, and two the doc fills out) form found on the web. Met with the doc, he completed his two pages, did and quick exam, I paid my fee and walked out with the form, all four pages.
Completed the slide presentation on line, and took the quiz at the end. Hit the submit button, followed the instructions, and now I good for another four years before I need to go to the doc.

Is it not true one must complete the online training every two years?

[Hank]

1 hour ago, skykrawler said:

Is it not true one must complete the online training every two years?

Yes. Online training every two years, doctor visit every four years.

[midlifeflyer]

18 hours ago, ilovecornfields said:

So, you’re suggesting physicians shouldn’t be concerned about liability in an area they know nothing about or that every physician who has a patient who wants basicmed filled out should spend hours becoming an expert in the field (without compensation) just so they can accurately assess the risks and benefits and fill out that form for you because you’re that special.

I’m assuming you’re suggesting that all the AMEs that refuse to do basicmed also “know nothing” about aviation medicine and liability. Compared to, for example, yourself, who is apparently an expert in both?

Seems a little narcissistic to me, but then I really shouldn’t comment because that’s not my specialty.

That's a lot of assuming.

[ilovecornfields]

20 hours ago, midlifeflyer said:

A BasicMed doctor is not saying the pilot is safe to fly. The BasicMed doctor is saying she is "not aware of any medical condition that, as presently treated, could interfere with the individual's ability to safely operate an aircraft."

So, yeah, I'd say it would be a stretch to associate the usual non-medical "pilot error" with the medical exam enough to the point if even asking questions.  Maybe if it were one of the extremely few medical-related accidents and it was a condition the doc should have uncovered in the exam, it wouldn't be a "stretch," just very difficult.

The common "ok to return to work" note after an injury or illness probably  carries greater exposure. That doesn't mean some physicians  aren't worried about even remote liability in an area they know nothing about. 

Well, then please correct my assumptions. Why do you think so many AMEs are refusing to do basicmed when you feel so strongly that the “remote liability” in an area “they know nothing about” is the reason for not doing them and how, specifically, are you qualified to comment so intelligently on the reasons for doctors refusing to do basicmed? Seems like quite a few assumptions on your part as well. At least I’m being explicit about my assumptions.

[Jerry 5TJ]

17 hours ago, carusoam said:

Our cog test for aviation comes in the form of a BFR... demonstrating cog skills and physical skills...

First, it’s a FR. 

Next, as a CFI, I am not charged by the FARs to evaluate cognitive skills as any part of a FR. FAA document AC 61-98D offers detailed guidelines for the FR.  No cognitive tests are directly mentioned.  

If a pilot does not meet the requirements for the FR (as interpreted by the instructor) then no log entry is made and no 8170-1 is submitted (the report is optional anyway).  Even glaringly poor performance goes unreported and generally the pilot goes off to find a different instructor.  

I have had the sad task of telling a beloved friend and mentor that he can’t fly his plane anymore because he had lost a general situational awareness and moreover had no  awareness of his deficit.  He was still a fine man and a wonderful human being but at 84 he could no longer fly his Mooney safely.  

With difficulty I persuaded him to fly only with another pilot.  But he could have ignored me and carried on.  

[cliffy]

As I'm to OP I'll pose a question-

How many doctors have been sued after giving ANY type of physical to a pilot?

[ilovecornfields]

5 hours ago, cliffy said:

As I'm to OP I'll pose a question-

How many doctors have been sued after giving ANY type of physical to a pilot?

I don’t know how many have been sued but that’s not really the point. If you ask me to sign a form saying that I see no deficiency that would interfere with your ability to do something then I’m obligated to assess you for that. Most of these cognitive tests like the MOCA set the bar really low and if I’d never met you and you asked me to sign that form then I don’t think it would be unreasonable to expect you to be able to pass that test.

Correct me if I’m wrong, but I believe the FAA and AOPA made it pretty clear that they wanted your primary care doctor to do the basicmed form because they would presumably be familiar with you and be able to attest to whether or not they thought you would have any conditions that would interfere with your ability to pilot a plane. That’s what I did and had no problem getting my form signed. 

If you go see a doctor you’ve never met before and ask them to evaluate you, how do you expect them to do it? If you go complaining of chest pain do you get annoyed when they want an EKG? I can understand that it would not feel good to have someone seemingly question your cognitive abilities by asking you to take a test, but I don’t think it’s done out of laziness, irrational fear of a lawsuit or any personal attack against you— it’s just a well established and standardized way to assess a minimal level of cognitive ability for what is clearly a cognitively demanding task. 
 

Despite what those outside the medical community love to claim with no evidence to support it, most of us, most of the time try to do what’s right for the patient. Most medical malpractice suits aren’t due to medical errors and most medical errors don’t result in lawsuits so “defensive medicine,” while real, is not what drives most medical decision making.

It frustrating but unfortunately commonplace these days for those with no knowledge of a subject to be the most vocal about it and when anyone with any knowledge or credentials in the subject tries to correct the deficiency they get shouted down by the “know nothings”, insulted, and then called arrogant for thinking they know more than someone else (when did knowledge and expertise in a subject become a liability?). I’m not directing that to anyone specifically and certainly not at you, but I’ve been generous with my time and tried my best to explain why this might have occurred to you and what actions might help you in the future. In return I’ve revived potty humor and attacks against me and my profession.

Other physicians on this site have contacted me privately and explained why they no longer comment on medical issues and I now see their point. I will refrain from doing so in the future and you guys can figure it out for yourself. Shouldn’t be a problem since there certainly seem to be enough people here who think they know everything.

[cliffy]

Then I'll post another question-

If you recall, I haven't pilloried anyone in this conversation that I started. I only asked a question- the same question that I asked at the first Doc appointment and was told that because I "questioned" the necessity of this test I was told he wouldn't continue. Seems there is a very sensitive spot that has been found in just "questioning"  the need for a certain medical test.

If the design of the BM exam is supposed to be at the level of any other plain physical (athletic, CDL driver. etc) when would a COG test be appropriate in those instances or are pilots carved out just for being pilots?

I watched a nice video about 2 'older" Docs" doing rounds with Interns at a hospital a short while back. I was amazed at what they could discern of a patients condition (without prior knowledge) just from palliative and verbal examination and direct observation. It really was something to watch. The premise of the video was that with proper training and observation maybe just jumping to a battery of tests trying to determine what was wrong might be not the best way to do things. 

I would think that with training (and yes I'm a layman in the medical field but that doesn't mean I can't observe and read and learn something out of my chosen field of vocation) I would think that if a big enough COG problem was evident in a simplified written test then if that test  was failed the presenting malady would also be readily apparent and observable just by talking with the patient.

Maybe a better way of doing things might be to actually spend a few minutes of time with someone and observe for any COG process shortcomings before requiring a written test. A written exam that many will have objections to. Maybe have some basis for giving the test before it is imposed as a perquisite for passing the physical exam.   

Are Docs not good enough to observe a patient for the few minutes used while going through all the steps of the BM check list and get a feeling about the patients COG ability? Are there not any observable indicators of someone's COG ability to point a Doc to, then maybe doing a written test rather than just saying "do it or I'm done with you? No discussion, no interplay with the patient, no ability for the patient to question the necessity for the test?  Just an edict from on high so to speak? That is the experience I had. Don't question my authority, just do it or else!

Again, from the start of this thread I haven't executed anyone and I'm not here either, all I'm doing is asking questions    

[midlifeflyer]

13 hours ago, ilovecornfields said:

Well, then please correct my assumptions. Why do you think so many AMEs are refusing to do basicmed when you feel so strongly that the “remote liability” in an area “they know nothing about” is the reason for not doing them and how, specifically, are you qualified to comment so intelligently on the reasons for doctors refusing to do basicmed? Seems like quite a few assumptions on your part as well. At least I’m being explicit about my assumptions.

My comment about "something they know nothing about" was specifically referring to physicians  who are not AMEs, and that I think it's very understandable. 

Beyond that, as I explain to clients, a low risk of exposure does not mean zero risk of liability and everyone makes their own assessment of how much they think there "really" is and how much they are willing to accept. That assessment may be data driven, it may be driven by knowledge a subject, it might be driven by realistic or unrealistic views of the legal system, or by something else entirely.  I challenge no ones personal decision, whether it be a physician's  choice of whether to fill out a BasicMed form or a pilots decision whether to carry passengers.

If you read more than that in my comment, too bad.

 

Edited May 23, 2021 by midlifeflyer

[Eight8Victor]

On 5/22/2021 at 12:51 AM, kmyfm20s said:

For all of us that don’t know the big words. Traits of a Narcissist, copied and pasted.

• People with NPD expect to get special treatment.
• They exaggerate their own smarts, success, power, and looks. 
• The lack of empathy leads them to take advantage of people, with no regrets. 
• Narcissists may be extremely jealous and ultra-sensitive. 
• Because they tend to be very thin-skinned, they may angrily lash out at any criticism or push-back.
• Narcissists also may lash out when they feel like they’re not getting special treatment. 
• Underneath all of these traits is a deep sense of insecurity. 
• And — no big surprise, when you consider all these traits — narcissists may find it super-difficult to have healthy relationships, and have loads of trouble at work or school

LOL

[cliffy]

As the OP I think we can end this thread now

Thanks to all who contributed

[MooneyMitch]

Did you ever notice that when you blow in a dog's face, he gets mad at you, but when you take him for a car ride, he sticks his head out the window? 

Here's another one;

Can a hearse carrying a corpse drive in the carpool lane ?

No hidden meanings, just thought these were funny and a good way to help end this thread.

Happy day to all ! 

 

THE END !!!

[carusoam]

1) Everybody gets to post things, within reason...

But...

2) Not everyone’s posts count the same....

3) One doctor brings great insight to the topic...

4) another doctor throws on some potty humor to the thread...

5) the thread goes on...

 

6) It is important that the thread comes to a conclusion, The OP gets some answers... before the humor and side tracking begins...

7) Yes... it is a big distraction when you are spending your time writing from your expertise, with all the due diligence... and somebody tosses a grenade in...

8) Grenades come from anyone, from any direction...

9) Some grenades are aimed with intent...

10) Some are an attempt at being funny, or lowering tension... with not much intent involved...

 

11) Cog tests are really fun... when today’s results are better than yesterday’s.

12) Cog tests can be a drag... when today’s results are worse than yesterday’s...

13) One bad result on a cog test doesn’t mean the end is near...

14) It may mean there is some work to get done to make things improve.... both brushing and flossing...

15) There are also ways to study for the test when you know it is coming...   

Where things get really tough...

• You are an expert in your field...
• Your name is known throughout your industry...
• The degrees are hanging on the wall...
• People are interested in your thoughts...

 

• There are thousands of active participants on MS...
• Not all of them know who you are...
• If they did Know you once...   can they remember you today?
• It really helps when you can use a real name, a real avatar pic, and a real location...

 

• Everyone brings something to the table... even just the readers who don’t ever comment.
• Some bring more than others...
• Some have more to bring than others...
• Sometimes we can wait a year... before a big distractor comes through with some great input...

 

• One thing for sure... we can’t eliminate members... or put them on hold or punish them somehow...
• “If I killed all the goalfers, they would lock me up, and throw away the key....” - Caddy Shack. 

MS is an experiment in public speaking...

Some people pick up on the quirks, and others avoid writing anything altogether...

Some people see through the quirks to deliver their message...

Some people use the user-blocking feature...  (blocking isn’t challenging enough for some people)

Some people have a huge sense of humor and can easily take things in stride....

 

In the end... MS can make you a better writer... more skilled at getting your message across... to a wider variety of people... to a giant audience...

 

Always remember...  whether you are reading or writing... there is no BAC sensor on the send button.... 

 

For any questions on how this all works... PMs are a way to handle the non-public questions...

Best regards,

-a-

 

[MooneyMitch]

“ but wait, there’s more “.... Bullwinkle 

[thinwing]

On 5/22/2021 at 1:12 PM, midlifeflyer said:

That's a lot of assuming.

he appears to be very good at that