Passing this along for anyone going through something similar. I’m over 40 with a 3rd Class Med. During a routine exam, my doctor wrote in my med chart suspected afib based on my relaying a time six months before when I felt like I had a rapid heartbeat that lasted for an hour or so. When I went to my AME to renew my Med Cert she found the note and deferred me and said I would hear from the FAA with a list of requirements. Keep in mind I don’t suffer from Afib symptoms, I’m not on any heart medications, and I stay in good shape. A couple of weeks later the letter from the FAA arrives, they need me to provide documentation of the following tests taken within the last 90 days: Echocardiogram, 24 hr Holter Monitor, Sleep Study, exercise Stress Test (with Bruce protocol), and Thyroid panel blood work. So I go to the local cardiologist’s office, find a nurse, and we read the letter together. She immediately says there is no way the doc is going to sign off on ordering all these tests. “They are not medically necessary.” I beg her to let me talk to the doc. Fortunately he agreed to meet with me even though I didn’t have an appointment. His initial reaction was “no way.” But, I pushed harder and said that flying meant the world to me and to please help. He didn’t want to do it, but in the end he ordered all the test and filled out the FAA Afib form. He also warned that my health insurer may not pay for the tests. $10,000 worth of testing later, we confirmed that I didn’t have any symptoms, and didn’t need any treatment. All of the test results were submitted to the FAA via overnight delivery service. 3 weeks later they were finally scanned into their system. Two months later I received a letter from the FAA advising I was approved for a special issuance Med Cert, but would need to submit to them annual update reports with a 24hr holter monitor re-test. The time, the money, the aggravation, all because I told my primary care doc that I felt like I had a rapid heart rate 6 months beforehand for a short period of time. Good Grief!! Why did I say anything????
“Suspected” Afib leads to Waste of $$$$ and Spec. Issuance
- Thread starter 422Phil
- Start date
Perfect example of how the entire aeromedical requirements for private GA pilots are an expensive and time-consuming overkill.
While protecting others is certainly an admirable goal, the trouble in the case of the FAA aeromedical system is that there is no good evidence that the requirement for a 3rd class medical to fly GA aircraft for recreation improves the safety of flight.Philip Kinney said:
The FAA argues that their experience with the HIMS program is indirect evidence that it helps and the data from Sport Pilot indicates no effect. Pretty weak evidence.
So the serious question is whether such mixed evidence is a valid justification for forcing pilots to endure all this time and expense. I would argue that the overall experience with regulatory systems also bears on this point and suggests it is likely not worth it from any rational evaluation of the cost of accidents, both in terms of lives lost and money.
The sort of problems you note here, an agency becoming overly intrusive, continuing unnecessary expenses, etc. are all typical problems with regulatory schemes to prevent bad outcomes. See Mises “Bureaucracy”.
Of course you have to get that first medical certificate. Of course I guess the point may be, switch to BasicMed ASAP.hindsight2020 said:
Given the apparent low rate of such alarms, apparently the positive predictive value wasn’t so bad. From the second study provided:
“Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram.”
For a test like this, one really needs to consider all possible test outcomes to estimate utility.
Agree with others here that of course neither the PCP nor the AME should consider that performance accurate enough to be making clinical decisions. Just an indicator that perhaps it is something to look into.
“Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 (95% CI, 0.76 to 0.92) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 (97.5% CI, 0.69 to 0.74) for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram.”
For a test like this, one really needs to consider all possible test outcomes to estimate utility.
Agree with others here that of course neither the PCP nor the AME should consider that performance accurate enough to be making clinical decisions. Just an indicator that perhaps it is something to look into.
This may help clarify - https://en.wikipedia.org/wiki/Positive_and_negative_predictive_values#DefinitionLindberg said:
