By MAJ Brett A. Matzek M.D., FS
The relationship between a pilot and the Flight Surgeon has always been a complicated one. From the early days of Aviation, Flight Surgeons have been tasked with establishing and enforcing medical standards to improve the safety of flight. This task, at times, means recommending that aircrew not perform flight duties if they develop a condition deemed distracting or dangerous in the flight environment. Tension sometimes arises from the perceived unilateral power of the physician to “ground” the Aviator. This action can have professional, financial, and mission consequences. While the Flight Surgeon’s goal is to keep an Aviator healthy and flying, they also have a mandate to make flight duty recommendations to the commander.
The Flight Surgeon is specifically trained on the science of Aviation medicine as well as the science and tasks of Aviation duties. Some may wonder why the docs fly as rated crew or fly at all. It has been found to be the best way a physician can understand the stresses that aircrew face, build trust and confidence with the aircrew, and many times, it is how the doc discovers what medical issues might be present. Aviation significantly dis-incentivizes the revelation and treatment of disease. Pilots are anxiously aware that medical issues could potentially lead to grounding. This is where a good Flight Surgeon can put their aircrew at ease, as most medical issues do not require grounding, those that do are often only temporary.
It is critically important to ensure pilots are getting their information from accurate and reliable sources when it comes to medical care. Fellow pilots, hearsay, and many online sources are often inaccurate and based on incomplete information. Each situation is nuanced. Additionally, most healthcare providers are not familiar with the stressors of flight. The Flight Surgeon must interpret their recommendations and treatments and make flight-duty specific recommendations. Many assume that any condition will lead to the loss of the ability to fly, including common things like hypertension or sleep apnea. Obviously if this were true there would be very few eligible pilots and the Aviation mission would not get completed. Beyond the written regulations, Flight Surgeons are trained to use their Aviation medicine training and clinical judgement to determine if a condition is a danger to the safety of flight. This may be due to sudden or subtle incapacitation. They must also consider if continued flight duty is likely to worsen the aircrew’s condition.
The worst thing a pilot can do is falsify their medical status, either through omission of data or production of false data. A common example is getting treatment and medications “off the books”. While it is against Army regulation and illegal in the civilian world, it is also more likely to result in improper or incomplete treatment. Consider for example, getting medication from a friend or online source for treatment of mild asthma. It may seem that you are adequately controlling your symptoms, but there may be better treatment modalities available and regular disease surveillance might not be performed as it should. Poor treatment can lead to significant worsening of the medical condition over time. A manageable and flight-compatible condition could evolve over time to one that requires permanent disqualification and sometimes even a medical evaluation board.
We have all heard the phrase, “an ounce of prevention is worth a pound of cure”. Pilots certainly understand this from a mechanical sense. You wouldn’t let an aircraft issue pass if you knew that, if left unchecked, it could result in a catastrophic failure. The same goes for medical conditions. If they are undertreated, hidden, or ignored for too long, it leads to worsening of the condition. Consider back pain and neck pain, a nearly universal issue for pilots, many are worried about bringing this up with their Flight Surgeon for fear of being “downed”. What they may fail to realize is that treating the condition early, with conservative treatments such as proper physical therapy, can prevent permanent issues down the road. This is the case with many medical issues. Treatment early will likely result in little to no downtime, while delays in treatment may lead to permanent issues with flight status. One must also consider that there is life after the Army, whether in a cockpit or not, and those untreated chronic issues may greatly decrease your future quality of life.
Hopefully, I have made the case that the Flight Surgeon is your ally. Our goal is to keep you and your passengers safe, both during your next flight and for years beyond. A good Flight Surgeon’s reflex is not to “ground” a pilot, and for most conditions the surgeon can successfully treat the condition while keeping the Aviator in the air. Build a good relationship with your surgeon, fly with them often, and have faith in their desire to keep you healthy and flying.
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Questions for the Flight Surgeon?
The views and opinions offered are those of the author and researchers and should not be construed as an official Department of the Army position unless otherwise stated.
MAJ (Dr.) Brett A. Matzek is a flight surgeon at the School of Army Aviation Medicine, Fort Rucker, AL.