Getting Personal

by Dr. John Beasley, M.D.
Aviation Medical Examiner
Professor Emeritus and Clinical Professor
Department of Family Medicine
University of Wisconsin – Madison
Published in Midwest Flyer – February/March 2017 issue

Recently, an aviation legend who will remain nameless, almost bought the farm… not because of a lack of ability to out-fly the enemy in combat, nor for any problems with his air show skills, but partly because he did not have a personal physician. Fortunately, a doctor friend of his happened to be with him during his time of need. As the physician stated: “Only by having a strong professional relationship with a personal physician can we get the best advice and treatment when it is needed, especially in light of the fragmented state of medical care in the U.S.” (Paraphrased).

I have to agree with that – and it’s becoming more challenging for both patients and their doctors. (I note that Physician Assistants and Nurse Practitioners also provide excellent care, but I’ll use the term “doctor” in this article.)

Back in the day, one “doc” treated the whole family, caring for folks in the office, the hospital and the nursing home – even making the rare house call. He or she knew you as an individual. Now there are urgent care centers where no doctor ever gets to know you as an individual; hospitalists (working in shifts), who never see you after discharge; and a myriad of sub-specialists. There may be a different doctor if you are pregnant or have diabetes.

So, who cares? Well, you should. You deserve a doctor who knows and understands you…knows what you are worried about, what your strengths and support systems are, and what your goals of care are. Sure, you want the “best care,” but “best” is defined by what’s important to you!

Take, for example, the treatment of high blood pressure. If your blood pressure is borderline, is it worth the hassle and (albeit minimal) risk of side effects for what may be marginal reductions of risk? Do you want screening for breast or colon cancer? To make decisions regarding this requires knowing the potential benefits – but also the potential risks.

It’s important to have somebody you can trust. I recently heard of an airline pilot who after a relatively minor injury had some high blood pressure. Rather than just get it treated, he elected to not renew his medical for fear of a denial. He was out of work for two years because of a simple problem that could have been treated with no risk of a denial, but he didn’t have anybody he trusted to help with the problem.

If you do develop some problem, then both you and your personal physician have a starting point. Your personal physician will also be able to work with you to maintain your health so you can keep flying. Yeah, I know that soon (thankfully!) you won’t need that pesky Third Class Medical, but it’s still better to not have a heart attack than to have one. If you and your doctor know each other reasonably well, it will increase your ability to deal with minor issues over the telephone or by electronic communication. Your doctor may be your Aviation Medical Examiner (AME ) or not; either way works.

I recently had to select a new doctor, as my previous one retired, and I have the good fortune to know a lot of docs at my clinic. So I was able to pick one who has about the same approach to medical care that I do. She knows all the guidelines and how to use the computer, but at the same time, she is not too driven by the guidelines or too immersed in the computer. She has a very knowledgeable approach, but one which is tempered by really good common sense. She’s willing to listen. Fortunately, I’ve not had much to tell her, but I know she’ll be there if (and at this age, when) I do.

I’ll admit that this is more difficult if you are young and healthy and living in different areas of the country with frequent moves, but at some point when you are settled in one location, you should try to establish an ongoing relationship with a personal physician.

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