President’s Corner 3rd Issue 2022
Give Yourself the Gift of Good Health – Don’t Be a Grinch!
The holidays are a wonderful time to remember and celebrate those aspects of our lives that we are grateful for. Some of the most important are the love of family and friends, the opportunity to be involved in aviation which we are so passionate about and the gift of good health. All three are related. Without our health, both physical and mental, it is difficult to fully enjoy family, friends and flying.
Self-care is very important. In previous newsletters, I have written about the importance of healthy habits and regular attention to improving wellness and resiliency. Regular practice of healthy nutrition, exercise, avoidance of harmful substances, protection from physical hazards and regular consultation with health care providers addresses your physical wellbeing. Mental wellbeing is equally important, but often neglected. I have written about this extensively in the past and will mention it briefly again.
The International Civil Aviation Organization has published a wonderful book that I feel should be in every pilot’s library. “Fitness to Fly – A Medical Guide for Pilots.” It has nine well written chapters specifically for pilots. Chapter topics for physical health include Cardiovascular Disease, Cancer, Musculoskeletal Injury, Hearing and Vision, Nutrition and Travel Health. Chapter topics for mental health include Keeping Mentally Well, Alcohol and Drugs, Sleep and Keeping Mentally Well.
The chapter on Mental Wellness lists six key steps for optimizing your performance. These include:
- Building connections and relationships
- Being physically active, especially outdoors
- Continuous learning
- Giving to others and gratitude
- Knowing When and Where to Seek Help
Let’s focus on “Knowing When and Where to Seek Help” as this is an area that pilots neglect or avoid…to their detriment. As pilots, we are confident, competent, independent problem solvers. We rely on our own skills and training to solve novel and challenging situations (resiliency). These are outstanding attributes in the cockpit. Unfortunately, when it comes to admitting we need help in our lives, these otherwise beneficial attributes interfere with seeking out experts to help us get metaphorically back on our lives’ magenta line. We were all trained in Crew Resource Management in the cockpit. We should apply the same concept in our personal lives in order to perform at our best, enjoy our lives and maximize our health span.
Pilots and those requiring medical certification for their professions or avocations have another major barrier to seeking help – Fear of Loss of Medical Certification. We all have told ourselves that we will be fine and don’t need to see a healthcare professional for a physical or mental wellness concern and that it will get better. Some have sought healthcare but failed to report those encounters when completing the medical application, both in the civilian and military worlds. The consequences of avoiding healthcare or concealing it can be severe. We are stealing the gift of good health from ourselves, our loved ones and our colleagues.
Dr. William Hoffman, a pilot, AME and neurologist has done and is continuing outstanding research in the area of Healthcare Avoidance due to fear of aeromedical certificate loss in Aviation Personnel. He has done this research for the FAA and the military. His subjects include pilots from professional civilian and military organizations, student and general aviation and non-US countries. His findings are consistent across all types of aviation. They are startling in their magnitude, but not surprising to those of us in aviation.
His major findings are related to the prevalence of healthcare avoidance behavior. In one recent study of nearly 4,000 pilots, 56.1% of US pilot reported a history of some sort of healthcare avoidance behavior due to fear for aeromedical certificate loss. He defined healthcare avoidance as self-reported: 1) informal care seeking (family, friends, other pilots, internet, dentists, etc.), 2) nondisclosure on aeromedical screening, 3) flying despite symptoms and 4) prescription medication use not disclosed. Importantly, a sister study demonstrated that 78.6% of US pilots reported a history of anxiety related to seeking healthcare and 60.2% reported delaying or not seeking healthcare due to fear of certificate loss. Many pilots often identify with these findings – you are not alone. The US Air Force has recently awarded his research group with a large research grant to study to impact of pilot healthcare avoidance, perhaps a signal of cultural change in aviation. References for Dr. Hoffman’s research are listed at the end of my message. Additionally, he has recent work published in Scientific American and a fictional book on the topic, “Wings of Deceit.”
The most recent issue of the Federal Air Surgeon’s Medical Bulletin has an excellent article on Healthcare Avoidance and its effect of personal health and aviation safety by Zykevise Gamble, a pre-med student at Howard University doing an internship at the FAA Office of Aerospace Medicine. I recommend reading this article and regularly using the “I’M SAFE” checklist to assess personal fitness prior to every flight. I have written about this in numerous previous articles and in light of Dr. Hoffman’s findings, believe the I’M SAFE checklist is even more critical for every pilot to complete before every flight. Recent revisions of FAA policy as noted in the Guide to Aviation Medical Examiners allows AME’s to issue medical certificates for several physical and mental conditions that previously required FAA review. Healthcare seeking avoidance behavior is not in anyone’s best interest.
What is my holiday message? Seek qualified professional healthcare when you have any concerns about your physical or mental health. Trained peers can assist if you have those resources available to you, but not seeking care, using “Dr. Google” to treat yourself or concealing conditions and care can lead to very poor outcomes. If you need assistance with medical certification issues, the aerospace medicine physicians at AMAS can assist you confidentially. A trusting relationship with your primary care physician or AME also can minimize healthcare seeking avoidance. Think of yourself as you do your aircraft – don’t delay or avoid routine and urgent maintenance. It is not good for longevity and safety. This is the best strategy for a long and productive career in aviation and a healthy life outside of aviation.
Give Yourself the Gift of Good Heath – Don’t Be a Grinch!
Have a Safe and healthy Holiday Season and New Year
- Hoffman W, Chervu N, Geng X, Uren A. Pilot’s healthcare seeking anxiety when experiencing chest pain. J Occup Environ Med. 2019;61(9):e401–e405
- Hoffman W, Barbera D, Aden J, et al. Healthcare related aversion and care seeking patterns of female aviators in the United States. Arch Environ Occup Health. 2021;3:1-9.
- Hoffman W, Aden J, Barbera D, Mayes R, Willis A, Patel P, Tvaryanas A. Healthcare avoidance in aircraft pilots due to fear for aeromedical certificate loss: a survey of 3,765 pilots. J Occup Environ Med. 2022;64 (published online).