[Flyin'Dutch']

I note the following advice given to doctors from the GMC

https://www.gmc-uk.org/guidance/ethical ... /30666.asp

From the GMC Website:

Disclosures in the public interest

15. Disclosing personal information about a patient without consent may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. This could arise, for example, if a patient may pose a serious risk to others through being unfit for work or if conditions at work are unsafe.9 If you think that a disclosure may be justified in the public interest, you should follow the guidance at paragraphs 63–70 of Confidentiality.

Disclosing information in the public interest
63. Confidential medical care is recognised in law as being in the public interest. The fact that people are encouraged to seek advice and treatment benefits society as a whole as well as the individual. But there can be a public interest in disclosing information to protect individuals or society from risks of serious harm, such as from serious communicable diseases or serious crime.23

64. If it is not practicable to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public’s interest in keeping the information confidential.

65. Such a situation might arise, for example, if a disclosure would be likely to be necessary for the prevention, detection or prosecution of serious crime, especially crimes against the person. When victims of violence refuse police assistance, disclosure may still be justified if others remain at risk, for example from someone who is prepared to use weapons, or from domestic violence when children or others may be at risk.

66. Other examples of situations in which failure to disclose information may expose others to a risk of death or serious harm include when a patient is not fit to drive,24 or has been diagnosed with a serious communicable disease,25 or poses a serious risk to others through being unfit for work.26

67. When deciding whether the public interest in disclosing information outweighs the patient’s and the public interest in keeping the information confidential, you must consider:

a. the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health

b. the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent

c. the potential harm to others (whether to a specific person or people, or to the public more broadly) if the information is not disclosed

d. the potential benefits to an individual or to society arising from the release of the information

e. the nature of the information to be disclosed, and any views expressed by the patient

f. whether the harms can be avoided or benefits gained without breaching the patient’s privacy or, if not, what is the minimum intrusion.

68. If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if it is practicable and safe to do so, even if you intend to disclose without their consent.

69. Decisions about whether or not disclosure without consent can be justified in the public interest can be complex. Where practicable, you should seek advice from a Caldicott or data guardian or similar expert adviser who is not directly connected with the use for which disclosure is being considered. If possible, you should do this without revealing the identity of the patient.

70. You must document in the patient’s record your reasons for disclosing information without consent and any steps you have taken to seek the patient’s consent, to inform them about the disclosure, or your reasons for not doing so.[/quote]

[cockney steve]

Is it not a possibility that the GP *could* give an ultimatum to the patient . " You place me in a difficult position, so, either you advise your employer and authorise them to acknowledge to me , sometime within the next XXXX hours, OR I have to report the situation to the regulatory body, in which case it will seriously harm your future prospects.

The irony, in Lubits' case, is that his course of action did , indeed harm all his future.

[4535jacks]

There has been a bit of (interesting) thread drift here, but to get back on track.
With the caveats, that "that was then, and this is now," and "past performance is no guarantee of future returns," I can tell the OP that during my time as an AME I have seen initial unrestricted Class 1 certificates issued to certain applicants with a history of migraine more than 10 years previously once they had provided appropriate reports as requested (usually as a minimum a report from the applicant's GP to confirm no consultations or prescriptions for migraine/headache/visual disturbance in the last 10 years) and complied with any further relevant medical inquiries which often included a consultation with a CAA specialist in Neurology.

Certification, if granted, was often accompanied with a warning that any further manifestation of migraine a) must be reported and b) would would jeopardise continued certification.

Thanks Dodo, this was just what I was looking for! Hopefully I will be one of those certain applicant to gain a class 1 with previous history of migraines.

[Jack2145]

Hi dodo, Ive been clear for 7 years and a bit now and today seen a neurologist who said he doesn’t see any reason why I would get it refused. But he did say that once a migrainer always a migrainer. Everything else is passed and waiting my AME is just waiting for this specialist report for the neurology. I was on propanalol for a bit and had an attack a week in young age on average. An mri scan turned out all normal. I stopped taking any medication and a GP letter stated this and the fact they had gone in April 2011.

Any advice would be seriously appreciated thankyou.

[Dodo]

No, sorry, no advice really.

I am not clear if you have actually applied for a higher class of medical than the LAPL that I think you said you already had.

If you have applied for a class 1, then I understand that a history of migraine always requires a CAA decision.
If a Class 2 then it is an AME decision based on the flowchart though the CAA "may" offer guidance if requested by an AME.

Again if it is a class 2 you might want to ask your AME if he or she would consider asking the CAA if they would give an opinion as to whether the report you have submitted for the Class 2, would in the future, be acceptable for an initial Class 1. The CAA may be prepared to do so or may simply advise that you book a class 1 initial and see.

hope all goes well.

(multiple edits for grammar rather than meaning)

[Dodo]

PS and if you do undertake a class 1 initial and it is declined it is frequently worth an appeal. http://www.caa.co.uk/WorkArea/DownloadAsset.aspx?id=4294976715

[4535jacks]

Is there a list of CAA approved neurologists as I would like to be reviewed by one prior to applying for my class 1.

[JoeC]

May it be 'better' for a CAA recognised neurologist to be responding to an official investigation after you've done your class one rather than before? You may end up seeing them twice!

[Dodo]

With the caveat that I may be a bit out of date.

As far as I know there is only one Consultant Adviser in Neurology to the CAA, and also as far as I know they do not see patients elsewhere.

Applicants usually see them after the initial class 1, in the CAA clinic at Gatwick, and after the CAA have had an opportunity to review the applicant's own Consultant's report, and the rest of the Aeromedical Centre's report on the initial Class 1 medical, and not before.

[4535jacks]

Has anyone been refused a class 1 in recent years if they have a history of migraines but have met the CAA's requirement of 10 years headache free and are there any types of migraines or accompanying symptoms that will mean an initial class 1 one will never be issued regardless of how long the applicant has been headache free?

[Dodo]

"Has anyone been refused a class 1 in recent years if they have a history of migraines but have met the CAA's requirement of 10 years headache free and are there any types of migraines or accompanying symptoms that will mean an initial class 1 one will never be issued regardless of how long the applicant has been headache free?"

If you are asking me personally, I have no idea.

[Flyin'Dutch']

Has anyone been refused a class 1 in recent years if they have a history of migraines but have met the CAA's requirement of 10 years headache free and are there any types of migraines or accompanying symptoms that will mean an initial class 1 one will never be issued regardless of how long the applicant has been headache free?

Who knows?

The only thing that matters is whether you will get a Class 1 or not; every application is judged on its own merits and to know whether you pass or not is by going for a medical and go through the process.

There are people who didn't manage to get a Class 1, not because of an issue they had which they knew could be causing a problem, but because of something else which came to light in a different area (e.g. eyes/ECG etc.), similarly there are those who got a Class 1 medical despite having an issue they had been worrying about prior to the medical.

Procrastination is not going to help.

[Aspiringpilot1991]

Hi everyone,

Late to the party on this one but I am currently in the mist of a AME referral to a Neurologist in a bid to take up a scholarship for my ATPL. I had a history of migraine type headaches in school (1 every 1/2 years - I didn't visit the GP). I then didn't get them roughly between 2008/2009 - 2013 and got less severe type headache, minus visual disturbance or any vomiting - I went to the GP as a precaution due to previous history as a teen. The GP diagnosed classical migraine, and prescribed imigran. Since then I have not experienced one since, nor did I use the medication or get a repeat prescription. It's over 6 years. Following an MRI scan and blood tests all being fine, my Neurology report has been sent to the AME ready for CAA referral. Based on the migraine flow chart, my last episode over 6 years ago was not debilitating and with an obvious trigger of dehydration (this has been backed up by a letter from my GP). What do you feel the likelihood of getting the class 1 unrestricted is?

Any help would be greatly appreciated

[Flyin'Dutch']

Hi,

You don't need help - you need a decision from the CAA and nobody can really advise you what the outcome will be as it will entirely depend on the contents of your report.

At face value I would say that it is looking good but that is just based on what you have written.

Good luck with that and enjoy the training when it is all done.

[Aspiringpilot1991]

Thanks for your reply. Fingers crossed!