Taking the FAA medical exam may bring on a slight case of heartburn for some pilots - especially those who have attained the dubious status of senior citizen. Several years ago, I interviewed two very knowledgeable MDs on the subject of getting through the medical with the optimum chance of success, and their tips are still timely.

Ian Blair Fries, MD, is chairman of the AOPA Medical Advisory Committee, a Senior Aviation Medical Examiner and holds ATP and CFII certificates.

Q: I've heard advice to the effect that the pilot should apply for the lowest class medical he or she needs. For example, I had a second class medical for many years because I have a commercial certificate, but I decided some time ago to drop down to a third class because I don't fly for commercial purposes. Do you agree with that approach?

Fries: The general recommendation that we give - by "we" I mean myself and the AOPA - is that you should only go for the class of medical that you need. There's no advantage to going for a higher class. You might find out that you don't make the grade for that certificate, and at that point you have a certificate that has been denied or deferred, and from then on you have raised the issue that you have something that is not quite as good as it should be.

There has been a change in the regulations. It used to be that you could not go for an ATP unless you had a first class medical in your pocket. Now you can go for an ATP without that first class medical. Of course, to act as an ATP, you do need a Class I.

Q: Some pilots may go for a higher class simply because they feel that they're getting a more thorough medical examination.

Fries: The aviation medical examination is a specialty examination with one purpose only: to determine whether or not you are healthy enough to fly for the time period of your medical certificate. It is not meant to be a health maintenance exam, a checkup, or anything else. If you and the doctor choose to make it something different, that's fine, but understand that that is not the reason for it.

If you feel that you would like to know whether you could pass a higher class, simply say to the doctor, "I need a Class III, but would you do me a favor while you're doing this examination and tell me whether I would have qualified for a Class I?" That way, you haven't reached where you don't have to and if it turns out that you would not have qualified, you may still be eligible for the Class III.

Q: Conversely, if you apply for a Class I and you don't qualify, can the doctor offer to lower the exam to a Class III?

Fries: Strictly speaking, when you fill out the Form 8500, you are requesting a particular class, and the doctor's only obligation is to determine whether or not you meet that class.

Q: Of course, one should routinely get medical checkups from the family physician.

Fries: Yes. For example if you come for an exam to your family physician, he may do certain tests based on his knowledge of you and your family that would not be part of the aviation medical exam. He may want to do blood workups or a prostate exam, which is not required. You may have a family history of some disease that tips him off that you need to have certain things done. There's a large number of things that a competent physician is going to look at when he is doing an examination that is different than answering the FAA's question, "Is this person qualified to fly?"

Q: Some pilots will ground themselves, even though they can still pass the FAA medical. Maybe they're getting more forgetful with age, maybe they're concerned that something may disable them suddenly despite the fact that it hasn't appeared in the exam. Are there any guidelines about deciding voluntarily that it's time to mothball the pilot certificate?

Fries: Our experience with older pilots who have been flying for awhile is that they do a fairly good job of judging their capabilities. They give themselves more time when they fly, they don't undertake flights under hard instrument conditions¾in other words, they begin to do things that continue their ability to be safe. They tell me, "You know, I don't fly at night anymore," or "I don't fly more than two hours at a time now." A good, seasoned pilot makes decisions that keep him and his passengers safe. The decisions may change over a period of time, but there are no hard and fast rules that apply to everybody.

Q: Another thought is a pinch-hitter course for a spouse or someone else who flies with you regularly and is not a pilot.

Fries: I think that's good advice, but I don't think it's age-dependent. Anybody who can, should have a pinch-hitter, regardless of whether he or she is 18 or 81 years old. And I think it would be a mistake to suggest that somebody who is older should now depend upon that pinch hitter. I don't think you should be making a different decision as pilot-in-command, based on whether or not you have someone who is a pinch hitter in the right seat.

Q: Another suggestion that applies to anyone who flies is to wear a good noise-attenuating headset¾regardless of age.

Fries: Everyone should be protecting his or her ears, that's correct. But also, if your hearing has less acuity, a headset in many cases will help that. For example, you can turn up the volume quite a bit more than you can with an overhead speaker.

Q: Anything else you'd like to say to older pilots?

Fries: Statistics show that pilots in their 60s, 70s and 80s tend to fly less. A concern that I have is that they remain current, and since they fly less, they are less likely to be current.

Q: How do you define currency for, say, a VFR pilot who has no legal currency requirement other than the BFR?

Fries: I don't know if I can give you a number, but if you have come to the point where you're not flying enough¾and you know when that is, you're just not as comfortable as you used to be¾it's time to fly with an instructor and bring up your level of comfort. No matter how thick your logbook, it's like the story of "what have you done for me lately?" What happens more than anything else is that the judgement begins to go; you haven't been exercising your ability to make judgements.

Dr. Henry Rowe is an AME whose entire practice consists of medical examinations and treatment of pilots. He flies a Comanche and is 80 years of age.

Rowe: I've been preaching for about 30 years to pilot groups: "Don't ever quit flying, because flying keeps you young. It keeps your wheels turning, it keeps your interest and your focus, and it's something rather special to do."

Stop and think about how few people in this world can get in an airplane and make it go. So pilots are an exceptional group and usually have something on the ball in order to make that grade.

Q: Tell me about your background as an AME.

Rowe: I already had a private pilot ticket when I went to medical school. And while at medical school I upgraded to instrument and commercial. Shortly after I graduated in 1958, I applied for Aviation Medical Examiner, and have been doing it for 40 years. I joined the FAA at Denver Center in 1971, then in about eight months I went to Oakland Center as Assistant Regional Flight Surgeon. I retired from the FAA in 1985 and came to Santa Maria, where I started in occupational medicine and a local industrial medical group.

Q: But now you are one of a few doctors who specialize in pilots.

Rowe: There are three of us in the world who do nothing but pilots. In my practice, I see that pilots as a group are more interested in their health and want to keep flying, so they usually look after themselves better than the general population and they tend to address problems right away, before they get out of hand. So pilots as a whole are a healthier bunch and I encourage them, when the least little thing comes up that might affect their flying, call me and let's address it right up front and get rid of it as soon as possible.

Q: I've heard it said that a pilot should not use his AME as his personal physician, because there might be a conflict of interest.

Rowe: Yes, there is a conflict of interest. A good and honest physician can accommodate the conflict reasonably well, but I do think it's better to have them separated. The main reason for that is that an AME sees the person once every two or three years, or more often with a higher grade of certificate. As he gets older, he may need to see his private physician more often to take the long view for better care.

Q: What is the most common medical problem that you see that may affect the pilot's ability to keep flying as he or she gets older?

Rowe: The most common problem is visual acuity. The average person will have to have reading glasses starting at forty or earlier. Incidentally, the laser correction for acuity is marvelous. I had a very mature lady from Los Osos come down for her physical and on the way she stopped in at an ophthalmologist's office in San Luis Obispo. She walked in wearing glasses, she walked out not wearing glasses and when she came in here she was seeing 20/20.

Q: Aren't there several types of procedures?

Rowe: Yes. The original procedure is the radial keratotomy. It was invented by the Russians and it wasn't very good, because each one of those little six scratches across the eyeball had a "v" shape on the bottom; it acted like a prism and would scatter light, so when you were landing into the sun you couldn't see. But the laser treatment puts thousands of little dots on the surface and there's no prism effect. OK City did not like the radial keratotomy, but they do like the laser treatment.

Rowe: The next common problem is blood pressure. In the US, we are fat. The latest measure of obesity is the Body Mass Index. It applies to men and women of all ages. The formula is: weight in pounds times 703, divided by height, in inches, squared. Twenty five is ideal, thirty and above is obese. As weight goes up, the lower figure on your blood pressure (diastolic) goes up, so that's the first sign that you're putting on too much weight. If you don't pay attention to that and start to get control of your weight, eventually the top figure (systolic) will start going up also.

The best exercise for people over 50 is walking. A two-mile walk every day is very adequate. Walk as fast as you can and shake your butt as hard as you can. Spend six weeks working up to two miles, a little longer each day.

Q: What about diet, nutrition?

Rowe: There are lots of programs out there and most of the big sale items are not worth the money and the trouble. Pilots in general are intelligent enough to know what junk food is.

With the aging population, after blood pressure problems and obesity, usually heart problems follow. Because of the fat in our diets, we clog up our arteries and have to have heart bypasses or angioplasties, or we suffer heart attacks and a piece of muscle dies.

Q: Would it be helpful if the AME is a pilot?

Rowe: The FAA prefers AMEs who are pilots. If there are two physicians in a town who apply for a designation and one is a pilot and the other isn't, they'll give it to the pilot. The pilot-AME has a better understanding of the whole picture and is likely to do a better job for OK City; the error rate is far less.