Chart Lore

There is a common pitfall that pilots need to be aware when they are moving forward with medical certification and that is the issue of "chart lore."

"Chart lore" is when something gets put in a patient/pilot's medical record (chart) that is simply inaccurate. This becomes a huge problem for pilots and a frequent source of frustration any time the FAA is requesting documents/medical records. Let me illustrate with an example:

I recently had a pilot working to get his medical certificate for the first time and had to submit medical records to the FAA regarding his history of heart disease; specifically a "current detailed clinical progress note" from his treating cardiologist. Unfortunately, included on the side of that progress note was an autopoplulated list of historical diagnoses including "anxiety." Because of this, he received a letter from the FAA med cert division requesting additional information regarding the pilot's history of having "anxiety." The pilot was thoroughly confused as he had never been known to carry a diagnosis of anxiety and subsequently had to clear up this confusion with his primary care doctor and submit updated records to the FAA. This caused an additional 3 month delay in getting his medical certificate.

The issue is complex, but ultimately boils down to a few things:

1. When you see your doctor and tell them about some new symptoms you are having, the doctor may proceed with labeling you as having a specific diagnosis, especially if they need to link a test/medication to a qualifying diagnosis for insurance to cover it.

2. Then, due to auto-population of information into clinical notes, this erroneous diagnosis gets carried forward indefinitely and automatically included in all subsequent "current detailed clinical progress notes" whether it is accurate or not.

3. Few physicians have the time to dig in and correct these errors during your short annual check up so they remain forever included in your medical record and nearly every piece of documentation in said medical record.

So what is a pilot to do?

Well, there are three approaches you can take:

1. Call the medical records department at your health care institution and request your medical records in whole or part. This is challenging since you may or may not be able to understand what is being said about you in modern day medical jargon.

2. Schedule an appointment with you primary doc to review and correct any issues in your medical record prior to submitting documents to the FAA.

3. Log in to the "patient portal" and review your medical records directly from your computer/phone - doesn't eliminate the challenges with jargon as mentioned in option "1."

My personal preference is to have pilots bring in their documentation so I can review with it with them in person and make sure the FAA is getting everything they requested and nothing they did not. I also look for these hidden diagnoses that may cause trouble so we can work to fix an erroneous diagnosis before it causes a major misunderstanding with the folks in Oklahoma City.

Thank you for reading, and I hope this information empowers you to know what is in your medical record before submitting documents that may be inaccurate and cause significant strife in getting your FAA medical certificate.

Doc Hartman