Hello, med examiner here

Discussion in 'The Welcome Wagon' started by KenleighMD, Aug 7, 2019.

  1. KenleighMD

    KenleighMD Bobtail Member

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    Hello everyone,

    I'm a medical doctor who recently certified to offer medical examiner services. I joined the forum to have a better sense of the issues facing CDL drivers. I know some of you have had negative experiences with MEs. I hope to change that in my practice. In fact, the best training to become a ME specifically emphasizes that our goal is to find a way *TO* qualify drivers whenever possible, not the other way around. Some practitioners out here are in it to turn a buck and blow through the training without regard for drivers or public safety.

    Hopefully you'll welcome me.

    Does anyone here know the appeals process for a driver DQ'd for reasons other than vision, hearing, diabetes or seizures; peripheral neuropathy, for example? I understand a process exists but the FMCSA site is a dumpster fire when it comes to finding information. Their phone agents refer only to the website. Where are the forms for filing a nonstandard appeal? I'd like to be able to advise future patients what their options are if they end up getting a medical DQ.
     
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  2. x1Heavy

    x1Heavy Road Train Member

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    In the old time if a doctor found something that is a issue needing fixing the 90 day DOT Med card was used. It was a explicit warning to fix whatever it is that is the problem because you might not get another DOT medical card.

    FMCSA has backed away from Waivers. I also believe medical technology in all it's forms has advanced to where some of the old problems are easy fixed today or managed by new drugs which do not impact schedule one drugs under DEA.

    The Government is focused on pain medicine as a enemy right now. That's the main thing.

    Long ago when I was in school I was told i have 50 some odd years before the spine or something important gives out from the physical labor that was part of trucking combined with what we called the old iron. Hardly any luxury. I am one of those.

    The last few years has featured work and this year I have more work to do, essentially surgery this surgery that fix fix fix like you would a older car with bad parts taken out and replaced with modern better than new.

    I do not have problems with DOT examiners overall. But I do have one policy with any Dot examiner in the USA.

    \No, no no nope never, sorry . ha not that. no no no no and no. IF they want to really examine me and find issues using what tools may be around the typical mass DOT exam clinic.... they are welcome to try it. My body is covered in surgery spots etc it's like a story book to any doctor with sufficient knowledge.

    I am not hiding anything. Issues are present on some days. But on good days I go to DOT doc.

    I would not want to do that now. I believe there is a law now that requires doctors to examine any prescription records of a prospective patient before going in to do the visit session. I have a way to go before all of that history will settle down versus Urine and Hair tests. There are also new medicines in my state that simply are superior to anything in walmart pharmacy or any such place. (Non THC products) I don't particularly like these but I cannot deny watching and feeling a bothersome palsy go away pretty much for the rest of a day after a drop is applied during one. Poof gone.

    It's leaving a door open to where I walk away from doctors and all medicine entirely dispensed by doctors. It's a possibility.

    Something else indeed. Full circle from Vietnam and don't say no into what we have today.
     
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  3. KenleighMD

    KenleighMD Bobtail Member

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    I'm straightforward with patients: I'm not here to screw you over. My job is to keep everyone safe, including you. If we're honest with each other we can do both of those things and keep you out of trouble in the future. Unfortunately, some people will DQ a driver and leave them without any clue how to proceed, caring little for the fact a family livelihood is at stake.

    The reality is that there are only 4 strict DQs, pretty much everything else is negotiable one way or the other.
     
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  4. x1Heavy

    x1Heavy Road Train Member

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    If anything that requires DQ will be high blood pressure. A good meal and coffee in morning pushes me into a working range of 150/100 that is where I like to be for work. However books say that is hypertension two I think.

    DOT says 140/90 is cut off. I once had trouble at 21 with BP out of the blue and if there was any problems I am battling today that's BP. Altenolol (A beta blocker) is a old medicine prescribed to keep it under a range. But above 100/60 and a good 70 or so beat.

    Part of that blood pressure has been proven to be dealing with strange doctors. I think they call it white coat. Part of that problem is when a doctor wishes to say in the ER for instance take a adversarial stand over a subject that is matter of State Law of which I am familiar with as well and under no contract on certain medicines its a problem.

    I do not seek conflict with a DOT doctor at all. I know if anything that BP will be a problem and one way or another it needs fixing. My family ancestry includes people who die from strokes into the late 80's or 90s routinely. Probably from BP too high to treat without medicines that knock em down and cause a problem with getting around.

    I have had nurses assessing BP react in shock when the machine presents a really high number. I have to calm them down and say that provided I am not experiencing any other issues at the present time its not a exigicant emergency. (Now there is a word, I hope I used that in proper context)

    My motivation to fix the BP comes from the knowledge that the Kidneys must have a certain range to operate at and not above that range. Should they fail then existing in the Dialysis center is not living.

    I hope this helps you understand one issue I do have that precludes any trucking right now pending future work.
     
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  5. Cattleman84

    Cattleman84 Road Train Member

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    Don't DQ someone unless there are NO other options and you will have lots of business.
     
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  6. x1Heavy

    x1Heavy Road Train Member

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    If I went to visit him for a DOT exam and the BP is running wild, it will not pass.

    I would not hold it against him. The main problem this year in my world is looking for the root cause and solve it. Its not as cut and dried as that. Some days I swing too low. I know how to rest and tolerate it adding coffee or other fluids to volume that problem away. But what I think if anything is if we don't get this fixed the body must fail.
     
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  7. KenleighMD

    KenleighMD Bobtail Member

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    This is correct. Some of the DQ things are matters of law and non negotiable. With others there are discretion but explicit guidelines exist that can't be ignored. You can't certify someone with rampant, excessively high BP because of the high percentage risk of sudden stroke.
     
    Last edited: Aug 7, 2019
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  8. Numb

    Numb Crusty Curmudgeon

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    the BMI, sleep apnea, neck too big, scam the mega corps are running is one of the main problems.

    they have their own "sleep dpc's" they refer people too and you always end up buying a machine.
     
  9. x1Heavy

    x1Heavy Road Train Member

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    I'll add one more.

    Let's say a trucker get a quality physical and alls well. Pick one. 2 year card etc.

    The minute they walk into a orientation with the "Required" DOT Medical card attached to the CDL needed for Tier One Interstate and Intrastate Commerce (By the States now mind you for that CDL to be valid...) the company sends the driver to their OWN doctor who may or may not be there for a physical other than weeding out those who fail one of the 4 Lawful reasons to do so.

    Or in my case one time, decide to be more stricter than Federal Regulations. FMCSA has ruled after that incident its not a crime for a company doctor to do so.

    Here is the rub. You would think spinning money (As we say in the south) on DOT physicals is two steps backwards and one step forward. It discredits the DOT medical card system if no one honors the original valid issued card except the state.

    Who knows? It's wasted motion to do something twice.
     
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  10. KenleighMD

    KenleighMD Bobtail Member

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    It has to do with the state your CDL is registered in. If your state has tighter regulations than the feds we have to use the regs that are more strict. Similarly if you’re being certified for intrastate we are instructed to favor whoever has tighter regulations.

    Regarding doctors hired for a company there may be certain conditions attached to it with your employment contract. Certification training advises that we can apply employers standards. In general, though, we have broad discretion with how we apply most of the guidelines. I haven’t started offering ME services yet so I am uncertain of the nuances but this is something I’m going to look up.
     
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