Fit to fly

Dr A didn’t feel he had the competency or experience to be able to assess Mrs B’s fitness to fly and was reluctant to complete a form to state that she was “fit to fly”.

When Mrs B returned, Dr A took a full history of the date and type of surgery and how she had been in the postoperative period. He noted the absence of any symptoms of complications. He examined her abdomen and was satisfied that she appeared to be making a good recovery after her procedure.

He issued her with a medical travel clearance form for ten days post op and she changed her flight and travel plans accordingly

He discussed with her whether or not she should actually be flying so soon after surgery, and whether or not she should ask for assistance at the airport with the walking distances involved. He advised her to discuss her recent surgery with her travel insurance company.

Dr A offered to write a factual letter for the airline, stating the date and type of surgery. However, she was adamant that she required a medical travel clearance form.

Dr A contacted her surgeon, Mr C, at the private hospital. He agreed to review the patient that evening and advise her on her travel arrangements.

Mr C was not happy with the patient travelling the following day. He advised her to wait a full ten days until after her abdominal surgery prior to flying. However he issued her with a medical travel clearance form for ten days post op and she changed her flight and travel plans accordingly.

Case 2 – A trip of a lifetime

Mrs H had insulin dependent diabetes mellitus and came to see Dr K in a routine diabetic clinic appointment. She was delighted as her husband had organised to take her to Australia for their ruby wedding anniversary. She had read that people with diabetes may require medical travel clearance from their doctors before being allowed to board an aircraft. She had downloaded information from the airline’s website to show Dr K and she asked him to provide her with a letter stating that she was “fit to fly”.

GPs should consider the wording of statements for airlines carefully, and where possible offer factual information about a patient’s condition, the stability of it and presence or absence of recent deterioration

Dr K undertook a routine diabetic review with Mrs H. They discussed her medication regime, and she denied any hypoglycaemia symptoms. He looked at her recent blood results and conducted a physical examination. It appeared that her diabetic control was good and her condition was stable.

They discussed what she would need to carry with her on the flight. She would require needles, insulin, a blood sugar testing kit and medications for diabetic emergencies.

Dr K arranged for her to see the diabetic specialist nurse at the local hospital to discuss the insulin regime she would require for the flight, and agreed to provide a typed letter outlining her diagnosis and the fact that her condition appeared to be stable with no recent deterioration. On this basis he felt able to state that there appeared to be “no reason why this patient should not be fit to travel”.

Dr K also planned to outline in the same letter the equipment and medication that Mrs H would be carrying in her hand luggage and the reason why she needed to carry it.

He advised Mrs H to contact the airline in advance to discuss the fact that she would be carrying equipment and medication and to discuss her dietary requirements for the flight.

Case 3 – Last holiday before the baby comes along

Dr B received a form in her pigeon hole regarding Mrs F, a new patient to the practice who was 30 weeks pregnant. She had never met this patient before. In fact, her only medical record entry was when she became pregnant. She saw Dr B’s partner and was referred to the midwife.

The form was for medical confirmation of fitness to fly. It asked the doctor or midwife completing the form to state that the pregnancy was uncomplicated, providing the estimated delivery date and confirming that the patient was “fit to fly”.

The following day, Mrs F had a telephone consultation with Dr B. She told her that she had booked a long weekend in Prague with her husband, as they felt it was important to have a holiday before the baby arrived. She would be 32 weeks pregnant at the time of the trip.

Dr B discussed her concern about signing a form to state that Mrs F was “fit to fly” without seeing her. Mrs F fully appreciated her dilemma

Dr B took a history from Mrs F. It appeared she was fit and well and had had no problems during her pregnancy at all. This was her first pregnancy and she had been seeing the midwife regularly.

Dr B felt that before she could complete the form, she would like to see Mrs F for a face-to-face appointment and review her maternity notes. Mrs F was not keen to do this, as she was still working full-time and had already taken time off work to see the midwife the following day.

Dr B discussed her concern about signing a form to state that Mrs F was “fit to fly” without seeing her. Mrs F fully appreciated her dilemma.

After a discussion, they decided that it would be most appropriate for the midwife to complete the form for Mrs F, as she had been regularly seeing her throughout her pregnancy.

The following week Dr B received a message from Mrs F to let her know that her midwife had completed the form and she was off to Prague.

Summary

Air travel is so accessible and it is increasingly common for people to go abroad for holidays. Patients may not always consider that air travel is risky and consider that it is a routine matter for a GP to sign a fitness to fly statement.

Doctors may wish to consider discussing with the patient whether air travel could adversely affect a pre-existing medical condition. The guidance outlined by the Aviation Health Unit of the CAA is a useful resource as it outlines factors to consider including the effect of decreased air pressure in the cabin, immobility, timings of medication, the mental and physical effect of navigating through airports and the need for health insurance.

Fitness to fly can be an emotive area. Patients may have special reasons for wanting to travel and doctors may feel pressure to complete forms and declarations of fitness to fly. However, it is important that GPs act in their patients’ best interests and only make statements that are truthful and honest and not misleading.

Doctors may wish to consider discussing with the patient whether air travel could adversely affect a pre-existing medical condition

Doctors may wish to contact individual airlines’ medical advisors or the Aviation Health Unit at the CAA if they have specific queries.

Rather than signing a statement of “fitness to fly” doctors may wish to consider providing a factual letter outlining the recent course and stability, or not, of the patient’s medical condition. The final decision as to whether a patient may fly rests with the airlines and information provided from the GP will assist them in this decision.