After Germanwings, what next?

Predictably in the aftermath of the German-wings tragedy, the media chorus is ‘Something must be done!’. They say that the airlines  must do more about their aircrew’s fitness to fly, and especially psychiatric issues that might affect flight safety.

 

Easier said than done, for these reasons.

 

Although the best airlines will undoubtedly have proper welfare systems to protect aircrew health as far as possible, medical examinations are not their responsibility. This lies with the Civil Aviation Authority  (in the UK) which carries out all medical examinations with specially trained doctors. The examination is, as to be expected, pretty stringent and a medical certificate can be refused for common problems, such as high blood pressure. It is required every six months for all commercial pilots.

 

The media pressure, in the light of the astonishing revelation that  the German-wings co-pilot was having treatment for suicidal tendencies, is for greater attention to psychiatric issues.

 

This highlights another problem.

 

The effectiveness of any medical examination depends on the patient being fully frank with the doctor. If he conceals the fact that he is taking medication for some unrevealed health problem it is extremely difficult to get at the truth. This is particularly so with mental problems which don’t often have  physical symptoms that would be revealed by a routine examination.

 

Interestingly, the FAA has lifted its ban on pilots taking anti-depressants as this merely encourages them to conceal the fact.

 

One possible solution is to require all doctors treating aircrew patients to notify the CAA if they discover a problem that might affect a pilot’s performance and flight safety.

 

But this raises immediate issues of medical ethics and patient confidentiality. Perhaps these ought not to be regarded as sacrosanct when public protection is paramount.