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BOSTON -- Fear that revealing health problems to medical professionals may result in losing certification to fly impels many pilots to avoid healthcare encounters, a survey indicated.

Two-thirds of military and paid civilian pilots reported having answered "yes" to at least one of four survey questions addressing reluctance to seek formal medical advice about health problems, according to William R. Hoffman, MD, a U.S. Air Force employee based at Brooke Army Medical Center in Fort Sam Houston, Texas.

In a poster presented here at the American Academy of Neurology annual meeting, Hoffman noted that both civilian and military pilots can be grounded if they have certain medical symptoms or diagnoses. Such actions "can have negative occupational, social, and financial repercussions."

Consequently, pilots may see disincentives to be truthful about their health if there is a chance that their employers or government or military officials will find out.

In a , more than three-quarters said they "felt worried about seeking medical care due to concern for their career or hobby." The new survey elaborated on the question by asking about specific aspects of reluctance. Respondents were asked to agree or disagree with statements including:

• Sought informal medical advice for fear of certificate loss
• Flew despite experiencing a new symptom (physical or psychological) that warranted evaluation
• Did not disclose prescription medication use
• Misrepresented or withheld information on a written healthcare questionnaire for fear of certificate loss

Respondents included 2,383 nonprofessional civilian pilots, 1,097 paid civilian pilots, and 261 military pilots. The web-based survey was advertised via social media channels often used by pilots and was also distributed to U.S. Air Force medical clinics.

Just over half of the unpaid civilian pilots denied ever hiding any of the four types of information. But that was true for only 33.6% of the paid civilian pilots and 32.2% of the military pilots.

Fortunately, among all respondents, only 6.8% said they had not disclosed prescription drug use as required, and just 16.8% acknowledged that they had kept new symptoms secret. But 45.7% acknowledged seeking informal advice in place of seeing a professional, and 26.8% said they had withheld or overtly misrepresented information on written forms. A few (2.2%) admitted to all four types of avoidance.

Women were somewhat more likely to have avoided disclosure in at least one way (62.0% of all female respondents vs 55.4% of men; P not reported). Lack of openness was also more common in younger pilots, especially those ages 25 to 40 (69.1% vs 40.7% in those older than 60). In addition, union membership and active-duty military status were associated with high rates of avoidance (70.1% and 75.8%, respectively, vs 51.8% among non-unionized civilian and military reservist pilots).

Hoffman suggested that neurologists recognize the potential for pilots to be shy about revealing their true health condition. "This might be mitigated through developing rapport with the pilot, asking questions about concerns related to their flying status, and clear communication about documentation and clinic course."

Additionally, he recommended, "it is good technique to order only the necessary tests for all patients, to include pilots to avoid false positives."

Importantly, however, medical professionals cannot promise to keep these discussions and findings to themselves. Hoffman noted that, if a professional has concerns about a pilot's health, it should be communicated to the official charged with evaluating that pilot's fitness to fly.

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