DOT exams are for Public Health and Safety

Commercial drivers can be very difficult to deal with when they have medical conditions requiring further follow up. There are a lot of reasons for this, most importantly to them, their livelihood.

But you have to remember we don’t do certified medical exams for the driver. They are done for public health reasons – making sure they do not have medical conditions which may interfere with the job of commercial driving, leading to over 100,000 injuries and more than 4000 fatalities every year from large truck crashes.

They are still in the mindset of “doctor shopping” which should be going away now with only certified medical examiners.

Sleep Apnea evaluation is up to the Examiner

It is frustrating for all of us that FMCSA has not issued a final rule on sleep apnea, but leaves it to the medical examiners discretion as to how to evaluate and certify such drivers. Some examiners I have heard require all drivers with a BMI over 30 to get tested, others just with neck size.

We chose the STOP-BANG method because it has been validated in the medical literature to be an accurate predictor of obstructive sleep apnea.

I have had many many drivers over the years want to discontinue their exam as soon as I mention something (often that they’ve tried to hide) that may be an issue with their certification, or that I could only give them a temporary until I get more medical documentation, not want to pay and “doctor shop” for someone who will not ask the right questions or catch that heart murmur or whatever, and issue them a 2 year card.

I had a 63 y/o guy recently who looked 83, wheezed down the hallway with his smokes in his shirt pocket and checked all “no’s” on his history form. When I asked about his very loud heart murmur he said “oh yeah I had an ECHO 2 months ago” Turns out he was also post MI, needed a stress test, a pulmonary function test, AND failed the STOP – BANG and needed a sleep test. He was of course disqualified but indicated he wanted to discontinue the exam and go somewhere else! I told him, sorry, we’ve already done your exam, I’ll be happy to gather all the information required to see if you can get at least a temporary (doubt it), but we have to list you on the registry as disqualified.

You cannot let them pull this kind of behaviour. You must collect the fee up front unless it is a corporate account that you bill, no refunds because they might not get certified. Once they check in and pay for an exam, that’s it.

When asked about why are you doing a STOP BANG, or any other screening or evaluation process you use for sleep apnea, explain that it is part of their medical history. Further questions can be answered by the doctor, NOT the MA. DO NOT indicate whether they “pass or fail” the STOP BANG/screening, that it is up to the doc. Simply state “You can ask the doctor about that.”

Providers, if you get through only the history section and it is clear they are going to need further evaluation and they want to stop the exam and go elsewhere, that is no reason to give them a refund.

Here is a short video of the evaluation and treatment algorithm for obstructive sleep apnea in commercial drivers:

Obstructive Sleep Apnea Algorithm

Or access the full course here:

Obstructive Sleep Apnea in Commercial Drivers Course

NRCME Goal to Prevent Doctor Shopping

We must do our part to prevent doctor shopping, one of the expressed goals of the NRCME certification process. If they fail, they go on the registry, and if some other examiner passes them, they will get a call from the NRCME to straighten it out and may intervene, or discipline an examiner who is passing someone who shouldn’t be.

If I find that someone I failed got a card from another provider, I will call that provider and the NRCME.