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Start Performing DOT Medical Exams
By Michael Megehee, DC
Of the three services that Dcs can offer to commercial drivers and motor carriers, the Department of Transportation (DOT) medical exam is usually the starting point. In previous issues of ACA News, we’ve described the benefits of performing the DOT exam. This article is intended to help you prepare to add DOT medical exams to your practice.
What Does the Medical Exam Include?
Although there is no current federal requirement for “formal” physician training, providers are required to be familiar with the Federal Motor Carrier Safety Association (FMCSA) medical standards and the “rigors” of driving. Begin by downloading the nine-page DOT physical form at www.teamcme.com/drivers/dot-physical- form/. You must be especially familiar with Pages 4 to 8 of the form. After performing the exam, the provider gives the driver a Medical Examiner Certificate, which the drivers must carry with them when they drive.
We all have patients who are drivers, and this is a good avenue to perform your first DOT medical exam. A complete DOT medical exam will require a 30-minute appointment. Half of that time is Spent with office staff, and half with the physician.
Required Tests and Equipment
A urine dipstick test for glucose, blood, protein and specific gravity is required; however, if you don’t perform this service, federal guidelines allow referrals to a lab or another physician. Urine dipsticks are CLIA exempt, but chiropractic scope of practice issues in Tennessee, Hawaii and New York may require a referral.
To test the driver’s hearing, providers use the “whisper test.” Those without an audiometer refer out drivers who don’t pass. For this reason, having an audiometer is convenient, but it must be a “pure tone” audiometer, and the automatic models keep your staff from having to manually administer the test. It also allows your staff to perform the yearly hearing tests required by OSHA for workers in noisy environments.
Other supplies needed to perform the DOT medical exam include an otoscope; blood pressure cuff; Snellen eye chart; stethoscope; and cards with signal green, red and yellow. There is no requirement for an otoscopic exam of the eye unless you suspect a medical condition, but you must visualize the auditory canal and tympanic membrane. Having an automatic blood pressure cuff reduces the workload for your staff, and stethoscope use is limited to breath and heart sounds and auscultating the abdomen and carotid arteries.
Visual acuity is measured for distance only (20 ft) and must be reported in Snellen-equivalent measurements. It is not necessary to use color vision charts, as the driver is only required to differentiate The colors of “signal” green, yellow and red. Having a card for each of these specific colors saves time as drivers, even if color blind, can nearly always distinguish them.
Diagnosis or management of medical conditions is not a requirement of the DOT medical exam. Your role as medical examiner is to determine whether the nature and severity of the condition poses a risk to safe driving. For healthy drivers, this is simple and straightforward. However, it can be challenging when a driver has a health condition that could pose a risk to safety. These include cardiac, pulmonary, mental and neurological conditions, as well as use of certain medications.
For drivers with medical conditions, examiners communicate with the treating physician and, in many cases, a recommendation to drive from the treating physician is a requirement. As you work with these other providers, the FMCSA medical standards provide the benchmark to make the driver status decision. The medical examiner, not the treating physician, makes that determination.
Learning the FMCSA medical standards and guidelines is the key to providing DOT medical exams competently.
While the comprehensive nature of your training at chiropractic school and private practice will serve you well, you will gain more specific knowledge of certain medical conditions not commonly managed in a chiropractic office. The FMCSA online Medical Examiner Handbook, available at http://nrcme.fmcsa.dot.gov/mehandbook/Mehandbook.htm, contains the answers to questions about some of the common medical conditions that affect Medical examiners use “best practice” to determine driving status, but a number of health conditions and medications always warrant driving disqualification. For these reasons, attending training is the best course to follow. At a live training, you can have your questions answered immediately and listen to the questions and answers of others. Rubbing shoulders with other medical examiners also leads to discussions of difficult and interesting cases.
The lack of required training has been the Achilles’ heel for performing consistent high-quality DOT medical exams The National Registry will for the first time require physician training. As the Final Rule is projected to be published this September, those that begin training now will have the edge. They will be familiar with FMCSA medical standards and will have established a client base. This is your opportunity to “specialize,” to raise the standard of DOT medical exams, serve the needs of the transportation industry, and participate in FMCSA’s goal to improve highway safety.
ACA News Extra...
Start Now! Free teleseminar—March 16, 1:30 to 2:30 p.m. EST
Recognizing the opportunity that providing DOT medical exams presents to DCs, ACA has partnered with TeamCME to provide comprehensive, hands-on training to doctors of chiropractic on performing the DOT medical exam, as well as alcohol and drug testing training. To learn more, register for a free teleseminar—March 16, 1:30 to 2:30 p.m. EST—at www.acatoday.org/teleseminars.
For additional information on performing the DOT medical exam and what supplies are needed, please go to www.TeamCME.com and fill out the physician information form. In the remarks section, please indicate that you would like a copy of “Getting Started.” Look for information regarding the 2011 training convention schedule in ACA publications, on www.acatoday.org or www.TeamCME.com.