It happens every year. Or, every other year, if you’re young, healthy and lucky.
What is “it”? It’s the dreaded DOT (Department of Transportation) physical examination.
What once was biannual slam dunk for most drivers has evolved into an event that strikes fear into the heart of every driver who is a few years older — and a few pounds heavier — than when their driving career started. The exam that used to be a perfunctory “check the box” event is more comprehensive than ever, relying on the physician’s opinion rather than simply meeting test criteria.
Hypertension (HTN), commonly known as high blood pressure, is a great example of how the DOT exam has changed over the years. HTN is very common among the U.S. population. Factors that can contribute to HTN include age, stress, obesity, smoking and more. Unfortunately, many drivers today are impacted by more than one of these factors.
In the past, drivers whose blood pressure exceeded DOT limits had some options. Most clinics would allow a return visit to recheck blood pressure. Some advised the driver to test early in the morning, skip the coffee or take a couple of aspirin before trying again. The driver could retest as many times as the clinic would allow.
If the driver still couldn’t pass, there was always the option of the clinic down the street, unless the driver’s employer specified a certain examiner. Drivers had favorites, sharing information about which clinics were more lenient than others or which had “problem” doctors. Drivers could even go to their private physician — or chiropractor or dentist — for a new exam. All that was needed were the proper forms.
All that changed on May 21, 2014. That’s when the Federal Motor Carrier Administration’s (FMSCA) National Registry of Certified Medical Examiners, a list of medical professionals allowed to provide DOT physicals, became effective. On Jan. 30 of the same year, a provision that required each state to revoke CDL driving privileges of drivers who did not have a valid medical examiner’s certificate (MEC) on file went into effect.
The new regulations changed something else, too. Rather than trying to get the right numbers to enter on a driver’s medical examination report, examiners were required to indicate that the problem was controlled. For many drivers, that meant a trip to their primary-care physician (if they had one) to be treated for high blood pressure or another condition identified in the exam. Sometimes the answer was as simple as a prescription for medication to treat the condition.
While the requirements of the exam were getting tougher, new medical conditions were added to the list. One of the most notable of these was sleep apnea and, more recently, chronic obstructive pulmonary disease (COPD). Physicians started measuring neck circumference and calculating body mass index (BMI). More than a few drivers were surprised by a requirement to undergo sleep apnea testing as a requirement for passing their physical.
Since many drivers taking pre-employment physicals are between jobs, insurance coverage for the testing — and any follow-up treatment isn’t available — putting the driver in a difficult situation.
Even drivers who are working can have difficulty getting regular medical treatment. Appointments are sometimes scheduled months in advance, and getting home for doctor visits can be problematic. Drivers who don’t have health insurance coverage can have difficulty paying for services. Worse, many drivers don’t even have a primary care physician, reasoning that a walk-in clinic will suffice if they become ill.
Obtaining and keeping a medical certification takes more effort than simply showing up for a physical exam once per year. Diet and exercise are important, of course, but passing that DOT physical (and keeping your driving privileges intact) begins with the right attitude about your health. It’s not about passing the physical. It’s about dealing with your health so you can continue in your livelihood — and your life.
Let’s return to our earlier example of high blood pressure. Diet and exercise can certainly help lower blood pressure, but making the lifelong commitment isn’t something everyone can, or will, do. Even for those who are dedicated to getting in better shape, it can take months to lose enough weight to impact blood pressure readings.
For many patients, the answer is a pill. Blood pressure medications are cheap, and it’s easy to get a prescription. The pills don’t take the place of diet and exercise, but they can have a quick impact on hypertension, reducing the risk of stroke or heart attack while reducing blood pressure enough to pass the physical.
Unfortunately, too many drivers take the medication only long enough to pass the physical exam, or maybe they just use up the first bottle. By doing this, they are ignoring a disease that kills thousands of people every year. Hypertension isn’t going away by itself. In fact, it’s likely that it will get a little worse every year.
Another common problem among drivers is diabetes, which typically shows up as glucose, a type of sugar, in a urine sample. Diabetes usually doesn’t go away by itself. When first diagnosed, it is usually treated with changes in diet, but it can progress to a point where medication is necessary. Medications might start with a prescription for pills and later progress until insulin is needed. As with hypertension, the examiner will want to know the disease is being controlled.
The point is that many medical conditions are lifelong. It’s up to you to take responsibility for maintaining your health so you remain safe behind the wheel and will make it home to your loved ones. Take the time to review your DOT physical exam and discuss it with the examiner. If you don’t have a primary care physician, get one. Deal with your health issues before they deal with you.
If you’re like most people, you’re getting older, you’re putting on a little more weight and your eyesight is getting worse. Go see your doctor.
Cliff Abbott is an experienced commercial vehicle driver and owner-operator who still holds a CDL in his home state of Alabama. In nearly 40 years in trucking, he’s been an instructor and trainer and has managed safety and recruiting operations for several carriers. Having never lost his love of the road, Cliff has written a book and hundreds of songs and has been writing for The Trucker for more than a decade.