As certified medical examiners, our role in conducting Department of Transportation (DOT) physicals is critical for ensuring the safety of our roads. The process involves a comprehensive evaluation of a driver’s health to determine whether they meet the Federal Motor Carrier Safety Administration (FMCSA) standards for operating commercial motor vehicles. A structured and methodical approach to performing DOT physicals not only enhances efficiency but also ensures that each patient is assessed fairly and thoroughly. Here is an outline of my systematic approach to conducting DOT physicals, which may serve as a valuable guide for fellow providers.

Step 1: Pre-Exam Review

Before entering the exam room, I first check whether our office has previously performed a DOT physical on the individual. Reviewing past records provides vital insights into the patient’s medical history, medications, certification durations, and any recommendations made during prior evaluations. For instance:

• Certification History: Understanding why a driver received a limited certification period (e.g., six months for obstructive sleep apnea evaluation) helps identify areas which require a current update in status.
• Past Conditions and Medications: Noting previous medical conditions and comparing them to the current MCSA-5875 form helps track changes or new concerns. For example, a patient who no longer reports taking oral diabetic medication could indicate controlled blood sugar levels through diet and weight loss. Alternatively, it could signal noncompliance if they discontinued medication without medical guidance.

If previous exams are available, I compare histories to identify any new developments or discrepancies.

Step 2: Reviewing Page 1 of the current MCSA-5875

Page 1 of the MCSA-5875 form provides critical details about the patient’s surgical history and medications. I focus on these areas to identify potential concerns that might impact the patient’s ability to drive safely:

• Surgical History: Surgeries such as hernia repairs, neck procedures, or orthopedic operations may affect range of motion or lifting capability. A surgical history which includes cardiac procedures could require additional standards to be met.
• Medications: Reviewing medications offers clues about the patient’s current health.

Step 3: Reviewing Page 2 of MCSA-5875

Page 2 expands on the patient’s medical history. For certain medical conditions, I will print out the appropriate MCSA form to give to the patient to have their treating provider complete. For example:

• Diabetes: If the patient has diabetes, I print and provide them with the MCSA-5870 or MCSA-5872 form for further documentation by their treating provider.
• Controlled Substances: For patients taking controlled substances, I print the MCSA-5895 form, which they must have completed by their provider.

To simplify the process, I place the responsibility on the patient of ensuring the form is filled out and returned by their treating provider.

Step 4: Reviewing Page 3 of MCSA-5875

Page 3 of the form includes critical data points such as height, weight, blood pressure, pulse, and urine dipstick results. Each measurement is carefully reviewed:

• Height and Weight: I calculate the patient’s BMI to assess potential risks for obstructive sleep apnea or other conditions.
• Urine Dipstick: Abnormal results, such as proteinuria, may indicate the need for further evaluation. If hematuria is present, is the patient a female of reproductive age?
• Vision and Hearing Tests: I verify these results against FMCSA standards to evaluate for the possibility of the patient requiring a referral for further testing.

This detail-oriented review ensures all preliminary information is filled out in entirety and provides a foundation for the in-person evaluation. This initial review allows me to enter the exam room prepared and providing a more focused assessment.

Step 5: Meeting with the Patient

After the preliminary review, I enter the exam room, introduce myself, and wash my hands. The in-person evaluation begins with a thorough discussion of the patient’s medical history, as this sets the stage for the physical examination.

Discussing Medical History

I review the information provided on the MCSA-5875 form with the patient to clarify and expand on their responses. This discussion highlights areas requiring additional focus during the physical exam. For example:

• Post-Surgical Patients: A patient with a history of shoulder surgery may require a detailed shoulder examination. If the patient had a recent CABG, the sternum would be properly examined to ensure full healing.
• Diabetic Patients: I might perform specialized tests such as two-point discrimination or filament sensation testing to assess peripheral neuropathy.
• Condition effecting Grip: Patients with carpal tunnel, cervical radiculopathy, or finger amputation should be assessed with a dynamometer for adequate grip strength.

Step 6: Performing the Physical Examination

The physical exam is tailored to the patient’s medical history and any conditions noted during the discussion. Any abnormality must include further documentation. Here is an example and how I address it:

• Musculoskeletal Conditions: For patients with a history of finger amputation, I document detailed observations. For instance:

“Patient has amputation of distal phalanx of the fourth digit on the left hand. Patient achieved dynamometer results of 58, 56, and 55 lbs. with the left hand and is right-hand dominant. Patient shows no limitation in power grasp or prehension.”

Step 7: Certification Determination

Once the exam is complete, I discuss the certification determination with the patient. Transparency is key to building trust, so I explain:

1. The Reason for the Determination: Whether the patient is certified for the full two years, a limited period, placed on determination pending, or disqualified, I provide clear explanations. If the patient questions the decision, I will present literature from The Medical Examiners Handbook or The DOT Medical Examination by Natalie Hartenbaum. I like to take the approach of, “Let’s work together to fulfill these medical recommendations.”
   
    I commonly hear from the patient, “but those are just medical recommendations.” My answer to this is to explain that I should follow the recommendations unless I have data or literature which supports a different decision.

2. Next Steps: If further evaluation or documentation is needed, I ensure the patient understands what is required, such as completing forms like the MCSA-5895 or obtaining additional tests and the timeframe allowed for such.

Finally, I complete the MCSA-5875 Medical Examination Report and the MCSA-5876 Medical Examiner’s Certificate and upload the information to the FMCSA National Registry via electronic form MCSA-5850.

Conclusion

A structured approach to performing DOT physicals ensures thorough and consistent evaluations for all patients. By taking the time to review previous exams, thoroughly assess medical history, and tailor the physical examination to individual needs, certified medical examiners can confidently certify drivers who meet FMCSA standards while addressing any potential risks.

Adopting these best practices will not only improve the quality of your evaluations but also strengthen your role in promoting road safety. Remember, every step you take as a certified medical examiner contributes to the greater mission of ensuring that commercial drivers are fit to operate vehicles safely and responsibly.