One of the things I do at work is perform dept of transportation physicals. With a healthy patient this goes smoothly and takes 10 minutes. I had one the other day that took 30 minutes. Keep in mind that truck drivers in general have poor health. They spend all day seated with almost no physical activity. When they stop driving for the day they eat whatever is available at the truck stop. These choices are almost never healthy. In their free time many have been known to undertake risky behaviors. They also are never at home and so they do not see a healthcare professional unless it is urgent These are not just stereotypes. When I worked in health insurance all but one of the companies I worked for refused to underwrite policies for over the road truck drivers. Flat out. No consideration, no negotiations.

So back to my 30 min DOT physical. This guy in his 50's comes in having been on Xanax for 20 years. His psychiatrist is weaning him off of if by putting him on another benzodiazepine. Since he stopped taking Xanax his blood pressure has shot up to 170s / 110s. This blood pressure is incompatible with driving commercial vehicles in the US. Furthermore, taking benzos on a daily basis is also - they are too sedating. Now he's been driving for 20+ years while taking Xanax daily. I certainly never saw him before but this apparently never concerned any of the examiners who cleared him medically in the past. So, now it is up to me to tell this guy that I can't pass him. Now he can get these forms filled out by his specialist providers stating that, in their professional opinion he is not at risk and the medications he is taking won't make him take a nap at the wheel. If he does and comes back with a slightly lower blood pressure I can give a three month card. Well he proceeds to complain that I am taking away his livelyhood and then starts calling everyone he knows. But he won't leave my office. He calls his daughter who works in healthcare and she tells him to go somewhere else and not tell them about his medications and conditions. He calls his employer and complains to them. They run through every scenario; when will he get his Rx for his BP filled? How long can he drive on his current card? Who's going to pay his bills? Why won't I accept some 8 word note he brought in from his PCP stating he is under his care? Then he tries to call everyone of his providers to get them to talk to me so I will sign off on his med certain card. Only it's ten to five so he can't get ahold of them. He complains how I am taking away his livelihood by not clearing him and that all he wants to do is drive his truck and make a living. I explain to him that I want to continue to make a living as a PA and that if he were to wreck his truck i could loose my PA license. He turns to me and asks:"what's a PA"?