The individual's vs. the organization's doctor: value conflict in psychiatric aeromedical evaluation

Physicians who perform aeromedical evaluations are aware of the value conflicts inherent in being both a physician and a social agent. This paper examines some of the conflicts which occur when the psychiatrist acts as an aeromedical examiner. Five areas are examined: 1) the use by the psychiatrist of the authority delegated by the social system, 2) issues of confidentiality, 3) efforts of the social system to influence the psychiatrist's findings, 4) the requirements to make decisions in areas where scientific data is lacking, and 5) the physician's imperative to "do no harm" to his patient. Recommendations to minimize the impact of these factors through recognition, open discussion, and thoughtful structuring of the physician-patient relationship are made.