Does anyone here perform DOT Physicals?

[PAnewgrad50]

I was recently certified to perform DOT physical examinations.  While seeing my colleagues perform these DOT examinations, 99.9% of them are straight forward with no real issues.

 

Of course my first patient for a DOT certification shows up, checks no to all past medical history, and I think great a perfect start.  

 

Turns out that the second he took off his shirt he had surgical incisions all over... "I tore my labrum" "I had a biceps tendon tear repaired" These are no big deal... I can easily assess functionality and strength of these body parts... 

 

The real concern came when I look in his mouth and noticed he did not have a uvula.  I inquired with the patient, who told me he had "loud snoring" (which he omitted in his health history) and according to him as a result "had his uvula and probably his tonsils removed". Since sleep apnea is a big deal to the DOT, I became concerned and told him I could not certify him until he got a letter from his treating physician stating that his sleep apnea had been treated and resolved, along with the appropriate studies.

 

Patient returned to the office 3 hours later, swearing up a storm, stating "I never had sleep apnea, I had a deviated septum"  Turns out he had a  uvulopalatopharyngoplasty and septoplasty performed almost 10 years ago, which resolved this issue.  He did have a report documenting all of this.

 

At this point I issued him certification, as there is no guideline by the DOT stating a deviated septum is grounds for disqualification.  I used my medical judgement to deem the patient safe to drive.

 

Did I make the correct decision?

[bradtPA]

Myself, I might have asked him some Epworth sleepiness scale questions, and if I had further doubts, scheduled a sleep study.