What is a DOT Physical? That is a good question. Unfortunately, the answer you receive will most likely vary with who you ask. I will shed some light on the question I get most often, “What is a DOT Physical?”
New Federal mandates have changed the way DOT physicals are performed in most offices. The good news is drivers have been very receptive to the increase in service they receive. For years physicians have been charging for their signature a medical certificate for everyone who breathes and has a heartbeat. This practice is unethical and the US DOT has ensured that they are committed to ending this dangerous practice.
When doing a DOT Physical, the DOT Medical Examiner has two categories of conditions for which he is looking at. Those two categories are referred to as “discretionary” and “non-discretionary”. What is a DOT Physical? There are four (4) “non-discretionary” standards. These are the standards which every single driver must meet to pass the federal minimum standards for fitness for duty. They are as follows: (1) Vision; (2) Hearing; (3) No seizures; (4) Must not take insulin for diabetes (although this does not apply to all intrastate drivers, depending on the state.
Outside of the “non-discretionary” standards, there are several “discretionary” standards. The following are minimum DOT Physical guidelines which are to be applied to the “discretionary” standards. If the DOT Physical medical card examiner is not doing ALL of the following, drivers may be subject to losing their Commercial Driver’s License. Blood pressure and heart rate are checked, vision and hearing tests must be administered and a urine specimen must be collected. The urine specimen is collected to check for glucose, protein, blood and specific gravity (concentration). These are indicators of how well your organs are functioning and may indicate diabetes, renal pathologies or other visceral disorders. When properly performed using all DOT Advisory Criteria, the DOT physical exam generally takes on an average of 38-55 minutes.
Physical Examination: Medical Examiner Responsibilities. Regulations – The Medical Examiner must perform the described physical examination (NOTE: The regulations do NOT say trained assistive personnel may perform ANY part of the following exam – the exam described below is the responsibility of, and MUST be performed by the CDL DOT Physical provider). When done properly this exam often takes approximately 30-45 minutes.
1. General Appearance: The Medical Examiner (ME) should note any abnormalities with posture, limps, or tremors, as well as making note of the driver’s emotional state and overall appearance. The medical examiner should be looking for potential adverse impact on safe driving.
If the driver markedly overweight, the ME will consider the clinical and safety implications when integrated with all other findings. The driver’s BMI should be considered in the totality of the clinical picture to determine if sleep apnea is or may be present.
The DOT Medical Examiner will also look for signs of current alcohol or drug abuse. If those are noted, the CDL Physical examiner must refer the driver to a Substance Abuse Professional for evaluation.
It is with regret that this even needs to be mentioned. We understand that drivers sweat, particularly in the heat and humidity that is South Florida. But if your odor is so foul and or offensive that it is making people hold their breath and or you are clearing out our office so that people do not have to smell you, your exam will be immediately terminated. You are strongly encouraged to bathe and brush your teeth prior to your DOT Medical Exam. From a clinical standpoint, strong body odor may mask other smells indicative of certain pathologies and hinder the ME’s judgment. Either way, this is not acceptable.
2. Eyes: At a minimum, the DOT physician must check for pupillary equality, reaction to light and accommodation, ocular motility, ocular muscle imbalance, extraocular movement, nystagmus, and exophthalmos. These findings may indicate pathologies that require further evaluation, render the driver unfit to drive commercial vehicles, or may even be qualifying on a case-by-case basis.
3. Ears: The Medical Examiner should check for evidence of any disease or condition effecting the ear(s). At a minimum, the certifying physician must check for scarring of the tympanic membrane, occlusion of the external canal, and perforated eardrums. CLEAN YOUR EARS PRIOR TO YOUR DOT PHYSICAL/MEDICAL EXAM. If the ME cannot see your tympanic membrane (ear drum), then you cannot be certified.
4. Mouth and Throat: Conditions of the mouth and throat must be evaluated to determine whether the condition or treatment requires long-term follow-up and monitoring to ensure that the disease is stabilized, and whether the treatment is effective and well-tolerated.
5. Heart: The DOT physician must examine the heart for murmurs, extra sounds, enlargement, and a pacemaker or implantable cardioverter defibrillator. The ME will also check the lower extremities for pitting edema and other signs of cardiac disease. ICDs are disqualifying.
If the ME finds any abnormalities that indicate the driver may have a current cardiovascular disease accompanied by and/or likely to cause symptoms of loss of consciousness, difficulty breathing, collapse, or congestive cardiac failure, a cardiologist clearance will be required.
Work restrictions are not permitted. The DOT Physical/Fitness for Duty Examination is an all-or-none examination. The commercial driver must be able to perform all job-related tasks, including lifting, to be certified.
6. Lungs and Chest: The Medical Examiner must examine the lungs and chest for abnormal chest wall expansion, respiratory rate, and breath sounds including wheezes or alveolar rales. The ME will also check for impaired respiratory function and cyanosis or bluing of the skin and nail beds. Clubbing of the fingers is an indicator pulmonary disease.
7. Abdomen and Viscera: The DOT physician must check for enlarged liver and spleen, masses, bruits, hernia, and significant abdominal wall muscle weakness. The ME will check for tenderness and listen for abnormal bowel sounds.
8. Vascular System: The DOT physician must check for abnormal pulse and amplitude, carotid or arterial bruits, and varicose veins. The ME should also check for pulses in the distal extremities.
9. Genitourinary System: The DOT physician must check for hernias. Specifically, the ME will evaluate any hernia that causes the driver discomfort to determine the extent to which the condition might interfere with the ability of the driver to operate a CMV safely. Further testing and evaluation may be required. NOTE: A driver who has not provided a urine specimen CANNOT be certified.
10. Extremities-Limb Impaired. The DOT physician must check for fixed deficits of the extremities caused by loss, impairment, or deformity of an arm, hand, finger, leg, foot, or toe.
The ME will ensure that the driver has sufficient ability to grasp objects in the upper limbs to maintain steering wheel grip, as well as sufficient mobility and strength in the lower extremities to operate pedals properly.
Signs of progressive musculoskeletal conditions, such as atrophy, weakness, or loss of muscle tone consistent with Muscular Dystrophy and other conditions will be evaluated. The ME will also look for signs of clubbing or edema that may indicate the presence of an underlying heart, lung, or vascular condition.
11. Spine, Other Musculoskeletal: The DOT physician must check the entire musculoskeletal system for previous surgery, deformities, limitations of motion, and tenderness. The ME will want to know if the driver has a diagnosis or signs of a condition known to be associated with acute episodes of transient muscle weakness, poor muscular coordination, abnormal sensations, decreased muscular tone, and/or pain. NOTE: Drivers confined to a wheelchair are not necessarily disqualified, but an SPE will be indicated.
12. Neurological: The DOT physician must examine the driver for impaired equilibrium, coordination, and speech pattern. The driver must not have signs of loss of balance. Reflexes should be symmetrical, and the foot reflex, also known as Babinski’s reflex should not be present. The driver will also be evaluated for loss of sensation and positional abnormalities.
The DOT physical examination should be conducted carefully and must, at a minimum, be as thorough as the examination of body systems outlined in the Medical Examination Report form. For each body system, the DOT Physical examiner must mark “Yes” if abnormalities are detected, or “No” if the body system is normal. The DOT Physical provider must document abnormal findings on the Medical Examination Report form, even if not disqualifying.
The CDL DOT Physical examination is for public safety determination and is considered by the Federal Motor Carrier Safety Administration (FMCSA) to be a “medical fitness for duty” examination. Above are the Federal minimum regulations that DOT CDL Physical providers must perform and those regulations are taken directly from the Federal Motor Carrier Safety Administration. Companies and physician providers may require additional testing, but these are the DOT Physical minimum standards that ALL DOT Physical providers MUST follow.
Trained assistants may measure height and weight. However, the Medical Examiner must sign the Medical Examination Report form. A link for reporting rogue examiners not following the minimum FMCSA standards will be provided at a later date.
We proudly provide Federal DOT Physicals for all of Broward County to include 33314 Davie, Ft. Lauderdale, 33334 Oakland Park, 33325 Sunrise, Tamarac, Hollywood, Plantation, Margate and Pompano Beach.
Where to get a DOT Exam. Directions: We are centrally located in Broward County just south of I-595 and west of State Road 7/US 441. Turn west onto Oakes Road from State Road 7 and follow the signs to the Florida 595 Truck Stop. We are located inside the Main Building.
Weekend and evening Federal DOT Physicals for DMV CDL appointments are available.
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