I have been a private pilot for about 20 years.
My usual practice is to go for a medical in the
beginning of the month in which my current medical expires.
That way I get the full 24 months of coverage (class 2).
Bad idea.
This time, my AME decided that he needed to send
my case to the FAA for review (an arguable choice).
This started a chain of delays and requests for additional
info that went on for months.

Lesson1: Don't wait until your medical is almost up
before renewing. Hence a 24 month medical should more
realistically be 22 months, if you want un-interrupted flying.

It does not take much to trigger this process and it
is hard to predict, as the rules seem to be a moving target
and un-evenly enforced.
In my case, I started taking a medication for a very
marginal case of high blood pressure.
Neither my primary doctor or myself thought this was
a big deal, mostly precautionary. Apparently this sets
off alarm bells at FAA. They wanted an EKG, a plethora
of lab tests, repeated blood pressure readings, etc.
(I eventually was issued a medical, but only for 12 months.)

Lession2: I also learned that you need to find an AME who
understands the FAA polices and procedures.
This makes a huge difference if any issues arise.
Mine turned out to be surprising clueless and handled the
matter in an inappropriate manner, which caused some extra delay.
I would still be going around in circles if another MD/pilot
friend of mine stepped in and wrote a medical report that
properly addressed the FAA requests.

We need a way to identify the better AMEs.

For more details, contact me off-list


Joel Williams