Adding onto what I said, it's absolutely awful that pilots have to do this. People have given up on their dreams because of these archaic rules. Sending unconditional love and support for anybody trying to navigate this bureaucratic disaster of a system :ancom-heart:

There's a saying in aviation: You've got three people. Your doctor, your psychiatrist, and your aviation medical doctor. Your goal is to make sure the three of them never meet.

Don't use an AME that has a connection with the healthcare org you usually use, ideally they would have barely any records of you. Go to an entirely different area if possible. It's a hassle but taking precautions can only ever help you. These orgs rarely ever intercommunicate, it's up to you to disclose to them what you're taking. They will do a urine test, but the security from my experience is nonexistent. You could just do the classic sneaking in your friend's piss or, if whatever you take leaves your system fairly quickly, just pause it a day or two before your appointment (of course only if you're absolutely sure it won't have a detrimental impact on your wellbeing). If you work at the airlines though they will do their own drug tests, and chances are you're gonna have to be creative about workarounds. Fortunately the test they use never actually picks up my meds, nor do I believe that they are supposed to detect anything other than the standard illicit fare like cocaine and heroin. I'm not exactly an expert on cheating drug tests though, there's people who can explain it much better than me probably.

The only way they could possibly find out is if the totally random doctor somehow got their hands on your medical record from a different org (that they won't know has your record), if somebody snitches on you, or if the FAA gets a court to subpoena it for some reason, which would only happen in the event of some major fiasco.

If at some point in the future they come up with an integrated medical records system (unlikely considering the state of this country) then yeah. But that's just speculation and if that did happen, about half the community who are 100% concealing some sort of meds (read toxicology reports from the NTSB, almost every single pilot had some sort of drug in their system they didn't report taking) from the FAA are gonna be in hot water, which will definitely lead to public backlash. Frankly it's more likely that they actually progress on these issues than the aforementioned scenario.