Quite simple really, empower the DAME to issue the full 12 Month certificate on the spot. A whole load of conditions should be 'normalised' especially in Multicrew ops. I have thought for a while now that the whole aviation medical lark is a bit of a waste of time, there should just be a basic checkup each year and barring any horrendous developments you should be good to go, if you develop a serious condition then and only then should you be referred to AVMED for management, otherwise for he majority of conditions surely the DAME can manage the plan. I have know 4 pilots now over the last 10 years who have died due to unexpected cardiac events, all were relatively young 45 - 55 and on the face of it fit and healthy and in possession of Class 1 medical Certificates including recent ECG's. Can you see, hear, talk and pee on a stick please should be the extent of the checkup, along with blood pressure and weight readings for tracking.