Medical Approval Issues

[uncfnp]

If you asked this question of someone with seasonal allergies 1 year ago that was prescribed Flonase (fluticasone propionate), They would have to answer "yes". If you asked the question today, the answer would be "no" (the drug has moved OTC). Has the risk profile appreciably changed in 12 months?

And to further complicate matters some people still get Fluticasone as a prescription drug. Can be cheaper that way.

Bottom line is that no medical screening tool is perfect and questions will always be open to interpretation but I do think there is room for improvement on the questionnaire that would allow risk identification, reduce false positives and decrease the pressure to answer "no" to irrelevant/minor issues.

I wonder what % of instructors actually want to know? And what % of the dive shops/op.s many of them work under actually want to know?

Richard.

I have a signed medical release as a precaution. But when asked, my instructors have prefer "no" answers plus copies of my medical release. So I wonder too how much of the perceived dishonesty has been encouraged by the industry itself, excluding our own excellent instructors of course.

 

[RJP]

The people mentioned above have no qualifications to judge my health and no privacy training in order to handle my protected health information.

Right. That's why we have your doctor sign the form.

The only box your doctor needs to check says "I find no medical conditions I find incompatible with diving."

This whole "issue" is only as difficult as you want to make it.

 

[redacted]

Right. That's why we have your doctor sign the form.

The only box your doctor needs to check says "I find no medical conditions I find incompatible with diving."

This whole "issue" is only as difficult as you want to make it.

In terms of your risks as an instructor, what is the difference between a questionnaire marked all NO, and a questionnaire marked all YES accompanied by a Dr statement that he found no medical condition that he considered incompatible with diving?

 

[tursiops]

In terms of your risks as an instructor, what is the difference between a questionnaire marked all NO, and a questionnaire marked all YES accompanied by a Dr statement that he found no medical condition that he considered incompatible with diving?

Were both questionnaires answered truthfully?

 

[redacted]

Were both questionnaires answered truthfully?

Your guess is as good as mine.

 

[RJP]

In terms of your risks as an instructor, what is the difference between a questionnaire marked all NO, and a questionnaire marked all YES accompanied by a Dr statement that he found no medical condition that he considered incompatible with diving?

Silly question, when you think about it in practicality.

Assuming you're talking about the same diver... I would have no idea what my risk was if I had been given a falsely completed form with "NO" indicated on every line. With a doctor's clearance I would know there is no condition he/she considered incompatible with diving.

 

[ev780]

Right. That's why we have your doctor sign the form.

The only box your doctor needs to check says "I find no medical conditions I find incompatible with diving."

This whole "issue" is only as difficult as you want to make it.

Then that is the standard. Physician certification required for all divers. Because there are a series of laws and regs protecting the patient and their privacy. If we want to go there then we go there and I am OK with that. Unrealistic but a great example. My issue remains with the checkbox system for someone who is not bound by ethics and law. Lets just have a simple form that attempts to transfer liability. Again, I am not opining on that either as law ins not my gig. Healthcare is. It does not need to get into specifics it just needs to note what can go wrong, inform them of the potential medical conditions that increase likelihood of bad things happening, and ask the diver to acknowledge the risks. That's it. Does the same thing as the invasive checkbox form.

Lets go with a pretty extreme example and mostly why we have such strong patient privacy laws. Say someone is HIV positive but well controlled. I am not sure if the forms actually ask this since I just check no all the way down the line without reading it anyway. But assume it does or about one of the many side conditions that result. Other than maybe buddy breathing(and that is a big maybe) there is no risk to anyone else on the dive trip. What if that information found it's way from some desk clerk to the boat captain, then divemaster and then the other passengers? Bad deal all the way around. Most people have no idea about modern control of HIV and hysteria is likely. Now I know it is a long way from HIV to a guy with a couple sinus problems but that is not the point. Private means private and the law guarantees me that right so I am in the only position I have which is to check NO.

And I don't even want to get into the whole thing about saving a ton of dough and finally getting that trip to a far away place only to have someone wholly unqualified tell me I am stuck on the beach. We need a better system if medical issues are such a risk as to prevent diving. If a physical is the best deal lets get DAN to draw up a set of physician guidelines I can take with me to my doc and get a medical certificate. As long as most docs can hang their hat on a set of accepted standards there will be few who will refuse to do the proper exam and sign the form. Let's face it people who dive are generally people of means anyway. Not that big a burden, right?

OK OK that last paragraph was a shameless troll but where do we draw this line? INMHO a simple acknowledgement or a full on medical certification is on the correct side and the check box system is on the wrong one.

Someone mentioned I was a bit harsh. True and I apologize for sounding thataway. Just kind of hard for me to acknowledge the bulls**t in these forms and decision making paradigms with regards to my health.

 

[redacted]

Silly question, when you think about it in practicality.

Assuming you're talking about the same diver... I would have no idea what my risk was if I had been given a falsely completed form with "NO" indicated on every line. With a doctor's clearance I would know there is no condition he/she considered incompatible with diving.

Just in case I am missing part of your point, what difference does it make if it is the same diver, different divers or identical twins?

As I realize how little you actually learn from these forms, I also recognize that it is only if a diver is not medically fit to dive that instructor risk might be a consideration. So, anything less than a thorough, current, and reliable dive physical leaves you not really knowing.

I guess it is a good thing you have been trained to deal with emergencies without exposing yourself to excess risk.

The only thing those forms do is to provide some level of liability protection to the scuba provider when the fit hits the shan.

 

[RJP]

Then that is the standard. Physician certification required for all divers. Because there are a series of laws and regs protecting the patient and their privacy.

See, you have a critical misunderstanding of healthcare privacy laws:

1.) They only cover healthcare providers, healthcare systems, and healthcare data companies.
2.) They don't cover scuba diving.
3.) They don't cover YOU.

You don't have an absolute, inalienable right to receive a scuba certification. If you want to receive a scuba certification, you need to willingly complete the medical forms. If you don't want to complete the forms, you don't have to. That is your right. But then you can't take the scuba class. Which is OK... because you don't have a right to receive a scuba certification.

See... it's really not that hard.

 

[tursiops]

The only thing those forms do is to provide some level of liability protection to the scuba provider when the fit hits the shan.

Yes, that is one good thing.
The other good thing is it probably keeps the truely unhealthy folks from diving.

And no matter how many times ev780 says it, there is NO invasion of privacy if you just provide a doctor's signature without the questionnaire. You don't like the questionnaire and refuse to provide me with one? No, problem, just give me a doctor's OK and we can ignore the form.