OWD license without a doctor's certificate?

[purbeast]

I did read your story. How much money did it cost you to do all that, including how much time off work, out of curiosity. If you had to go through that every year, would you be as sanguine? If you passed all those tests and had a doctor who was still hesitant to sign you off, what would you have done?

That's the peril of going to dive specific physicians. My conversation with my PCP is shorter, because they are already familiar with me and my history. And then I forget to bring the form with me. Or I bring it and forget it on a trip. Or even after all the normal testing, the doctor still won't sign because of their discomfort in accepting liability. Then you've gone through all the workup and discussions, but still don't have a piece of paper to show for it, so do you just never dive?

Well the first time I did all of that I didn't get a note, and yes it sucked but I still went through with it years later. As for how much it cost I don't know, because of insurance covering most of it, other than some copays and small bills. But I just used my HSA to pay for it so I didn't think much of it.

To me it's just the cost of doing business with my ailment. I've been on asthma medicine since I was 7 so it's just something I accept that I have to do sometimes in spending money for asthma related stuff.

Also, the first thing I did when I got my letter was make a digital copy, email it to myself, store it on my phone, and store it on google drive. That way I won't ever really be in a situation where I don't have access to it. I plan on bringing the original with me to GC when I do my checkout dives though just in case.

If I had to do it every year, I'm pretty sure I could just go back to the pulmonary doctor that signed off on me, do a regular checkup and have a discussion with him, and he'd sign it at this point. To me it's not that big of a deal.

I do have some comfort in knowing that the pros that I will be diving with will know that I have asthma or had it, because maybe it will make them keep an eye out or if something DID go wrong, they would know what it was that potentially happened. I could be overthinking about what they would do differently though, but in the end I took all precautions and didn't lie about anything so I am okay with that.

 

[SapphireMind]

Wow! Coming from a physician, that's hard to read.
So our New Diver (this is the New Diver forum) reads your comments and maybe concludes a) I shouldn't worry about the form; just check all No's, because it's nobody's business but me and my doctor, or b) if I think I have a problem, I better not go to a physician who has expertise in diving physiology, because it could cost a lot of money and time with no guarantee, whereas my local MD knows all about me and will just sign me off.

Did I get that right?
I'd like to think that my patients get valuable counsel. Most get signed off; some don't.

Nope, you didn't. Because you missed the fact where I said you should disclose medical information to people involved with the diving.

And the problem with going to a different physician who does not know you as well should be obvious - there are tests to repeat, records to find, more time off work, etc.

I don't doubt that you give valuable counsel, but like all self-pay physicians in the US, you have to be aware of the difficulties in dealing with all that out of pocket. For some conditions it is more important than others, and it becomes difficult to expect people to always go to a dive physician, especially considering many locations may not have dive physicians readily accessible. How much money do you think is reasonable for someone whose depression is well-controlled to spend for them to travel to a dive physician and pay out of pocket so they can be signed off? Or someone who had gestational diabetes (which would fall under a category that should be marked) or even mild pregnancy induced hypertension?

re: aversion to assuming professional liability

I have to think there are more than a few professions/vocations where the very real elevated risk of professional liability is a given, and anyone getting into that line of work knows that up front, like WAY upfront, but chooses to pursue that profession regardless. So asking someone to provide that service and expertise that they trained for, sometimes trained for years, with ALL that responsibility entails, seems to me pretty much to be a no-brainer. If they have buyers remorse on that career path, they change it.

Manage the risk? Yes.
Avoid at all costs? ....?

Managing the risks means you don't sign things that you can avoid signing, especially when it is a high-risk activity. My PCP will do it, but in the end, you are still trusting that it is the actual physician signature, without checking. You are trusting that I was honest with the doctor about my physical conditions, without checking. The signed piece of paper becomes meaningless because you are still essentially relying on the word of the diver that they are safe.

Wrong, doctor. Whether I trust you or not is irrelevant. After you die, it's your family I worry about. Because, of course (!) it couldn't have been your fault that you dived when you shouldn't have. It had to have been the fault of the dive boat, dive school, instructor, ANYBODY but the diver, their beloved family member.

Under your system, all I'll have is the record of someone who says they saw a doctor, with no doctor's signature to confirm. In today's litigious climate, yeah, that'll fly. If I'm threatening to not let you in the class without your signature promising that your doctor said it was okay, that's the textbook definition of being under duress.

Forget about the educational and safety value of checking a box and being required to follow it up and document it. Strictly from the CYA standpoint that so many seem to be focusing on here, it's a slam-dunk that I'll not take many divers assurances that their doctor said it was okay. Folks just don't know what they don't know, and if something they don't understand is now in the way of their new hobby...?

Again, I highly advocate people follow up on any and all conditions, and be sure they are safe for diving prior to engaging in it, and to be open with those who they are diving with about anything in their medical history that is pertinent. But having the doctor sign a form like it was a prescription or anything else is just theater. You have a signature, with no confirmation that it is a real physician, that the proper things were discussed, that the provider was well-versed enough in dive physiology to understand the risks, etc. No one is calling the physicians after seeing the scrawled signature to ensure they did enough testing.

You are making a lot of assumptions and inferences to what I am saying, which aren't true and getting fairly aggressive. Again, you are looking at it from the perspective of people who shouldn't be diving and are avoiding marking things so they don't get caught - which they will do no matter what, and/or will forge the signature. But the other end is people who are fine to dive and making it more difficult for them to dive. Someone who is on stable thyroxine shouldn't be turned away at a dock because they forgot a form or didn't realize it was needed for that.

Most dive accidents fall squarely on the shoulders of the divers, and I'm all for that, which is why a way for the diver to acknowledge their medical conditions and take responsibility for them is better (to me) than passing the buck to their provider. But communication (in my opinion) is far more useful for keeping people safe, rather than people feeling like they need to hide it because of a liability form. I think there are better ways to handle that liability and put more responsibility onto the diver themselves, because they are the one going into the water.

 

[SapphireMind]

Well the first time I did all of that I didn't get a note, and yes it sucked but I still went through with it years later. As for how much it cost I don't know, because of insurance covering most of it, other than some copays and small bills. But I just used my HSA to pay for it so I didn't think much of it.

To me it's just the cost of doing business with my ailment. I've been on asthma medicine since I was 7 so it's just something I accept that I have to do sometimes in spending money for asthma related stuff.

Also, the first thing I did when I got my letter was make a digital copy, email it to myself, store it on my phone, and store it on google drive. That way I won't ever really be in a situation where I don't have access to it. I plan on bringing the original with me to GC when I do my checkout dives though just in case.

If I had to do it every year, I'm pretty sure I could just go back to the pulmonary doctor that signed off on me, do a regular checkup and have a discussion with him, and he'd sign it at this point. To me it's not that big of a deal.

I do have some comfort in knowing that the pros that I will be diving with will know that I have asthma or had it, because maybe it will make them keep an eye out or if something DID go wrong, they would know what it was that potentially happened. I could be overthinking about what they would do differently though, but in the end I took all precautions and didn't lie about anything so I am okay with that.

Internet access is not always guaranteed, just as a warning. And if you live in the same place, it should be fairly easy to go to the same doc - but what if you move? Do you think it would be reasonable for all PCPs to refer mild asthma to a pulmonologist in order to get an inhaler? And on your thread, you said you had dived prior to getting the letter, what would you have done if you went through all that, had all the tests point to you being fine, but the pulm still didn't want to sign off?

I just think there are better ways to release liability to the diver than asking their doctor to sign a note annually. Or worse, some dive shop says when you arrive that the letter from 8 months ago isn't recent enough, so they will exclude you.

 

[rsingler]

@SapphireMind , virtually everything you have cited is an imaginary horrible easily waived by a single visit to your PCP, or something you already know you shouldn't be doing:
1) gestational diabetes and PIH (you should strongly reconsider diving while pregnant, especially potentially preeclamptic - you should know this)
2) stable depression - not an issue
3) hypothyroidism on thyroxine (Really? As a medical professional, you worry about getting waived for this?)
Meanwhile, the things you need a specialist consult for, like diving with syncope and asthma, you state that you lie about.

Your comment about a dive shop rejecting an 8-month old waiver is a straw man argument. Doctors' clearances are good for a year, though a shop can of course do whatever it wants.

I'm not sure what your anger toward the system is, but it seems misplaced. You talk about forged signatures and taking someone's word for things, when you admit that you lie. The lawyers will work all that out. It's not the job of the instructor. In that, other posters are correct: one function of the form is as liability protection. With your statements, I'd say they need it!

 

[SapphireMind]

@SapphireMind , virtually everything you have cited is an imaginary horrible easily waived by a single visit to your PCP, or something you already know you shouldn't be doing:
1) gestational diabetes and PIH (you should strongly reconsider diving while pregnant, especially potentially preeclamptic - you should know this, doctor)
2) stable depression - not an issue
3) hypothyroidism on thyroxine (Really? As a physician, you worry about getting waived for this?)
Meanwhile, the things you need a specialist consult for, like diving with syncope and asthma, you state that you lie about.

Your comment about a dive shop rejecting an 8-month old waiver is a straw man argument. Doctors' clearances are good for a year, though a shop can of course do whatever it wants.

I'm not sure what your anger toward the system is, but it seems misplaced. You talk about forged signatures and taking someone's word for things, when you admit that you lie. The lawyers will work all that out. It's not the job of the instructor. In that, other posters are correct: one function of the form is as liability protection. With your statements, I'd say they need it!

I know you've been fishing for this, by constantly calling me "doctor", so here you are: I am not, I'm a critical care NP. That doesn't make what I say untrue. But I am not angry at the system. I roll my eyes at the system.

I don't dive while pregnant, in fact I can't get pregnant again - try again. But the form asks "Have you ever had or do you currently have.." - which is where it delves into the stupid. I don't have any anger - if you notice, I'm not insulting people or making digs like others. I disagree with the system because I think it is pointless. It's not a matter of whether it is something that can be easily waived, it's the fact that someone on thyroxine shouldn't need to worry about a waiver.

You say the clearances are good for a year, well, unless the dive shop says otherwise - and that "unless the dive shop says otherwise" is where people get skittish and why they are less likely to disclose. I would prefer a system where people can talk about it openly without worrying that people like you are going to jump in. You may have missed it in your rush to be angry with me, but I've had extensive work ups from specialists, which is why my current PCP (also not a doctor) would be able to sign it, or any of my colleagues honestly. Your attitude is what makes it more difficult. Yes, I had diabetes for 3 months while on high dose steroids. I don't have diabetes anymore, not even pre-diabetes! I've had multiple ECHOs, holters, tilt-table, orthostatic testing for my syncope, which turns out is very predictable and avoidable. I have had a methycholine challenge and seen specialists for my breathing - all checks out, mild reactive airway disease. Again, I disclose the fact that I have a history of syncope and asthma to all people participating, and why those won't come into play. I also had liver failure once too, but unless you replace my air with green tea, I'm at no risk with that. They don't ask about that one, amusingly. But I have been treated for dehydration before, when I got a GI bug really badly, about 18 years ago. That technically should also be disclosed.

The dive shop doesn't want to be liable for allowing someone to dive that has any medical conditions, it's the best way to shift that liability to me, legally speaking, and not pawn it off onto my PCP.

You seem hell-bent on assuming that I don't think people should see a provider - which isn't what I'm saying at all. I'm saying that people should see their provider, there should be better discussions between people who are diving together, and the form inhibits that and penalizes people for being honest. I think people absolutely should get worked up for conditions that could impact diving, but that person on thyroxine who forgets their doctor's note shouldn't be stopped from diving.

At the bottom of the PADI form it says: "I agree to accept responsibility for omissions regarding my failure to disclose any existing or past health condition." And so I do: I accept responsibility for those conditions. They have been thoroughly investigated, are not an issue, I am very cognizant and careful about them and inform those I am with about them (because again, if I'm not feeling well at all, I'm going to call a dive much faster and with less provocation than others) But, I want to accept that responsibility onto myself.

 

[KenGordon]

I don't know who said this; the forms are retained for 7 years.

If the forms are not retained as someone else said, there's a whole other level of legal liability, because then you don't have proof the form was actually signed or filled out.

I did, we have an online system where the diver acknowledges that the form has been completed.

In the EU keeping the forms is a burden from a data protection point of view. It is not impossible but a hassle to comply and there is no benefit. It does not matter to me whether you ticked yes to question 1 or questions 1 to 10, if the doctor is happy I am happy. I don’t even care whether a doctor was involved, all I need to know is that a diver is medically fit enough. The details do not matter.

We are a dive club, not a business. Businesses might choose to keep them longer.

 

[KenGordon]

Nope, you didn't. Because you missed the fact where I said you should disclose medical information to people involved with the diving.

I am a person involved with the diving. Your medical information about how you did test x or y for condition p is gobbledygook to me. I have litterally no idea whether that is the gold standard or the at home test, or why it might matter or just anything about it. You do seem to believe that those details matter, honestly they don’t. I don’t care about them, that is the purpose of the doctor.

you are still trusting that it is the actual physician signature, without checking. You are trusting that I was honest with the doctor about my physical conditions, without checking. The signed piece of paper becomes meaningless because you are still essentially relying on the word of the diver that they are safe.

The diver has some incentive to not lie, see below,

I think there are better ways to handle that liability and put more responsibility onto the diver themselves, because they are the one going into the water.

I find that the people I encounter are prepared to take the doctor seriously. If they are told to stop after 50 years they stop, if they have a condition that they think might be an issue or is on the form they are willing to see a diving doctor and head the advice.

Nobody is looking to die in the water.

 

[SapphireMind]

I am a person involved with the diving. Your medical information about how you did test x or y for condition p is gobbledygook to me. I have litterally no idea whether that is the gold standard or the at home test, or why it might matter or just anything about it. You do seem to believe that those details matter, honestly they don’t. I don’t care about them, that is the purpose of the doctor.

Nobody is looking to die in the water.

I definitely agree with your last statement. That's why I think the form isn't ideal as it is - no one is looking to die, and a doctor's note to confirm that is what I think is silly.

And if I am describing things to people, I don't describe the tests or whatever, I describe, in layman's terms, what I have and why that shouldn't be an issue.

 

[KenGordon]

And if I am describing things to people, I don't describe the tests or whatever, I describe, in layman's terms, what I have and why that shouldn't be an issue.

But I don’t care, even in layman’s terms. And now you expect me to believe you for sure rather than some doctor. Ok, you might have made up the doctor, but then at least the lie is explicit rather than actually the last step in a series of misunderstandings.

You end up asking me to 1) evaluate your condition and 2) evaluate your compitance to have an opinion on that condition.

Here those forms are signed and stamped by the doctor. And the doctor needs to be one of a list on the back of the form.

 

[SapphireMind]

But I don’t care, even in layman’s terms. And now you expect me to believe you for sure rather than some doctor. Ok, you might have made up the doctor, but then at least the lie is explicit rather than actually the last step in a series of misunderstandings.

You end up asking me to 1) evaluate your condition and 2) evaluate your compitance to have an opinion on that condition.

Here those forms are signed and stamped by the doctor. And the doctor needs to be one of a list on the back of the form.

Except you said earlier that it didn't really matter to you if there was a doctor involved.

I'm not expecting anyone to evaluate anything. I'm being communicative. That's the difference.