Yes/No requirement for Med form

[JackD342]

until the latest training bulletin - Q: A student completes the PADI® Medical Statement and answers “yes” to one question. The student then takes the entire Medical Statement to the doctor to be evaluated and to secure diving fitness approval. The student returns with the doctor’s written approval and signature to dive, but not the questionnaire page the student filled out. What should I do? A: Ask the student to retrieve the questionnaire page for your records. The Medical Statement is one of the three required forms completed by a student and retained by you for at least seven years. If your student provides a signed document from a physician attesting to the student’s fitness to dive (on something other than the PADI Medical Statement), you still need to have the student complete the PADI Medical Statement for your file. This provides baseline information in the event new conditions arise after the doctor visit.

Can't believe I was behind on this thread. That Training Bulletin update is NOT new rules, it is clarification of the longstanding process. I got into some significant back-and-forth on the topic with @tridacna last fall and couldn't get any source, verbal or in writing, to support his position. I cornered one of the key PADI corporate folk at DEMA 2018 and asked if this issue could be addressed in a Quarterly Training Bulletin. She thought it was a good idea, and now here we are, all on the same page... I hope...

 

[tridacna]

I am surprised that you allow yourself to dive, given your own rules about ego.

Unlike you, I AM a medical doctor and a Type 1 diabetic. You are stigmatizing all insulin dependant diabetics with you toxic ignorance. Since you clearly have no idea re: the safety of insulin dependant diabetics underwater then you should defer to the physicians that do. The risks of hypoglycaemia can be completely mitigated before you hit the water, especially if you consult with any general practitioner/family medicine physician. Hell, you can even treat hypoglycaemia underwater at 130’ with a simple tube of cake frosting in your BCD or pocket (and yes, I tried it simply for fun...chocolate is the best!). Even with >10 years of diving I have never suffered a hypoglycaemic episode while diving by following a few simple steps beforehand. Contrary to your skewed perspective, and the movie industry (i.e. Con Air), insulin dependant diabetics don’t spontaneously lapse into comas or seizures without warning. Most diabetics, that don’t intentionally overdose on insulin, actually have their glucose slowly climb upwards if they do nothing at all. Even if we didn’t take the few simple steps to guarantee no hypoglycaemia on a dive, most of us can easily feel the initial effects and treat it well before it is an issue. These are things I discuss with all of my insulin dependant diabetics that wish to dive. I even helped one patient get a waterproof insulin pump rated to diving depths.

It is people like you that lead patients to lie on the medical form and subsequently skip coming to their physician to learn the simple ways to make diving safe for them while taking insulin. I am disheartened to see such discrimination. The ego, to think you know better than the patient (who lives with this daily) and especially their physician (who is specially trained to instruct patients about their condition and how it impacts their activity). A physician doesn’t even need to know a thing about diving as the associated risks (drowning) and ways to avoid/mitigate risk (avoid hypoglycaemia) are essentially the same if the patient were simply swimming at the surface.

If there are any insulin dependant divers that would like tips to improve safety in the water, please just send me a private message.

Great post but it’s “insulin dependent” not “dependant”. Adjective not noun.

 

[Edward3c]

sorry to reopen an old can of worms - but the latest PADI training bulletin states the opposite - can you post your correspondence with them?
Q: A student completes the PADI® Medical Statement and answers “yes” to one question. The student then takes the entire Medical Statement to the doctor to be evaluated and to secure diving fitness approval. The student returns with the doctor’s written approval and signature to dive, but not the questionnaire page the student filled out. What should I do? A: Ask the student to retrieve the questionnaire page for your records. The Medical Statement is one of the three required forms completed by a student and retained by you for at least seven years. If your student provides a signed document from a physician attesting to the student’s fitness to dive (on something other than the PADI Medical Statement), you still need to have the student complete the PADI Medical Statement for your file. This provides baseline information in the event new conditions arise after the doctor visit.

In the U.K. this procedure would be illegal, and since the GDPR came in throughout the rest of Europe. There is no legitimate reason for a dive operator to know an individuals medical conditions as the UKSDMC have a procedure where if the diver ticks yes, they must get a fitness to dive certificate from a UKSDMC medical referee. The certificate does not disclose the medical condition, but it may place limits on the individual’s diving.

I wouldn’t want to be the one trying to justify contravening the GDPR (particularly sensitive information) just because an American organisation said I should.

 

[pauldw]

Saying that the medical form only has to be submitted, not actually filled out, is facile. Criticizing people for filling it out but lying, may be legitimate because lying is wrong, but it is quite annoying to have to get a doctor appointment because you admitted on a form you take a statin, like so many millions of other people do, especially when the form is just a cover-your-butt formality for a corporation (and particularly when you know your doctor will likely just sign the form without much thought). I will admit that when I didn't want to be bothered once, I "interpreted" the prescriptions question to be asking if at that exact moment I was placing pills into my mouth (but of course, that's not actually honest). And I'll admit that when on a trip in which someone with me unexpectedly decided to do a Discover Scuba Diving class and had to fill out the medical form, I pointed out beforehand that they wouldn't be able to take the class if they checked anything "yes" (and left it to them to decide what to do). Most places I've been to pop that form on you at the beginning of the first class, which just exacerbates things (and I know an instructor who had a family coming in for a birthday scuba experience in the shop's pool, and the birthday girl didn't have a doctor's signature and so wasn't allowed to dive, and the party ended quickly). There's a conflict for people who try to be honest but don't like to be jerked around by counterproductive bureaucratic nonsense, and end up having to choose between two bad things. I suspect that for every instructor bemoaning not being able to trust their students to share all their medical information with them, there's a student upset about an instructor with too much fondness for red tape and for sticking their nose where it doesn't belong, and perhaps for being likely to kick someone out just because they might be an inconvenience.

That situation isn't helped by people going on here about how they'll make their own decisions about whether someone else is medically fit to dive, when they aren't qualified to make those decisions. For example, T1D isn't epilepsy, and someone with hypoglycemia isn't likely to manifest that by suddenly and unexpectedly convulsing. Responsible T1Ds following DAN guidelines can dive. I suppose the concern for instructors is whether a given person is responsible, because some certainly are not, and no one wants to have to recover the body of a foolish person.

It seems like a difficult question to solve, but like any situation it can be solved more easily if people stay calm and don't get testy, and respectfully explain their concerns.

 

[DBPacific]

I'm jumping in really late to this thread, sorry, but I feel obliged to comment. I have had to get 4 dive medicals in the last year. Two because different organizations and universities demanded I use _their_ medical form, 1 for the initial OW, and 1 because a condition reared its ugly head and my prescriptions changed. I've always thought it would be better to be safe than sorry - if the very unlikely happens and something goes south during a dive and I'm unable to speak or I'm unconscious, my buddy/instructor will know why and be able to relay my medical information to whomever I get treatment from. I don't have epilepsy or diabetes, I have chronic migraines and insomnia for which I take medication. I don't have a car or car insurance and there is no dive doctor within at least 2 hours of me. Since most of my recent training has been through my university, I've been able to use their doctors.
If every instructor and buddy I have from now on insists on new medicals like they have for the last year, chances are I'll just start checking off 'No.' It's expensive, absurd, and takes days if not weeks to be seen for dive medicals with an actual dive doctor repeatedly while my condition hasn't changed in the 10 years I've had them. I know how my meds and my body responds to exercise, to being on and in the ocean, and how they change on an hourly and daily basis. I also know how to prevent the worst migraines and how to control the ones that I get. I don't do dives that I know won't mix well with me and that I can't adjust for to make sure my head won't get in my way. It took me years to find a neurologist who could say anything about my head. I don't take kindly to instructors who try to play doctor.

 

[yle]

I appreciate the candid advice (I agree), but I'm looking for an actual PADI standard.

If the doctor signed the medical, you could assume the student checked "yes" to every question. And then decide if you want to be responsible for them in the water.

 

[yle]

When Joe Blow instructor can show me a license to practice medicine issued by the state, then we can talk about his forms. Until then his job is to teach, not try to diagnose my medical problems or try to calculate my odds of having an medical issue like diabetes while diving.

Actually, an instructor's job is more than just teaching. It's also their job to make sure you exit the water alive, and hopefully in the same condition that you entered the water. Some instructors think this part of the job is more important than the teaching side, but some students apparently disagree.

 

[yle]

Hell, you can even treat hypoglycaemia underwater at 130’ with a simple tube of cake frosting in your BCD or pocket (and yes, I tried it simply for fun...chocolate is the best!)

Are you suggesting that an instructor could teach a new OW student, the very first time they are taken to open water, to ingest cake frosting while underwater? On behalf of all instructors, I'm flattered that you believe this would be reasonable... but we do have our limits.

Even if we didn’t take the few simple steps to guarantee no hypoglycaemia on a dive....

"Guarantee" is an awfully strong word. Are you willing to bet your career as a physician on this kind of "guarantee"?

I am disheartened to see such discrimination.

There is a simple solution: you can become a scuba instructor. You would be the perfect instructor to specialize in students with Type 1 diabetes (and maybe you could also take some with Type 2.) In the meantime, please try to understand that those of us tasked with the responsibility to keep our students safe while we have no real experience with the symptoms, effects or treatment of Type 1 diabetes will often decide that the safest option for those students is to not allow them to join our class. You can call it discrimination if you like, but it's discriminating in favor of safety.

 

[mscmicrobiology]

Are you suggesting that an instructor could teach a new OW student, the very first time they are taken to open water, to ingest cake frosting while underwater? On behalf of all instructors, I'm flattered that you believe this would be reasonable... but we do have our limits.



"Guarantee" is an awfully strong word. Are you willing to bet your career as a physician on this kind of "guarantee"?



There is a simple solution: you can become a scuba instructor. You would be the perfect instructor to specialize in students with Type 1 diabetes (and maybe you could also take some with Type 2.) In the meantime, please try to understand that those of us tasked with the responsibility to keep our students safe while we have no real experience with the symptoms, effects or treatment of Type 1 diabetes will often decide that the safest option for those students is to not allow them to join our class. You can call it discrimination if you like, but it's discriminating in favor of safety.

Yes, there are steps to guarantee no hypoglycemia that are simple and take place on the surface before you dive. The information and strategy is sound and I provide it to my patient. I will even get them to repeat it back to me to ensure understanding. I have no control over whether they follow my advice or not, my job is to inform them of risks and how to mitigate. The final decision re: thier medical decision and the potential consequences are the patients (providing they are competent to make decisions). That concept seems lost on you instructors. I would not as a physician write a note banning someone from diving for a non-medical reason, I am not the expert on the non-medical parts, you are. I would expect that If you clearly informed someone that they should not descend to 150’ during thier training with you and they do, the consequences are on them. You cannot exclude every single diver because you worry they MIGHT go to 150’ (not a good business model btw). To do so takes away informed consent and no one would dive. If they state thier intention to go to 150’ and their experience/training/equipment does not make that a safe option then you DO have the experience and training to make that call as a dive instructor, not me as the physician. To prevent them from diving for a perceived medical issue for which you are not trained to advise, diagnose, or treat is double trouble as you are removing the persons right to informed consent with thier physician and overstepping your bounds by acting like a physician.

Now there are some medical conditions which are absolute contraindications like pneumothorax. I will still explain risks but that there is no way to compensate therefore an exception to informed consent since there is no way to mitigate. That situation results in a do not dive letter. The difference, is that I know what is a relative medical contraindication (can be mitigated and trained for) or what is an absolute contraindication (significant risk with no way to compensate) and am trained/certified to deal with them. You seem to be confusing relative contraindications with absolute ones, simply banning everyone with a perceived medical issue....something again that you are not qualified to do.

Btw the frosting example was an, apparently unsuccessful, way to lighten the mood. It is a valid way to treat hypoglycemia for advanced divers but more like redundancy for simple surface stuff a discover scuba diver could pull off.

 

[tridacna]

If the doctor signed the medical, you could assume the student checked "yes" to every question. And then decide if you want to be responsible for them in the water.

Thanks to @JackD342 - I have a satisfactory answer to my OP.

I remain certain that 99% of instructors will accept a signed medical statement from an MD which will trump everything else - standards be darned. Ultimately, it’s simple - decision is up to an instructor to accept a student or not. If the instructor harbors any doubts, tell the student to complete all the questions then decide.