Anything to Declare

[2new]

I have a question about self certification and getting medicals done by new doctors while travelling. I am all clear on the questions except possibly one.

About 4 years ago at a time of high stress and personal trauma my doctor diagnosed me with clinical depression, as I didn't feel comfortable with the diagnosis, i didn't feel negative or desparate just tired, I didn't take the medication (I personally believe these meds are given out very easily these days for almost anyone who mentions a stressful situation to their doctor) and the symptoms disappeared shortly afterwards. A conversation with a friend subsequently who is a Consultat Psychiatrist said that they believed it was a misdiagnosis (the alternative being insomnia and stress which was solved by a few good nights sleep), but of course my doctor would not amend my records.

The next two times I went to see a doctor at that practice, they seemed to assume first that it would be stress related in some way, until I convinced them that I was not stressed in any way, causing them on one occasion to realise that ,in the time I had been registered there, they had never done a physical on me, afterwhich they discovered those particular symptoms were due to slightly low blood pressure.

One possible reason for this misdiagnosis was that a couple of years previously I experienced breathing difficulty on a couple of occasions that were never explained but thought maybe to be panic attacks (although at the time I felt in no way stressed or paniced) or a reaction to chemicals that I was exposed to in work, this hasn't happened in 6 years since I stopped working in that environment.

I would describe myself as a carefully confident person and feel that I have no problems remaining that would in anyway affect my diving, or my ability to be a good and safe buddy. In fact although I am just a open water certified and quite inexperienced I felt quite proud when my more experienced diving friends said they would feel totally comfortable diving with me.

I hope to do a lot more diving in the future and if possible do my AOW and Rescue Diver certs in the relatively near future.

Which brings me to my questions.
Should I say 'yes' on the form next to 'behavioural problems' knowing that this may cause a local doctor to decline me based on not knowing the detail/history ?

If I must see a doctor for certification, where self certification is not an option, should I declare it to the doctor risking them declining me ?

Should I mention this to a potential buddy, knowing that it is so far in the past and may cause them unnecessary discomfort ? I don't want to lie to a buddy, but would anything I say not appear out of proportion to the details above ? Their main concern would probably be that I panic under pressure, but I am known for being very capable under pressure.

Sorry if this seems a bit rambly but I thought it would be better if I gave you all the possibly relevant facts up front. Any help in this would be greatly appreciated, I am planning on going on a holiday soon where I'll need to see a local doctor to certify me.

I would hate for this to be dragged up everytime I need a medical if it is unnecessary.

Thanks

 

[DocVikingo]

Of course, the ethically proper & medically conservative thing to do is to report this history in the appropriate location on the medical self-certification form. There is no a priori reason to expect "a local doctor to decline me based on not knowing the detail/history." If your history is as you present it, one would expect that the certifying physician/medical referee could make an intelligent decision based on a simple examination of you.

Let's put your situation into perspective, keeping in mind that there is only your self-report of what has occurred. Matters such as any previous history, time lines, and the nature & extent of symptomatology are not fleshed out as fully as they might be, and I'm sure you appreciate the possible implications of this.

Okay:

If one goes far enough back into a person's life, there is a very high probability that signs & symptoms of a vaguely psychiatric nature, often quite fleeting, can be identified. These phenomena are just part of being human, and for the most part do not fulfill the criteria for diagnosis of a recognized mental disorder.

Should all divers that fall into this category be forever required to report them on self-certification forms? No doubt mental health professionals, dive medicine experts & others would argue this various ways, but I suspect that a substantial proportion would indicate that at some point such reporting can cause more problems that it prevents.

Of real importance is whether or not there have been recent manifestations of psychiatric disorder, or any reason to suspect that previous manifestations may reappear.

You experienced otherwise undiagnosed breathing difficulty on a couple of occasions 6 years ago. There has been no recurrence since you left a work environment involving possibly provocative chemicals. At the time of these attacks, you in no way felt stressed or panicked.

You also indicate that about 4 years ago, at a time of high stress & personal trauma, you were diagnosed with clinical depression. Your sole complaint at the time was tiredness, possibly related to inadequate sleep, and this resolved shortly without treatment.

[As an aside, again based on what you have reported, neither of these clinical pictures even remotely approximate those required to supportably diagnose an anxiety or affective disorder].

Finally, you feel that you are a carefully confident person without remaining problems that would in anyway affect safe scuba, and believe that your more experienced diving friends perceive you as a worthy dive buddy.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

 

[2new]

Thanks for the reply.

I appreciate that you are in no position to give medial advice, I guess I am asking for an ethical opinion or an indication of any risk I would be taking should I not declare.

You are right that I haven't given you all the information, there could be details in the stress that I reported and the way in which I communicated it that caused the doctor to reach the diagnosis. I have read a very good page on such disorders linked to from this site (i believe it might actually be yours) and believe at the time I displayed a couple of the symtoms listed, but not apparently enough for a diagnosis on their own. I do not believe that I currently display any of those symtoms and have not for a very long time.

Putting that aside, I feel that I am completely back to my 'old self' and feel that as the period of time has been considerable without relapse that there is little risk of it jeopardising my safety or that of my buddies.

My conclusion at present is that as I feel that it is safe for me to self certify as long as I keep the level of diving relatively simple (to err on the side of caution), but I should find an early opportunity to discuss this with a Doctor, just to confirm that there is no longer a risk. If the doctor says that it will not be an issue then I guess it would then be safe to leave it off the form in future.

Does this sound like a reasonable approach ?

Thanks again for your help with this

 

[The Iceni]

2new once bubbled...
. . . Does this sound like a reasonable approach ?

Hi 2new,

Like DrVikingo no doctor can tell you "yea" or "nay" on the net, but to my mind it sounds like you have exactly the right approach to diving fitness.

Sadly, I see far too many patients nowadays with short-term reactive depression or stress related problems with the classical symptoms of insomnia or early morning wakening. We GPs have an low threshold for treatment in an attempt to help (that's why you come to us after all!). For example, low doses of the old-fashioned tricyclic antidepressant amitriptyline have often been prescibed simply because it helps the patient to "slow down" and get a good nights sleep - and heal himself. This does not mean the patient has an affective psychosis.

Equally welll, salbutamol inhalers are often given for "wheezy bonchitis" in children and teenagers. This does not mean the patient has asthma.

As DrVikingo says, it's a part of being human.

At least you have the right attitude. I fear self-certification can allow applicants with serious problems (such as epilepsy) to hide it.

May I suggest that having demontsrated a sensible attitude, as an adult you allow your concience to decide?

But remeber it is not just your own neck at risk?

By the way, what part of the world are you from?

 

[2new]

Hi

Thanks for the advice and reassurance.

I find self certification a little worrying myself, from the point of view that people can potentially choose to ignore potentially dangerous ailments on the other hand it can potentially be a deterrant to otherwise healthy Divers. One of the people who I had intended to learn to dive with was restricted to 10M and so couldn't complete the course because a local doctor didn't have all the information necessary to judge the risk his one asthma attack several years previously could cause to him while diving. This was particularly upsetting for him as we had booked a weeks holiday in the med for the sole purpose of learning to dive. He has since been informed that his particular ailment (apparently triggered by pollution in very cold weather , if that makes sense) does not pose a significant risk.

It is this example that makes me concerned about indicating it on form and seeing a local doctor while travelling, that doctor, with the best will in the world, may not find himself willing to certify me fit without access to all of the history, which I can understand (I wouldn't expect any professional to accept responsibility without all the information). I would rather have myself cleared or not by someone with access to all the facts.

As it happens my GP (I'm UK based BTW) will not do Dive certifications (hence I am asking here), but I may be able to ask about this one specific point. I would rather try and find a nearby doctor with experience in Dive medicine. If you can point me in the right direction I would appreciate it.

Thanks again for your thoughts

 

[The Iceni]

2new once bubbled...
. . I'm UK based BTW

Thought so, 2new! I have made numerous waves criticising the self certification system for the reasons you gave (including a letter published in "DIVE" magazine). Your friend would have had a decent holiday (and would have been able to qualify) with the old system.

I often wonder about some of my GP colleagues here in the UK. Your experience was very common which is precisely why the BSAC changed the system.

My approach was (is) as follows.

Any GP can complete "Personal Medical Attendant's Reports" (PMAR) for insurance companies which prevents major problems being hidden. (The GP KNOWS the patient's medical history.)

BSAC medical Referees were there to offer (us) GP's expert advice in cases of doubt.

In my opinion we now have the worst of both worlds!

Referees are few and far in between and I applied to become one two years ago but the UKSDMC thought I needed to attend a basic diving medicine course to fill the gaps in my medical education (I am only a GP after all!)

I am sure you can imagine my opinion on that (It is voluntary, unpaid work after all)! It was unprintable!!!!. :egrin:

Having said that take a look at BSAC's website for list of referees in your locality. HTH

 

[Conor]

I agree, another case of convenience over quality I guess.

I would have hoped that a sport like Diving were the physiological and psychological effects are so varied and potentially dangerous would have organisations fostering communication between divers and medics (such as in the way this board does). The dive oragnisations appear to be trying to get as many people in the water as possible with the fewest barriers and unfortunately this can only lead to an increase in fatalities and serious injuries, unfortunately it will only be then that these things get rethought.

 

[2new]

Does this mean that you could request a PMAR fro you doctor to serve as a dive medical ?

 

[The Iceni]

2new once bubbled...
Does this mean that you could request a PMAR fro you doctor to serve as a dive medical ?

You could, but you would be wasting your money! Such a report provided by a GP is no longer accepted (at least by BSAC! It may serve for a diving holiday abroad, though). You have to consult a specialist who knows nothing about your medical history.

Depressed, epileptic, alcoholic, asthmatic psychopaths take note :egrin: