Asthmatic looking to scuba dive - had a dive physical today...

[Kingpatzer]

I would like to state that I find it quite offensive that people here are implying that 1) the physician in question saw the patient, with no intentions of giving him what he wanted, because he would make money from doing so. First off, primary care docs don't make that much money. Secondly, the average primary care doc is way overbooked (because there is a shortage of them) and doesn't need to do dive physicals to make a living. And third, believe it or not, most physicians aren't even very good businessmen, let alone looking at their appointment books for what's profitable and what isn't.

I'd note that he was not a primary care physician, he was a specialist. And while, as the OP pointed out in the post following yours, he did not in fact charge for his services it wasn't a reach to assume he did -- even though he indicated he wasn't interested in assessing the test results fairly in the first place.

Second, saying he needs to find a doctor that isn't afraid of his own shadow is really unfair and unkind. You are asking someone to tell a patient that he will not die as a result of his disease. If the doc is wrong, the patient will die. If the patient dies, the doc can be sued for a tremendous amount of money, based on all the earning power of all the years of life that the patient lost, as well as pain and suffering from the family. In whatever kind of job you do, do you give people 100% guarantees? What's really at risk if you are wrong?

According to the OP - the physician told him he verbally he is fit to dive and has no or at least very little additional risk. The OP also indicated that even though this was a DAN recommended physician, that the Dr. in question indicated he would not sign off on the OP diving on the simple fact that the pre-existing diagnosis existed regardless of what the test showed. The OP indicated that the physician's rational around this was because of liabilities fears. How is that, as described, not overt fear of litigation over patient care? It certainly isn't bravely standing by a diagnosis.

I'm glad to hear the doctor has changed his mind and is willing to sign off on the diving based on yet one more test. But prior to knowing that point, the picture the OP had painted was not of a physician who was putting his medical opinion first.

 

[Kingpatzer]

I guess the solution to this is to have a medical form that requires the doctor to . . . that simply indicated Fit / Unfit /Temporarily Unfit for service.

. . .

As an aside... some agencies do have stricter medical guidelines. An instructor in the UK, has to have a full commercial medical. Any recreational diver in a UK armed forces club has to have a full medical, including chest x-ray and lung function test. It's just a case of safety before profit....

I would be all for that.

 

[terrylowe]

There are a lot of factors here.

One is that the definition of asthma is a little fuzzy. It ranges from people who only have discernible abnormalities when they are having a viral illness ("reactive airways disease") to people who are dependent on multiple medications, taken each and every day, to be able to maintain the ability to walk around normally. Obviously, people at that end of the spectrum shouldn't dive, period. It is questionable .......

Once again, VERY eloquently stated. Nice job!

 

[Kingpatzer]

But they, and the shop or instructor or agency or dive operator, are asking ME to guarantee that nothing untoward will happen.

I have a medical waiver for my condition. It nowhere states that the physician is guaranteeing anything, least of all that nothing untoward will happen. What it does say is that diving is not contraindicated for me at the time of the signature based on the physician's evaluation of my specific condition.

 

[terrylowe]

...even though he indicated he wasn't interested in assessing the test results fairly in the first place.

Huh? He was going to unfairly interpret his tests? I think you've been overstating this and a few other things in this thread.

The OP indicated that the physician's rational around this was because of liabilities fears. How is that, as described, not overt fear of litigation over patient care? It certainly isn't bravely standing by a diagnosis.

Bravely spoken like someone who has never had to defend themselves in a lawsuit.

Some physicians have not been sued very often. It may be a little easier for them to clear someone to dive with minimally abnormal tests. Other doctors may have been sued multiple times or had particularly painful awards against them.....in which case they may be more likely to hesitate to clear a diver with an abnormal test. Unless you are married to the physician in question, you have no idea which lens he/she was using in deciding on whether this patient can dive with no additional risk.

 

[Kingpatzer]

Huh? He was going to unfairly interpret his tests? I think you've been overstating this and a few other things in this thread.

He just did not want to 'medically clear' me because if something DID happen to me, it could lead back to him giving me the go ahead.

he flat out told me on the phone that chances are he will not clear me for the sole fact that i have asthma.

Taking the OP at his word, the physician felt he was not at additional risk, but had decided prior to seeing him that he would likely not clear him. Moreover, given the fact that after reconsideration the physician changed his mind, it suggests that he recognized his own reluctance was not medically founded (and kudos to the dr. for deciding to go beyond his initial reaction eventually).

Bravely spoken like someone who has never had to defend themselves in a lawsuit.

Bravely assumed by someone who doesn't have a clue if that's the case or not.

Some physicians have not been sued very often. It may be a little easier for them to clear someone to dive with minimally abnormal tests. Other doctors may have been sued multiple times or had particularly painful awards against them.....in which case they may be more likely to hesitate to clear a diver with an abnormal test. Unless you are married to the physician in question, you have no idea which lens he/she was using in deciding on whether this patient can dive with no additional risk.

If someone is afraid to clear a diver because of prior law suits clouding their judgement against giving a medically warranted ok, then perhaps they shouldn't be being recommended by DAN. You're basically agreeing that fear of lawsuits trumps doctor's own best judgement. So once again, how does making a decission in that regard come close to puting the patient first?

 

[terrylowe]

If someone is afraid to clear a diver because of prior law suits clouding their judgement against giving a medically warranted ok, then perhaps they shouldn't be being recommended by DAN.

There you go...overstating again. This patient had abnormal tests. So you want DAN-recommend doctors to clear people to dive when they have abnormal tests? The delima for the doctor was..."OK this patient has an abnormal test. However in my medical judgment, it is reasonably safe for him to dive. How much of a risk am I willing to take to get him diving despite his abnormal test?" Rather than abandoning his patient to run from lawyers, he appears to be working out a way.

You're basically agreeing that fear of lawsuits trumps doctor's own best judgement. So once again, how does making a decission in that regard come close to puting the patient first?

I'd appreciate it if you didn't falsely summarize my opinion.

It didn't look to me that the doctor was putting his patient second here. It did look to me that he went above and beyond for this patient...even getting a consult from another specialist. It didn't look like the doctor was in this to make money to pay for his "50,000 square-foot-home".

That said, legal considerations are a part of many medical decisions....and this has contributed to many docs practicing defensive medicine and therefore raising the cost of medicine. Look at all of the tests this OP had prior to meeting the dive physician. Were all of those really necessary?

 

[k ellis]

Here's the rub -- many, perhaps most, dive centers are not reasonable. They will look at a form that someone signed saying "Why yes, I've had a history of x" and they'll exercise their rights to deny service even in the presence of a doctor's signature saying that the person is cleared to dive.

Honestly I think that one statement along says it all for 90 percent of the people who knowingly state that they are cleared when they do have a medical history. They spoke with their doctor and got the ok so why should they miss out on a dive is the typical way of thinking in my opionion. (Dont crucify me just stating what I think the reason is)

 

[purbeast]

well I did a beginner dive in Cancun off the coast of Isla Mujeres where we went down about 30 feet and it was amazing! I had absolutely no problems at all other than being a little nervous at first, but once down there and all felt comfortable it was simply amazing!

i think my brother and i are now going to try and do the classes and get certified to get more informed about everything and just overall get more knowledge!

here are a few pics they took of me. unfortunately my camera got a lenses error the day prior to our dive, but i fixed it, and within 5 minutes of going down it got a lense error again

http://i55.tinypic.com/fp5a55.jpg

http://i51.tinypic.com/23lzhmo.jpg

 

[terrylowe]

well I did a beginner dive in Cancun off the coast of Isla Mujeres where we went down about 30 feet and it was amazing! I had absolutely no problems at all other than being a little nervous at first, but once down there and all felt comfortable it was simply amazing!

i think my brother and i are now going to try and do the classes and get certified to get more informed about everything and just overall get more knowledge!

here are a few pics they took of me. unfortunately my camera got a lenses error the day prior to our dive, but i fixed it, and within 5 minutes of going down it got a lense error again

http://i55.tinypic.com/fp5a55.jpg

http://i51.tinypic.com/23lzhmo.jpg

CONGRATS! (On the diving and not on the lens error....)