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

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Your problem seems more legal than medical to me.

The doctor might believe that you are able to dive despite your asthma, but he cannot take the risk of getting sued by you or your family or some insurance company in case an accident $$$$ would happen.

Maybe you should find a doctor in some country where the legal culture is a bit more relax?
 
What is to debate? Are there other interpretations of this declaration?

The physician told him that he is fine to dive, but that he isn't willing to sign off on that point because the physician is afraid. The point is that in a ludicrously legalistic society, sometimes you have to be willing to decide if living your life based on other people's fears is really how you want to proceed.

He knows his physical conditions, and he knows the risks. Now, the one point that is very valid is that he may be risking his insurance, which is why I suggested he visit yet another physician for another viewpoint. But ultimately, he is free to assume the risk associated with choosing how to answer the questions on that document.

My own personal view is that a dive shop has no right to any specific health information at all. They have every right to ask if I have reason to believe I am fit to dive, and they have every reason to require that I get a dive physical where a doctor tells me that I'm ok to dive. But they have no right to any specifics at all. They aren't covered under HIPA, which means by giving them my medical information I am assuming a privacy risk where I have no means to restitution if they violate my trust. Further, the vast majority of dive shops have no medical expertise on staff and thus have no actual use for the data they request

Or is the debate about whether honesty and ethics should be allowed to get in the way of what someone wants to do? :shakehead:

Legal requirements have very little to do with honesty and ethics. Much of what is legal is highly unethical, and much of what is required to be honest is prohibited by law.

If I discovered that a student had lied on the declaration form, they would be immediately removed from the course, until they got medical clearance. If they didn't get medical clearance, then they would not get a refund.

That's entirely your legal right, and no one can or should fault you for that.

I detest liars.

I detest unwarranted intrusive questioning by overly legalistic corporations. *shrug*
 
Yep...and when that authority refuses to put their name on paper to clear you as safe.... then you need to understand that it is because they aren't willing to take a personal (legal) risk based upon the chances of you getting hurt... That says a lot!

It says they are more afraid of lawyers than they care about your enjoyment of your life is all it says.

You detest liars, yet you hold no vitriol for the physician who is not willing to put his medical opinion down on paper.
 
The physician told him that he is fine to dive, but that he isn't willing to sign off on that point because the physician is afraid. The point is that in a ludicrously legalistic society, sometimes you have to be willing to decide if living your life based on other people's fears is really how you want to proceed.

But isn't that what the physician was paid for?? To make a diagnosis and stand by it?

If the physician wasn't prepared to sign the paperwork, regardless of outcome, then he should have made that clear to the diver in advance?


He knows his physical conditions, and he knows the risks.

Does he? He's contemplating entry-level scuba training. He's not a doctor. So where exactly does he get this in-depth understanding of hyperbaric medicine?

My own personal view is that a dive shop has no right to any specific health information at all.

Really? Even if the customers' medical issues could prove a further danger to the staff that have to supervise them...and would be responsible for rescuing them?

Read the BSAC reports.... there's quite a few incidents of dive instructors getting bent/hurt/drowned during the process of attempted rescues.

...and then there is the business damage that tends to happen when a customer dies when under 'duty of care' of a dive center. Yes.. we all know that the dive centres isn't necessarily responsible, negligent or culpable in the event of a fatality.... but that doesn't stop the media from using headlines like "Diver dies at XYZ Dive Shop!" It's gonna damage trade and reputation.

And then there is the psychological damage on the dive staff, from involvement in a fatal incident. I know more than a couple of dive pros that quit the industry after being involved with a diving fatality. Some of these people had long-term psychological scarring as a result of it. Is it fair on them???

As a dive pro... I retain the right to choose who I accompany underwater. I expect those people to be medically fit to dive. This is my right and is in the interests of my own safety, health and well-being.

Lying to me about your medical fitness is fraud...and deprives me of my rights.

Frankly.... my right to safety...and my right to choose who I dive with on medical grounds over-rides anothers' right to lie...or right to dive....

It says they are more afraid of lawyers than they care about your enjoyment of your life is all it says. You detest liars, yet you hold no vitriol for the physician who is not willing to put his medical opinion down on paper.

Oh..there's plenty of vitriol for that....and if I were addressing such a doctor, I would make that clear :wink:

But on this forum, and in this thread, I am addressing divers, not doctors. :)
 
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 whether people at the other end actually even have asthma at all, and certainly, it seems as though between their incidents, they are probably quite safe to dive (as safe as anybody -- we don't think twice about allowing a 50 year old 2 ppd smoker to dive, without doing pulmonary function testing).

So we start with an unclear diagnosis, and then we get into the controversial nature of where to draw the line on diving safety. It used to be that any diagnosis of asthma was felt to be a complete contraindication to diving (just as diabetes was), but things have loosened up a bit. However, to my knowledge, there is no universally accepted set of criteria for "acceptable risk" for diving. I know what the folks at Duke use, but when you face the average GP with the question (or even, I would imagine, a lot of pulmonologists), they are not going to have solid guidelines to make a decision.

And then you get to the whole fact that diving is NEVER completely safe, and that diving as an asthmatic is somewhat less safe, but it is probably impossible to quantitate that risk (since nobody is going to do the study of taking sets of progressively more severe asthmatics into the water, to see where you start getting gas emboli :) ). When you go to a physician and ask, "Is it SAFE for me to do this?", you are asking for a kind of insurance which some physicians are not going to be very happy to give. And we vary as individuals, too, in our degree of risk-aversion. I would prefer to be able to tell someone, as best I can, what the increased risks ARE (which in some cases aren't really known) and let them decide. But they, and the shop or instructor or agency or dive operator, are asking ME to guarantee that nothing untoward will happen. That's hard to do. If the person embolizes, did they do it because they poorly controlled their ascent, or because they had asthma? How do we really know?

And finally, we have the litigation-rich society in which we live, where every doctor gets up every morning with the knowledge that something he does today, even with the best possible intentions, could embroil him for a couple of years with the legal system, at enormous cost of time and possibly money and definitely reputation. We learn pretty quickly how to stay out of legal quagmires, and one of the ways is never to tell anybody that they'll be fine, or this treatment will work, or this activity is "safe". You can't really blame us. Statistics tell us that it is not WHETHER you will be the object of a malpractice suit, but simply when.
 
But isn't that what the physician was paid for?? To make a diagnosis and stand by it?

Not at the expense of incurring any risk whatsoever to their masters at the insurance companies.

If the physician wasn't prepared to sign the paperwork, regardless of outcome, then he should have made that clear to the diver in advance?

But then he wouldn't have come in and paid the good doctor his exorbitant rate. Gotta pay for that 50,000 square foot house every month you know.

Does he? He's contemplating entry-level scuba training. He's not a doctor. So where exactly does he get this in-depth understanding of hyperbaric medicine?

Most likely neither are the people at the scuba shop who are asking him the questions. He has been told the risks by his physician -- who (if we believe the OP) basically told him are no greater than those faced by the average public.

Really? Even if the customers' medical issues could prove a further danger to the staff that have to supervise them...and would be responsible for rescuing them?

There is no reason they need any other medical information than "i've been told by my physician that I can dive."

Read the BSAC reports.... there's quite a few incidents of dive instructors getting bent/hurt/drowned during the process of attempted rescues.

And they know those risks when they become instructors. Heck, they know those risks when they take their rescue class.

...and then there is the business damage that tends to happen when a customer dies when under 'duty of care' of a dive center. Yes.. we all know that the dive centres isn't necessarily responsible, negligent or culpable in the event of a fatality.... but that doesn't stop the media from using headlines like "Diver dies at XYZ Dive Shop!" It's gonna damage trade and reputation.

Yup.

And then there is the psychological damage on the dive staff, from involvement in a fatal incident. I know more than a couple of dive pros that quit the industry after being involved with a diving fatality. Some of these people had long-term psychological scarring as a result of it. Is it fair on them???

And you know this person is going to die, and not the guy who didn't even go to see a doctor how?

Honestly, the people who are most likely to get into trouble are the one's who aren't showing the kind of due diligence the OP is showing here. I'd rather take someone down who has talked to his doctor than some 50 year old marginally over-weight guy who didn't go to the doctor and just checked all the boxes on the form. Wouldn't you?

As a dive pro... I retain the right to choose who I accompany underwater. I expect those people to be medically fit to dive. This is my right and is in the interests of my own safety, health and well-being.

Absolutely. I'm not saying otherwise. You're entitled to know that the person's physician told them they are medically fit to dive. You are not entitled to know that person's medical history or any other details other than that one statement. You aren't even entitled to know who their doctor is -- it's not your business.

Lying to me about your medical fitness is fraud...and deprives me of my rights.
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.
Frankly.... my right to safety...and my right to choose who I dive with on medical grounds over-rides anothers' right to lie...or right to dive....

Do you demand that all of your students have a complete dive physical and that you are provided with the detailed results of those physicals prior to accepting them as students?

If not, then you're a hypocrite for demanding a physicians sign off from someone who has a condition but has been told by their doctor that they can dive while allowing the guy next to him to get in the water without having seen a doctor at all.

Oh..there's plenty of vitriol for that....and if I were addressing such a doctor, I would make that clear :wink:

But on this forum, and in this thread, I am addressing divers, not doctors. :)

Good to hear.
 
You need a second opinion from a doctor that is familiar with scuba diving and isn't scared of his own shadow. Unless you have a physical abnormality that makes you different than any other mild asthmatic, you are going to be fine. Still need a doctor to tell you that but based on your exercise regimine, you will never encounter anything as strenuous as what you do above water on a regular basis. Hope you didn't pay that guy too much to say no because he's scared of lawyers. JMHO.
 
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.

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?

I know doctors have a very poor image in today's society, but really, the majority of us work very hard and try to do the best job we can, for an ever-decreasing sum of money, and under ever-increasing regulation and litigation risk.

(And as a personal side note, guys, I was a member of a dressage bulletin board for many years, and what made me leave it was getting attacked for being a money-grubbing rich physician -- which I am not, and which NO physician I know is. Yes, they exist -- but they are RARE.)
 
I guess the solution to this is to have a medical form that requires the doctor to tick a yes/no box. No option for abstaining.

When I did recruiting for the military, the candidates medical details were confidential. The medical forum was contained in a printed envelope. In addition to the medical examination papers, the examining physician had to complete, sign and stamp a statement on the outside envelope that simply indicated Fit / Unfit /Temporarily Unfit for service.

This could be adapted for the scuba agencies. A simple yes/no by the potential student at the end of the list of medical conditions would suffice to allow direction to a physician, or not. If needed, the student could be given the envelope and medical examination form to be taken to the doctor. The student would return with a sealed envelope (containing their medical exam results) and the outside of the envelope would have the Fit/Unfit medical recommendation, duely signed and stamped by the MD.

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....
 
Guys thanks for the replies and I have been reading each and everyone of them. I also did not mean to stir up a heated debate among the members of this board. You all seem very informed and have been giving me some good insight on the issue at hand.

I also want to just clear something up. The doctor I saw who did the scuba physical is not my primary care physician. He is a hyperbaric doctor who works at a wound and healing center at a hospital, and I found him from calling the DAN network.

Also when I first talked to him, almost a year ago, he flat out told me on the phone that chances are he will not clear me for the sole fact that i have asthma.

So even with him saying all of this, I did all of the prerequesite tests which involved going to see 4 different doctors/places before I even went to see him, which was a good 45 minutes away from where I live.

So I definitely did my due diligence and I did not simply go to my PCP and ask him for his opinion on this, I have been very throrough on this whole process.

I just wanted to clarify that because from reading some posts it seemed that some may have been confused a little bit.

Also the fact that he called me the following day, after calling another doctor to discuss my situation, to let me know that he WOULD medically clear me if I were to take a pulmonary test when I get back and have slightly better readings on my lower lung functionality also makes me feel even better about my current situation.

And on another side note, I read some comments about him taking my money. Well just to let you all know, he ended up doing this free of charge because he did not do the actual physical examination on me. When I was leaving he was walking with me and talking with me and I said "do I have to check out?" and he said that I did not, and then I heard him turn to the secretary and tell her "No charge him because I didn't have to do the physical examination aspect of the test".

So it definitely was not about him getting money, and I was there over an hour.
 
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