Dive Medicals

[Scubagermany]

Not necessarily. There is a compelling argument that for the average healthy individual there is no benefit to an annual exam, and possibly some danger.

“But what are the true benefits of this practice? Careful reviews of several large studies have shown that these annual visits don't make any difference in health outcomes. In other words, being seen by your doctor once a year won't necessarily keep you from getting sick, or even help you live longer. And some of the components of an annual visit may actually cause harm. For example, lab tests and exams that are ordered for healthy patients (as opposed to people with symptoms or known illnesses) are statistically more likely to be "false positives" — that is, when test results suggest a problem that doesn't exist. Even if these inaccurate findings affect only a tiny percentage of the more than 200 million adults who would undergo such exams, the monetary, practical, and emotional costs are huge.”

A checkup for the checkup: Do you really need a yearly physical? - Harvard Health

...

www.health.harvard.edu

This discussion began in 2015. I’ll agree that this study does not have a subgroup analysis for divers in specific, but I sure would like to see the evidence that the diving community as a whole is better off with routine physical exams for divers without any concerns about their health.

There is not much information given in this health blog, but usually Papers publishes in the New England Journal are worth a read.

From my own daily practice I must disagree. I have several Patients every day who come for their check up and I discover different chronic diseases each day. Most of these need treatment or surveillance as they usually lead to complications if left untreated over time (usually a period of 10 years is given for the complications to occur).

In a nation of obese people such as the US I have a hard time so imagine regular checks for Hypertension or diabetes do not uncover these illnesses in quite a lot of people. In Germany where people are obese, but not as obese as US citizens it happens regularly.

I would think divers want to know if they have a cardiovaskular disease.

 

[Miyaru]

The Dive Industry is hurting the entire Dive Community with the invasive medical questionnaire. The industry loses customers and dive community members who are frankly driven away by the personally invasive nature of the questionnaire. Frankly, it's none of their business. A medical questionnaire is not required for swimming lessons or for snow skiing, yet many people die swimming after having taken lessons and many skiers die at resorts.
I also don't trust the Dive Industry to properly protect my health record. I really don’t trust the Dive Agencies and local dive shops with this very personal data.
Frankly, I'm put off by the personal nature of the questionnaire and am repulsed by filling it out. I cringe when asking dive customers to fill one out.
I'm also repulsed by the Dive Industry's approach to liability. Dive Agencies seem to only be concerned with protecting themselves (CYA) with the excessive number of liability forms and the invasive medical questionnaire required every time a potential customer seems to be in contact with the Industry or a local dive shop. I get a sense of hostility from the Agencies (or feel it towards them) and in turn the local dive shops when working through the multiple liability forms.
Am I the only one who believes the Industry is making a mistake is their approach to liability and the invasive nature of the dive medical questionnaire? Are we losing dive community members and potential new divers due to the invasive questionnaire and Industry approach to liability?

There is an alternative form, which you could also sign. The main stipulations are:

• I accept that Mother Nature can tap on my shoulder at any moment to tell me that my number has come up, and if so, neither me nor any friends / family members will hold anyone else liable.
• I hereby state that nobody is allowed to act as a natural selection inhibitor in case anything would happen to me.

 

[tridacna]

Many of us are not close to answering no to all the questions on page 1 and 2. I will answer all the questions honestly and get sign off on page 3. I don't expect to do any more training in my dive career, perhaps this is a moot point.

I dove at a very high end resort in Indo last year. They insisted that every diver provide a PADI signed medical form. No training involved.

 

[dmaziuk]

From my own daily practice I must disagree. I have several Patients every day who come for their check up and I discover different chronic diseases each day.

One has to wonder whether it's the same set of patients who bring you one more chronic disease every time, and why are they still ambulatory, or it's the new patients every time and are there any healthy people left in Germany by now? -- Assuming your patient sample is representative of the country as a whole, of course.

 

[Scubagermany]

One has to wonder whether it's the same set of patients who bring you one more chronic disease every time, and why are they still ambulatory, or it's the new patients every time and are there any healthy people left in Germany by now? -- Assuming your patient sample is representative of the country as a whole, of course.

I
People get older and even though they were healthy a couple of years back they sometimes are healthy no longer. Hence the need for regular checks.

I found my statement not hard to understand. What is it that you do not believe about it?

 

[dmaziuk]

I found my statement not hard to understand. What is it that you do not believe about it?

I'm what you call "the it professional". In my profession if, say, you're seeing 8 patients a day 4 days a week, and your value of "several" is 3, that means you're diagnosing 12 new chronic diseases per week, or 576 per a 48-week year. If your experience is representative of ~500,000 (according to statista) German doctors, you are looking at just under 300,000,000 new chronic diseases per year country-wide.

For a country of 85,000,000 people, that's 3.5 new chronic diseases per person per year. Edit: and every German would have been diagnosed with 63 chronic diseases by their 18th birthday, and so on.

Does that answer your question?

 

[tursiops]

I'm what you call "the it professional". In my profession if, say, you're seeing 8 patients a day 4 days a week, and your value of "several" is 3, that means you're diagnosing 12 new chronic diseases per week, or 576 per a 48-week year. If your experience is representative of ~500,000 (according to statista) German doctors, you are looking at just under 300,000,000 new chronic diseases per year country-wide.

For a country of 85,000,000 people, that's 3.5 new chronic diseases per person per year. Edit: and every German would have been diagnosed with 63 chronic diseases by their 18th birthday, and so on.

Does that answer your question?

LOL. This is the problem of "IT professionals" dealing with the English language and real life.

 

[Scubagermany]

I'm what you call "the it professional". In my profession if, say, you're seeing 8 patients a day 4 days a week, and your value of "several" is 3, that means you're diagnosing 12 new chronic diseases per week, or 576 per a 48-week year. If your experience is representative of ~500,000 (according to statista) German doctors, you are looking at just under 300,000,000 new chronic diseases per year country-wide.

For a country of 85,000,000 people, that's 3.5 new chronic diseases per person per year. Edit: and every German would have been diagnosed with 63 chronic diseases by their 18th birthday, and so on.

Does that answer your question?

It seems your statistic is faulty.
It seems you do not know much about German health care.

1) My clinic treats between 150 and 250 patients per full day. This is a bit more than average. I do not see all of them personally every day though. Also we are open 5 days per week.
2) There are about 150.000 MD's who work with their own private practice, not 500.000
3) I specialise in internal medicine as well as other specialities and my clinic does offer services of a GP. That is a speciality where you see many more chronic ilnesses than being a gynacologist, ENT or a dermatologist. In my field of practise there are maybe 40.000 practicioners.
4) Since everyone has medical insurance, the patient is of course free to see more than 1 doctor. Quite often patients (especially new ones) do not tell you that they have been diagnosed with a special disease because the want a second uninfluenced opinion.

You can believe me that I did not exaggerate in the least in my statement.
If you like I invite you to work here for a week as an intern.

 

[kinoons]

There is not much information given in this health blog, but usually Papers publishes in the New England Journal are worth a read.

From my own daily practice I must disagree. I have several Patients every day who come for their check up and I discover different chronic diseases each day. Most of these need treatment or surveillance as they usually lead to complications if left untreated over time (usually a period of 10 years is given for the complications to occur).

In a nation of obese people such as the US I have a hard time so imagine regular checks for Hypertension or diabetes do not uncover these illnesses in quite a lot of people. In Germany where people are obese, but not as obese as US citizens it happens regularly.

I would think divers want to know if they have a cardiovaskular disease.

The question isn’t are you uncovering Illnesses, but are you actually making people healthier, or are you medicalizing people who do not need it?

More than one RCT and meta-analysis have concluded that yearly physical exams do not reduce mortality. Just one example…

“General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment; risk factor control, preventive service uptake, and patient-reported outcomes.”

General Health Checks in Adult Primary Care: A Review

Importance General health checks—also known as general medical exams, periodic health evaluations, checkups, or wellness visits—to identify and prevent disease are extremely common in adult primary care. Although general health checks are often expected and advocated by patients, clinicians...

www.medrxiv.org

The question becomes does the additional chronic disease diagnosis benefit a patient with a better quality of life, since there does not appear to be a lifespan benefit. There must also be the costs to society of those additional diagnosis and treatment vs the benefit to the individual and society.

Additionally the question of access becomes an issue. I agree that more primary care is better than more speciality care, and that primary care is the most cost effective method of healthcare. However if we expect every adult 18-100 to get a yearly exam it is likely impossible for primary care to keep up. My own WAG is that perhaps 50% of the adult US population gets a yearly physical and we don’t have enough PCP to meet the demand without months long waits. By deciding who is truly at very low risk for chronic disease and filtering those patients out from the yearly physical recommendation we can better use the workforce of physicians we do have?

The subset of population that are divers are no different than the population at large. If an apparently healthy 22 year old wants to dive, I don’t see any reason to compel a medical exam.

 

[tursiops]

If an apparently healthy 22 year old wants to dive, I don’t see any reason to compel a medical exam.

"Apparently"
Thus the medical questionaire, to try and ascertain if a doctor ought to examine that apparently healthy 22-year old.
and the issue is annual exams for divers....not just an entry exam for a new diver.