Dive Medicals

[The Chairman]

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

Sure, I want to know. I just don't need the dive-op to know. I have a strong heart with a very faint murmur. I'm old, fat, and ugly, so they decided to do a full battery of tests, including a cath, dopler, and ultrasound of my legs. They ultimately could find nothing wrong at all. Nothing. The doctor remarked that I had the heart of a younger man. However, mention that I had a cath and the medical peeps go all weird. Nope, telling them I got an A+ on the exams doesn't help. Ergo, I don't mention it anymore. It's not worth the hassle. If these medically informed people act that way, just imagine the needless angst I would have to endure with lay peeps.

 

[Scubagermany]

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.

Are you implying that patients are better up with untreated hypertension and diabetes because they will not die earlier?

 

[dmaziuk]

It seems your statistic is faulty.

No, it's your unstated assumption that your personal experience is representative of the population in general, and of the diving community in particular. Where I work that is known as Faulty generalization - Wikipedia

 

[Scubagermany]

Sure, I want to know. I just don't need the dive-op to know. I have a strong heart with a very faint murmur. I'm old, fat, and ugly, so they decided to do a full battery of tests, including a cath, dopler, and ultrasound of my legs. They ultimately could find nothing wrong at all. Nothing. The doctor remarked that I had the heart of a younger man. However, mention that I had a cath and the medical peeps go all weird. Nope, telling them I got an A+ on the exams doesn't help. Ergo, I don't mention it anymore. It's not worth the hassle. If these medically informed people act that way, just imagine the needless angst I would have to endure with lay peeps.

The dive medical form that I hand out usually is the one from the VDST. It just confirms that you are fit to dive. It would be unethical to write down any of your ilnesses.
Which is way more private than the questionaires you have to fill out on most bases.
It also gets on my nerves that they make you do it even if you have a recent medical with you.

 

[tursiops]

No, it's your unstated assumption that your personal experience is representative of the population in general, and of the diving community in particular. Where I work that is known as Faulty generalization - Wikipedia

That is completely unfair. He did not make that generalization, YOU did, apparently so you could then argue with it. Where I work that is known as being as ass.

 

[kinoons]

Are you implying that patients are better up with untreated hypertension and diabetes because they will not die earlier?

No - I’m implying that a blanket policy to see all adults yearly without any degree of risk stratification is potentially not the best use of a patient’s time and resources, nor the best use of a clinician’s time and resources.

The policy of seeing everyone yearly did not improve mortality.

We do know that finding and treating undiagnosed HTN and DM does improve mortality.

So we need to find the space in the venn diagram where we catch the overwhelming majority of undiagnosed chronic diseases while at the same time bringing the minimal number of patients into the medical system as possible.

Additionally the cost (financial as well as physical) of false positive exams and downstream testing need to be considered with any screening program.

To date I have not seen a good answer to this problem.

 

[Scubagermany]

I’m implying that a blanket policy to see all adults yearly without any degree of risk stratification is potentially not the best use of a patient’s time and resources, nor the best use of a clinician’s time and resources.

Of course. I never said anything like that.

 

[dmaziuk]

Additionally the cost (financial as well as physical) of false positive exams and downstream testing need to be considered with any screening program.

To date I have not seen a good answer to this problem.

Well, in theory the questionnaire weeds out true negatives and leaves only a very small proportion of divers who need to see a physician to weed out false positives. And it may have been true back when the "healthy" divers swam a 5-minute mile in full gear, smoked a pack a day, and died by 55 without ever knowing what "protected information" is.

Now that it's no longer the case, our screening system no longer works as intended.

 

[CG43]

In germany there is a common sence that a medical examination should be made before any demanding sporting activity.
This is also common in school sports and club sports. Usually organized in such a way that the examinations are free or cheap.
Diving in particular is often seen as a potentially dangerous sport that is only suitable for particularly suitable individuals.
And whether we destroy the diving industry with medicals , nobody thinks about that.
We do quite other things to thoroughly to destroy our economy !

On the other hand, some see the usual (Padi, SDI....) specialties and certification system as exaggerated
and an insult to the ability to think , learn and practice independently.
And fortunately, you can't sue a company anywhere in the world for having a
Cat put in the microwave to dry.

 

[The Chairman]

The dive medical form that I hand out

Just ask me. Personally, I call a dive if I have a hangnail. Most any issue you have on land will be ten times worse at depth. First thing I do on a dive trip when I wake up is to figure out if I'm going to be on that boat. I do a Valsalva maneuver to make sure I have no sinus issues and then continue to check out the rest of me. I then check Ventusky to see what the wind and waves are all about. My body can handle 3, maybe 4 ft seas, but nothing after that. Right after I broke my leg, I kept it to 2ft seas and less. I don't have that problem here in Cave Country. I've been diving since 1969 and have never been stuck in the water.

Rule #2: You can call a dive, at any time, for any reason, with no questions asked. The best time to call a dive is before you get wet, or even on the boat. Hell, sometimes the best place to call a dive is before you get out of bed.