"Dive Physician"??

[babar]

I'm now a dive doc. I'm finishing up a fellowship in hyperbaric medicine. In general, most of the questions on this board have to do with a specific medical problem. Asthma and diabetes are the big ones that come to mind, and they are surrounded by controversy, and may require LOTS of discussion, and testing. Another separate area is in the commercial or profesional diving fields, where there is potential employer liability. Commercial employers often have routine tests that they require, even for my current job, I required a chest xray and hearing test.
In a recreational diver without any specific complaint, the evaluation ought to be pretty straight forward. The purpose of seeing a specialist for this, is to be looking for trouble, the most likely problem areas are still going to be ears, heart and lungs. A good visual exam of the ears should be enough, unless there are specific complaints or problems with equalizing, in an older person a hearing test might be worthwhile. I agree with a stress test. A stress test is usually recommended for anyone(Over 40's to 50) starting any new exercise regimen. I would add an EKG to this, even if there are no problems, just to have as a baseline. I like to give the patient one to keep in his wallet in case of trouble so there is one available to compare. And if there's anyone out there who has had one done recently, please do that. Shrink a copy and stick it in your wallet. **end of public service anouncment**
A chest xray is a very reasonable test to do. I wouldn't say that it's a requirment for dive clearence, especially without any history of asthma, smoking, cough, chest pain, ect, but it's a relatively simple, inexpensive test to do that can give you a lot of information.
Regarding spirometry, in Austalia all divers must have that test done to be cleared to dive, apparently they are pretty stringent regarding dive clearence. It's certainly not a requirment here.
Now, all this being said, in my experience, the less you do, the more you have to say. Did he at least talk to you about what type of diving you were doing? Being safe, staying hydrated, that kind of thing? Providing literature or any helpful info? These are all things that can go a long way towards satisfaction with the visit. So the 70 second exam not withstanding, it sounds appropriate, but I agree there could have been a little more communication. Also some of these tests wouldn't be bad for your primary care doc to have anyway as basic health maintenece tests and while we are on the topic, did you have your colonoscopy yet :11: ? Enjoy.

Cheers, and feel good
Dr Babar

 

[BillP]

Listened very closely to detect any possibility of a PFO.

Just as an aside, it's pretty unlikely that you'd be able to detect a Patent Foramen Ovale by listening with a stethoscope. PFO's are generally detected by echocardiography (heart sonograms). A PFO can even be missed by an echocardiogram with the ultrasound probe on the outside of the chest. A transesphageal echocardiogram (with the US probe swallowed down the esophagus) with intravenous bubble contrast is more sensitive.

HTH,

Bill

 

[gkndivebum]

Went to a "dive physician" today [...]

Hi Jim --

It's a bit of a drive for you, but UCSD Medical Center in Hillcrest (San Diego) has an occupational
health clinic which includes a more comprehensive diving physical. No insurance accepted, and
the physicians who do this more or less volunteer their time and are board certified in hyperbaric
medicine. My first diving physical exam there some years ago was by Dr. Karen Van Hoesen, who
at the time was an active NAUI instructor and on the DAN board of directors.

[...] get an okay to participate in a 10-week advanced OW class this summer.

An AAUS sanctioned scientific diver program?

Being well over 40 myself I had to get a very comprehensive physical to get my AAUS Scientific
Diver certification.

 

[mccabejc]

An AAUS sanctioned scientific diver program?

Hey Gerard. No, I don't think so. It's the LA County Advanced Diver Program. I think it's kinda equivalent to the NAUI Rescue and Master Diver programs, plus a bunch of other stuff.

The medical form is pretty much the standard form, no special requirements. Just a doctor's okay.

 

[jbd]

Went to a "dive physician" today, for two reasons. The most important was to get a complete checkup by a dive specialist to make sure my almost 50 year old body is in great shape for continued diving. The secondary, and far less important reason was to get an okay to participate in a 10-week advanced OW class this summer.

So I go in there fill out some medical history, and he checks my history, and looks at me for about 70 seconds. Maybe less. His physical is only a fraction of what my personal physician does for a routine yearly physical. The only thing he did different was to ask me to get a cardiac stress test, and fax him the results, and he'll sign off on the okay.

All that for $75, which my medical insurance doesn't cover. So I'm scratching my head wondering why the hell I bothered to find a "dive physician", instead of going to my regular physician which would have cost me nothing.

Heck, I figured he'd require an x-ray, maybe some lung capacity tests, etc. Was I way out of line in my expectations?

Did you have anything marked on your history that indicated any health problems? If you have a yearly physical and there are no problems why wouldn't those records suffice for the course you are going to take?

 

[doctormike]

Went to a "dive physician" today...

So I go in there fill out some medical history, and he checks my history, and looks at me for about 70 seconds. Maybe less....

All that for $75, which my medical insurance doesn't cover. So I'm scratching my head wondering why the hell I bothered to find a "dive physician", instead of going to my regular physician which would have cost me nothing.

Well, it does sound like he at least could have chatted with you for a while longer....! On the other hand, if someone sees a lot of this, it might not take very long to pick up on the major problems that could affect diving throught a review of systems, a history, and a directed physical.

Reminds me of the old joke:

There was an engineer who had an exceptional gift for fixing all things mechanical. After serving his company loyally for over 30 years, he happily retired.

Several years later, the company contacted him regarding a seemingly impossible problem they were having with one of their multi-million dollar machines. They had tried everything and everyone to get the machine fixed, but to no avail. In desperation, they called on the retired engineer who had solved so many of their problems in the past.

The engineer reluctantly took the challenge. He came into the factory, looked closely at the machine, listened to it run for a few minutes, and marked a small "x" in chalk on a particular component of the machine.

The part was replaced and the machine worked perfectly again. When the company received a bill for $50,000 from the engineer, they were reluctant to pay it.

"This seems a bit excessive for one chalk mark," he was told, "Perhaps you'd better itemize your charges."

Within a few days, they received the following itemized bill:

One chalk mark . . . . . . . . . . . . . $1
Knowing where to put it . . . . . . . $49,999

 

[ScubaDadMiami]

DAN actually pubishes a pamphlet, which is pretty cheap (less than $10) on examinations for physicians regarding diving patients. You might want to get this from them and then compare what your doctor does to what is in the pamphlet. Better yet, give it to your doctor, asking what he/she would think necessary or unnecessary that is contained in it. Might be a "healthy" discussion for the two of you.

 

[Dr Deco]

Hello readers:

Recognizing a Problem

I am always pleased by someone who is able to quickly recognize a problem – or conversely, quickly know when nothing is there.

I am reminded of a patient who remarked to his dentist after an extraction. “Ninety dollars for five seconds of work!”

The dentist reply, “Remind me about that next time, and I will make it last a lot longer.”

Dr Deco :doctor:

Readers, please note the next class in Decompression Physiology September 10 – 11, 2005 :1book:
http://wrigley.usc.edu/hyperbaric/advdeco.htm

 

[Aquadoc68]

FIRST I am not trying to discreadit any Dr. for I am not one, Just a humble DMT who is good at what he does. I work in an Internal Medicine clinic and do about 12 GXT's a week.
I may have missed something but him asking you to get a GXT without seeing an EKG or you having exercise related chest pain seems a little out of line NOT WRONG MIND YOU just not needed without S/S. I am an US Army Combat Diver and Dive Medical Technician and I did not have to do a GXT nor have I given one to any one on my Team. Our PE's go like this CXR, EKG, Hearing, full fasting blood work up to include RPR. Focused History and PE, PPO2 test (but that is just because we breath 100% O2 on Dreager) and Neuro exam. But if it makes you feel better, spend the $$ on the GXT. JMHO
Aqua

 

[babar]

FIRST I am not trying to discreadit any Dr. for I am not one, Just a humble DMT who is good at what he does. I work in an Internal Medicine clinic and do about 12 GXT's a week.
I may have missed something but him asking you to get a GXT without seeing an EKG or you having exercise related chest pain seems a little out of line NOT WRONG MIND YOU just not needed without S/S. I am an US Army Combat Diver and Dive Medical Technician and I did not have to do a GXT nor have I given one to any one on my Team. Our PE's go like this CXR, EKG, Hearing, full fasting blood work up to include RPR. Focused History and PE, PPO2 test (but that is just because we breath 100% O2 on Dreager) and Neuro exam. But if it makes you feel better, spend the $$ on the GXT. JMHO
Aqua

RPR? really? what for? and how much extra does it cost? And regarding the stress test, it's a pretty standard recomendation for anyone over a certain age who is now starting a new exercise regimen. It's a oretty general screening test for exercise tolerance, the age where you starting screening is debated some say 40, some 45 or older, but I would get one in a 50 year-old if he hadn't had one.

Babar