Heretical thoughts on the diver's medical form

[drrich2]

We need to change from a required medical sign off (which is only required if the diver has either clear medical issues OR is totally honest on the form) to self-regulation with adequate and understandable information so that the diver will seek evaluation by the appropriate level of medical provider if there are issues.

To understand why things are done the way they are, it's key to look at the stakeholder interests involved.

1.) The recreational diver - in theory, this is what it's all about. In reality, bull. Supposedly there's this black and white 'fit to dive or not fit to dive' dichotomy, it's practical for someone to make that call, and the diver, his family, his doctor, the dive op., basically everyone agrees with this and the goal is to use paperwork to trigger this determination, which will be made by a qualified and competent where diving clearance is concerned medical professional and everyone will accept that accurate determination, including the diver. Bull.

2.) The dive op. - doesn't want to get sued (which can be a terrible ordeal, even if they 'win' - and even a win can be a pyrrhic victory - after all, what do they 'win?'). Staff don't want to have to deal with avoidable emergencies. If a poorly regulated diabetic passes out at 90 feet and by the time the guide notices him he's sinking past 140, it's late in the dive and everybody's on nitrox... So they need to exclude higher risk divers, or at least secure full deniability in case one dies on their watch.

3.) The agencies - I don't hear this angle much, but I imagine PADI, SSI and others need some kind of medical 'informed consent' effort to defray risk.

4.) The health care professionals you seek clearance from don't sign off on clearances for a living, so they're taking on substantial risk for little if any gain. If you die, people may come after them. How many general practice physicians are knowledgable about diving medicine?

The problem is 2-fold. First off, the interests of 2.) and 3.) drive policy. Yes, 1.) is part of it...but I think lawyers have more to do with driving this than doctors. Second...we have the issue of autonomy.

In a nutshell...I decide for myself whether I'm fit to dive in a given scenario. I'll wish to have the info. available to make an informed decision, including access to professional consultation and expert articles if needed. I will not surrender that decision to some 'big brother,' such as whoever I'm referred to. I recognize that checking 'yes' on one of those clearance forms will result in denial of service until I submit to formal evaluation and surrender that decision.

And if I did? Would I seek out some distant dive medical professional? No. I'd take the form to my family doctor, explain away any concerns I considered trivial, and likely get a clearance...that one could likely argue was largely a clearance by me. If he wouldn't do it, I'd shop around for someone who would.

In the real world, many divers are in their 40's and older. Particularly the distant dive trip takers, who can take a week off and pay for airfare, hotel, diving, etc... This demographic often has pretty well-managed fairly minor medical issues - high cholesterol, hypertension, enlarged prostate, arthritis, vision impairment, etc...

Bottom Line: You check 'yes' to anything on a medical clearance form and you may well have surrendered your autonomy to another decision maker you may disagree with, and put yourself out time, effort and money to secure a clearance you may've obviously not needed medically and the quality of which may be poor. But since the needs, wants and personal liberty of the diver don't seem to be the primary policy drivers...don't expect much change.

 

[lowviz]

I really didn’t mind (too much) since I doubted there was anything more available for care beyond an ACD plus I am sure they had DAN on call. ...//...

Plane on runway...

Odd. You guys are rather respected in my neighborhood. I'm quite aware of the training you guys get and what you need to do to continue your certification. Search on this:

"NPs are fully authorized to sign death certificates in 26 states."

Question. Do dermatologists have this authorization?

 

[drrich2]

Question. Do dermatologists have this authorization?

I suspect so. Reason being, the Dermatologist is a physician, who completed medical school, then part of residency (a matter of state law, but in my state for a non-foreign trained physician it was 1 year, last I checked) to qualify to obtain a medical license (which may have some requirements, such as passing exams).

In other words, I suspect bureaucracies tend to see 'physicians' as a group, rather than breaking it down by specialty. Otherwise, you've got to make calls like saying death certificates can be signed by family medicine, internal medicine, emergency medicine, surgery and cardiology physicians, but not psychiatrists, dermatologists, pathologists, radiologists, etc...

What a given physician is legitimately skilled to be doing varies widely, even within a specialty. Some family physicians do a lot of obstetric work, and I knew one who did a lot of general surgery (that sort of thing seemed more common in rural areas).

Often the question about what a given physician should do is left to him/her to decide, or the employing agency. For example, if a physician works at a hospital, that hospital has a credentialling process that delineates at least in broad terms what he/she is authorized to do.

All of which can lead to some scary scenarios. Some people think anybody with 'M.D.' on the end of their name ought to be at least on par with a paramedic or EMT and really good at CPR and comfortable managing medical crises. It ain't necessarily so...

 

[lowviz]

I suspect so. Reason being, the Dermatologist is a physician, who completed medical school, then part of residency (a matter of state law, but in my state for a non-foreign trained physician it was 1 year, last I checked) to qualify to obtain a medical license (which may have some requirements, such as passing exams). ...//...

I vigorously disagree with the implication.

My background includes hard engineering and biomedical engineering. Biomedical engineering is a bastard profession that allows the nuts and bolts engineers to effectively interact with primary health care professionals (and vice versa.) I claim that my profession gives me a viewpoint that necessarily encompasses both of the operantional ends of healthcare reality.

Me? I'm just a highly technical translator...

 

[ofg-1]

. But since the needs, wants and personal liberty of the diver don't seem to be the primary policy drivers...don't expect much change.

Well, I disagree with this. A diver always has the "personal liberty" to say no, and go and do something else. Framing a release, either medical or liability, as an infringement on your rights is disingenuous, you can always say no. You are not forced to use Amazon, but if you do, you have to agree to their terms of service. No one forces you to go diving.

These medical forms have been worthless for decades. We had doctors doing OSHA commercial diving medicals 45 years ago that used the warm body method. If you could walk into their office with $200, breathe for 15 minutes, not hack up a lung, bleed all over the place, or be missing an major appendage, they would sign the medical. We shared their names.

 

[drrich2]

Well, I disagree with this. A diver always has the "personal liberty" to say no, and go and do something else. Framing a release, either medical or liability, as an infringement on your rights is disingenuous, you can always say no. You are not forced to use Amazon, but if you do, you have to agree to their terms of service. No one forces you to go diving.

Ah, but can you say yes? If you share something from your private health info. that they find objectionable (e.g.: from a liability standpoint, since it's been disclosed), they can force you not to go diving (with them, and since many destinations are boat-only and like-minded and even shore diving tank suppliers might have people sign disclaimers, 'they' can do a pretty good job of shutting you out of diving as we know it, period. Unless you want to buy your own compressor off the Internet and live near shore diving).

So it's not disingenuous. It's a combination of practical realities and the old adage 'Where you stand on an issue depends on where you sit.'

We have laws intended to mandate privacy of healthcare info. and give individuals control over disclosure of their own. Concern over how 3rd parties might use it against them presumably drives a lot of the perceived need for that.

Me? I'm just a highly technical translator...

You know what you can and should be doing, in your profession. The average legislator does not. Also, some Dermatologists may be qualified to do death certificates. There's a lot of variation in physician practices and backgrounds. I'm not saying it's common or that they'd want to, just that it's not impossible. In some things, self-regulation goes a long way.

 

[lexvil]

Curious where this is an issue? Is it training or dive operations? I don’t recall ever being asked for a doctor signed release to dive anywhere and are we advocating a scuba license with periodic health screening?

 

[DBPacific]

The main issue I have with the form is that it's really annoyingly difficult in the US at times to find someone to do the physical whose signature will be accepted, and American healthcare in general is annoying for not knowing how much I'll have to pay for it because the insurance companies and hospitals always lie

On top of that, I have a chronic lifelong condition that I have to disclose because I'm also on medication, but even though I've had it all my life and have been medicated with no changes in symptoms or side effects for 5 years, the doctors I've gone to for medicals still insist on checking the box saying I'm required to get a yearly medical instead of the normal "this diver is clear for 5 years" like everyone else in my age bracket who are healthy. This just makes it even more annoying cause now I have to deal with US healthcare every single year once it's in my file. My condition isn't going to change, the medication probably won't change, and I know my own symptoms well enough to know if I can dive that day or not. If I have medical complications on a dive it will almost certainly be due to some other issue that I can't anticipate.

I know some international operators require a medical form outside of training. Who has needed a medical form, other than for training, and where was it?

I have to have regular medical exams for AAUS (USA) to keep scientific diver status, or to renew status if I lose it by not meeting requirements.

 

[tursiops]

the doctors I've gone to for medicals still insist on checking the box saying I'm required to get a yearly medical instead of the normal "this diver is clear for 5 years" like everyone else in my age bracket who are healthy.

So this is the AAUS or a work-related clearance? The 2020 Diver Medical is only good for one year, no matter what.

 

[DBPacific]

So this is the AAUS or a work-related clearance? The 2020 Diver Medical is only good for one year, no matter what.

The AAUS, and this was before 2020. I couldn't make any dives at all last year so I didn't even bother getting a medical since I'll have to do it again to renew anyways