Medical Privacy Concern

[Diver0001]

Props to the OP for protecting his privacy!

In fact, we're in total agreement on this !

Props to the OP for bringing this up and for thinking about his privacy.

R..

 

[DBailey]

Please see my response about knowledge of a specific condition, and the different emergency procedures required of a hypoglycemic shocked diver. I do not advocate the form because I like it, I use it because I have to. Lying on the form puts me at greater risk, and as I've shown with my example, the diver as well. Use your form, but if there is a yes, then I want to know some specifics because it can and does affect emergency procedures. There are at least two conditions, diabetes and asthma, which require specific protocols and affect how a person dives and the people around them. Failure to provide this information violates others right to know about increased risk.Your rights end at mine, and you have responsibilities to go along with those rights. it's a package deal, you can't unbundle them. To attempt it does not speak well of you. I would appreciate a detailed explanation of how you would arrange fully informed consent of all parties given the above two medical conditions without some sort of form in a legally defensible way. Until then, your opinion has no merit.

I note that you made no comment on the specific examaple and chose to take my response out of context of the entire post. Nice edit.

-Nomad

To me you are combining two different issues.

The first issue is the fitness of the diver to participate in the class/dive. The medical form and doctor's sign-off, if needed, covers this issue.

The second issue is the emergency procedures required for EACH medical condition. The way I read you post, you are advocating that every dive shop/instructor/operator be well versed in the emergency procedures for EVERY possible yes on the medical form and EVERY poosible combination on the medical form. Sorry but this is where the responsibility falls back on the student/diver.

If the diver is aware of a medical condition and the diving implications AND the diver is fit to dive, then the diver needs to review the special procedures with the shop/instructor/operator. My duty is to get you to the surface (as safely as possible), get you to shore, enact the emergency response, and provide basic first aid and CPR. Anything outside of that, don't expect me to know any special procedures even if you mark YES on your medical form.

 

[Divenomad]

Well said. How can the diver be aware of the diving implications if the diver fails to provide full information to the pro? The physician? Unlikely. Most docs have no knowledge of the practical aspects of diving (how do you keep your injector dry while submerged?) The 1st aid protocol for a hypoglycemic shock diver is readily available, and my agency requires that the instructor understand the protocol well enough to be able to clearly explain the responsibilities to the diver. The 1st aid requirements (the injector) is explained. 1st aid for diving injuries is clearly required. these most commonly include O2 , CPR, rescue breathing, and in the case of a diabetic diver, removing a cap, inserting the sharp bit into a nonresponsive diver, and pushing a button. Instructions are included. It's no different than an autoinjector for anaphalaxis, which, while not covered in detail, is covered in most 1st aid courses. It's not complicated. How is the diver supposed to know what the procedure is if the diver never asks the instructor because they lied on a form? The instructor cannot read minds, and cannot provide information if they do not know the requirement exists. The diver does not get trained properly because they lied on the form.

By lying on the form, the diver never gets the proper training, so they cannot be in a position of "If the diver is aware of a medical condition and the diving implications AND the diver is fit to dive, then the diver needs to review the special procedures with the shop/instructor/operator." They never got trained. They can't review. they don't know what they don't know.

 

[NudeDiver]

your opinion has no merit.

I suspected as much.

 

[Divenomad]

Nonresponsive. All I ask is that you back up your position of lying on a signed document that is legally admissible in court.

-Nomad

 

[NudeDiver]

Nonresponsive. All I ask is that you back up your position of lying on a signed document that is legally admissible in court.

Exactly - the underlying motivation here is about lawyers, courts and liability. It has been discussed. I don't think we're getting anywhere

But FWIW, I think someone lying on the form is unlikely to do anything but HELP the dive operator - so unlikely to be any harm there anyway

Cheers!
ND

 

[LeadTurn_SD]

This is very a good topic.

Medical privacy is a very valid concern.

Another concern is informed consent, and this issue cuts both ways. The diver needs to know any potential risks they are taking by diving with a known medical condition, and so does the dive operator by accepting the diver as a client / student.

My feeling is there are ethical and moral issues invloved beyond the obvious safety issues when a diver fails to disclose a physical condition that would prohibit them from diving.

I think the waiver forms could probably be improved to give a bit more privacy, but in the end I think it is important that the people you dive with (buddies, DM's, Instructors, etc.) know enough of your history, for certain health conditions, so that THEY can make an "informed consent" decision regarding whether to dive with you.

Best wishes.

 

[Divenomad]

Don't understand how the diver would help the operator. Truly, I'm not trying to argue with you (I know it seems that way) I'm trying to figure out what you would consider better, and how you to go about it. I'd like to live in a world where things can be worked out "with a handshake" and if anything, I have greater concerns about my privacy than you do, because I'm in a position to know exactly how fragile it is. I confess to frustration that you seem to think I'm trying to score points, and I'm not. I ask sincerely, show me a better way, one that works.

Many people lie on the form. I know this, every shop, boat, resort and pro knows it.it puts everyone in a bad position. I personally think that we ought to adopt European standards for privacy, much stronger than here.

I just don't see the world you advocate. I see a lot of selfish motivation and downright piracy. The bloody form is just a CYA thing. What i don't understand is that you seem to advocate protecting yourself and leaving everyone else hanging.

respectfully,
Nomad

 

[doctock993]

One thing that seems to have been missed in all the discussion here (if I missed this - whoops) is that HIPPA is Health Insurance Portability and Accountability Act (HIPAA) enacted by the U.S. Congress in 1996. The Privacy Act portion of HIPPA took full effect in 2003 and "regulates the use and disclosure of certain information held by "covered entities" (generally, health care clearinghouses, employer sponsored health plans, health insurers, and medical service providers that engage in certain transactions.) It establishes regulations for the use and disclosure of Protected Health Information (PHI). PHI is any information held by a covered entity which concerns health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of an individual's medical record or payment history." [Copied directly from Wikipedia]

Therefore, HIPPA is a USA designation and rule. These "protections" for health information are not present elsewhere and so if you dive outside of the USA, your information will not be covered under those rules/ laws. [As a USA licensed physician, I am not aware of equivalent rules in the EU/ Asia/ elsewhere.]

Also, should you be a diver like the OP and wish to keep your information private, why not just write on the PADI form - "See attached Medical Clearance Letter". Then you can individually describe to your DM any health issues that you have when you hand them your letter. That way your DM will know what issues may be present for you and your medical information will not be open for public viewing, nor known by anyone other than a "need-to-know" individual (your DM who NEEDS TO KNOW!).

Finally, while I understand that certain questions are highly private, the original intent for the Privacy Rule in HIPAA, was so that insurance companies, governmental agencies, employers, etc could not go rampaging into your personal physician's information/ hospital record. Are you really paranoid that the PADI form with your information is going to be stolen/ purchased from the dive shop in (name of some exotic, non-USA diving site)?

 

[LeadTurn_SD]

Finally, while I understand that certain questions are highly private, the original intent for the Privacy Rule in HIPAA, was so that insurance companies, governmental agencies, employers, etc could not go rampaging into your personal physician's information/ hospital record. Are you really paranoid that the PADI form with your information is going to be stolen/ purchased from the dive shop in (name of some exotic, non-USA diving site)?

True, but they still try to (some insurers, attorneys, etc.,).

And in any cases where there is a "legal" proceeding (personal injury claim, work comp injury, etc.) they generally can and do get your medical records via subpeona.

The first, last and often only line of defense for medical privacy is the doctor's office staff.

Sorry for the side track. We take you back to your regular programming now

Best wishes.