OWD license without a doctor's certificate?

[KenGordon]

Again, I am a medical professional. But yes, inconvenient is exactly it. It's not making people safer, it's not preventing suing, it's not protecting anyone, it is just a form to sign so someone would have a hard time suing the dive shop that rented me equipment. The same thing happens when conditions are omitted. Exact same outcome.

You are talking like everyone who goes for a diving medical is passed fit. The people it really matters for are those that are stopped from doing something which might kill them. Apparently that is not you, but that inconvenience is the price of finding out it is not you.

This scheme is a risk based filter. Higher risk people have to get a doctor involved. The idea is to keep the very high risk cases out of the water.

Dive instructors are in no position to make these judgements. For example, they don’t know whether some particular drug for controlling some particular condition is a problem or not, they will only ever be guessing. So unless the instructor is prepared to accept people dying what are they to do?

Given the physical condition of people who do dive, and what that says about fear of death, I suspect that we’d have plenty of people with genuine issues deciding to dive or being unaware of the risks if they were not pointed out by forms like these.

 

[SapphireMind]

You are talking like everyone who goes for a diving medical is passed fit. The people it really matters for are those that are stopped from doing something which might kill them. Apparently that is not you, but that inconvenience is the price of finding out it is not you.

This scheme is a risk based filter. Higher risk people have to get a doctor involved. The idea is to keep the very high risk cases out of the water.

Dive instructors are in no position to make these judgements. For example, they don’t know whether some particular drug for controlling some particular condition is a problem or not, they will only ever be guessing. So unless the instructor is prepared to accept people dying what are they to do?

Given the physical condition of people who do dive, and what that says about fear of death, I suspect that we’d have plenty of people with genuine issues deciding to dive or being unaware of the risks if they were not pointed out by forms like these.

At that point they still rely on the person who is doing the diving, and their explanation. Even if they have a doc fill out the form, that doesn't guarantee that the doc they get to sign the form really understands either.

Which is why a more open communication model would be a safer model for everyone involved. The person with the condition is likely going to be able to explain the condition and medications, where you come down to the person being honest about it, which is more likely to happen when the discussion isn't completely cut off with a referral to a form.

Again, it's not the seeing the doctor that's the issue for me, it's this insistence that a piece of paper being signed off inherently makes people safer. It doesn't. Talking to people about their medical history and limitations does. (which doesn't preclude a doctor having been involved prior). The form can point out all the risks and advise to seek medical opinion prior to diving, but having a doctor sign a form every year (especially on non-degenerative and non-cumulative conditions) is silly.

When people aren't afraid that *any* medical condition will get them barred (and it will, if they don't have that paper signed ahead of time) they aren't going to be forthcoming, and you miss the opportunity to have better dialogue.

Plus, I don't really like the idea of placing all the liability on the medical person either. My philosophy with medicine is the only thing I can guarantee is that I don't give guarantees. My condition, my body, my decision, my liability. People need to be well aware of all the potential ways meds, drugs and alcohol interact with diving, which could (should) be included in prelim cert imo. Maybe then if they haven't been diagnosed with something yet, it will give them pause to think about what symptoms they've had and how that could play into an underwater environment. But we should be talking openly about it, not just checking boxes and handing in a form, which doesn't explain why or how risk is mitigated.

 

[KenGordon]

Even if they have a doc fill out the form, that doesn't guarantee that the doc they get to sign the form really understands either.

Here (UK) the doctor must be qualified. There is a list of those.

but having a doctor sign a form every year (especially on non-degenerative and non-cumulative conditions) is silly.

Here they can sign the form to apply for as long as they think is appropriate. So get bent, answer yes to the DCS go to the doctor, he says “did you deserve it?” You say yes, he says, “ok, I can sign you off indefinitely for DCS things, but if it happens again we will need to review”.

Doesn’t that sound sensible?

If you came to me to train, and possibly to dive, and tried to persuade me your conditions were ok despite answering yes to the questions I will ask for a (qualified) doctor to tell me it isn’t ok. I have litterally no idea whether any particularly illness matters. I cannot be persuaded by arguments I do not understand.

BTW, talking of transfer of liability, do doctors actually get sued for signing off divers? If they do, and they were not qualified or otherwise didn’t do due diligence then surely that is the correct outcome? Everyone should be doing stuff properly.

 

[Jcp2]

In America, a doctor can be sued whether or not they were qualified and did due diligence. Anybody can sue anybody else in civil court for any reason. The validity of the claim is decided in court. The costs of pursuing the claim is borne by the party suing. The cost of the defense is borne by the party being sued. If the claim is unsuccessful, there seldom is repayment of the costs of the defense to the person being sued by the person who unsuccessfully sued.

 

[jlcnuke]

At that point they still rely on the person who is doing the diving, and their explanation. Even if they have a doc fill out the form, that doesn't guarantee that the doc they get to sign the form really understands either.

Which is why a more open communication model would be a safer model for everyone involved. The person with the condition is likely going to be able to explain the condition and medications, where you come down to the person being honest about it, which is more likely to happen when the discussion isn't completely cut off with a referral to a form.

Again, it's not the seeing the doctor that's the issue for me, it's this insistence that a piece of paper being signed off inherently makes people safer. It doesn't. Talking to people about their medical history and limitations does. (which doesn't preclude a doctor having been involved prior). The form can point out all the risks and advise to seek medical opinion prior to diving, but having a doctor sign a form every year (especially on non-degenerative and non-cumulative conditions) is silly.

When people aren't afraid that *any* medical condition will get them barred (and it will, if they don't have that paper signed ahead of time) they aren't going to be forthcoming, and you miss the opportunity to have better dialogue.

Plus, I don't really like the idea of placing all the liability on the medical person either. My philosophy with medicine is the only thing I can guarantee is that I don't give guarantees. My condition, my body, my decision, my liability. People need to be well aware of all the potential ways meds, drugs and alcohol interact with diving, which could (should) be included in prelim cert imo. Maybe then if they haven't been diagnosed with something yet, it will give them pause to think about what symptoms they've had and how that could play into an underwater environment. But we should be talking openly about it, not just checking boxes and handing in a form, which doesn't explain why or how risk is mitigated.

It's great that you are happy to discuss your medical conditions with strangers. There are lots of people that wouldn't be however, even if their only "yes" answer was to "are you presently taking prescription medications?" (that 21 year old kid that just got buddied up with a cute girl isn't disclosing the meds he's taking for his STD to her I'd bet, for instance). I certainly don't want to try and explain my knowledge of controlling my diabetes with random strangers, or try and convince them why my doctor feels I'm okay for diving when their friend/relative/neighbor with diabetes couldn't or they heard that diabetes meant you couldn't dive ever 20 years ago when they were learning etc. I want that instructor to say "your doctor said you're safe to dive medically and that's all I need to know".

What I want from a dive buddy (and try to do as a dive buddy) with a medical condition is for them to inform me of anything I need to know. As a general rule, if there's something I need to know beyond "my buddy is thumbing the dive" then their condition is probably contraindicated for diving at all. Sure, you could share how you take some meds and everything you do to be safe while you're diving, but the only thing I needed to hear to be a good buddy for you out of the paragraph worth of explanations is "you'll thumb the dive if you have a problem with diving safely at that point". I'd hope you do that for anything in a dive that made it no longer safe and I don't really care what the reason is at the time. If you want to explain after you thumb the dive, great. But I certainly don't need a big explanation of your medical history ahead of time.

If my buddy can dive safely, they should be able to dive safely. If there's a chance they may have to thumb a dive during it, then I'd appreciate an explanation of why they thumbed the dive after it's over if that happens, but anything I'd "need to know about during a dive or before a dive" (hey, I may pass out while we're 60 ft down) etc should be something that keeps them out of the water altogether.

The form limits the likelihood of the agency or professionals being successfully sued AND it provides students with a tool to try and help them understand their health safety risks by directing those at higher risks to see a doctor to determine their medical suitability for diving. To me, the second part of that is the more important part.

 

[JackD342]

@SapphireMind - it sounds like you fill out a lot of Medical Statements. Is that right? I don’t think I have ever been asked to complete one for a trip/excursion.
Realizing that some operators, agencies, and/or locales may have different procedures, the basic PADI standard only comes into play for instruction, including Refreshers. The Continuing Education document includes the Medical Statement and other releases, etc., and is good for one year. The second page, with the MD sign off is good for one year, contingent on nothing changing, which is the responsibility of the student diver. But if at 6 months that diver signs up for another course and casually mentions a recent potentially disqualifying medical event, I need to get some updated paperwork.

So if you are a recently certified OW diver just continuing to dive but not taking any further classes, I question the actual need for additional medical forms. But hey, if an operator has decided they require this to take your money and put you on their boat, that is their prerogative.

@SapphireMind you may have missed this earlier. I am still curious about why you seem to be filling out so many Medical Statements. Just trying to understand.

I suppose it is possible that some operations are treating the assignment of a guide on a dive as a professional responsibility similar to the instructor/student relationship that initiates all the paperwork. That just hasn’t been my past experience.

I 100% agree with those that have pointed out that filling out a form is not a magical safety blanket, and an argument can very much be made for MORE medical review, not less.

I went back and read a few to remind myself of what ALL of the documents say, not just the last paragraph before the signature line and the list of conditions.
These are instruments of communication that are intended to make the diver and other parties aware of the inherent risks and complications of diving, and to facilitate informed decisions. They seek to “manage” risk and liability, but don’t eliminate either. The reliability release uses the word “understand” nine times on one page! Part of that management of liability is the written documentation that the diver acknowledges they have been informed, to avoid any later conversations that include “I didn’t know” or “no one ever told me.” And yes, it is a good idea to periodically remind a diver of these issues and refresh the communication. Apparently 1 year seems to be a reasonable such period.
All those Online Terms of Service in our daily lives have conditioned us to sign on the line without reading what we are signing. I routinely instruct my divers to slow down and read it first, so the signature has true value.

 

[dmaziuk]

.. Some posters on here insist otherwise, but they refuse to check with PADI and insist on their own interpretation of the form.

Yeah... some people here refuse to check with the drivers of California and insist on their own interpretation of the stop sign. You know, where it doesn't say white on red s-l-o-w-down-and-keep-going.

 

[SapphireMind]

@SapphireMind you may have missed this earlier. I am still curious about why you seem to be filling out so many Medical Statements. Just trying to understand.

Every time I've rented gear or gone on a dive with a new company, I've been asked to fill out that form, which is why I think it's excessive and pointless.

 

[SapphireMind]

Getting to an approved doctor is (in the US) an additional out pocket expense, and depending on where you live, could be difficult. If I need to take a day off work, and pay out of pocket for an exam, and potentially other testing (that may have been done previously by another doctor, or that doesn't actually affect the outcome) that can go into upwards of a thousand dollars in cost, which is a substantial additional cost, and even just an additional 300 bucks every year is not nothing. It's already an expensive hobby, adding in annual costs for a liability form that does not actually provide for safety just doesn't excite me about it as a policy.

Whether it is my saying "Yes, I have spoken with my doctor at length, and I am cleared for diving", vs having a form that a doctor has to sign and potentially incur legal liability for, when really it is my responsibility and liability - I just do not see the benefits.

Someone asked about lawsuits, there are a lot. I work in pediatrics, so I get to be sued until my patients turn 18, fun times. If a doc signed off on a diabetic with good control, and the diabetic decided shooting for DKA would be fun prior to a dive, it will still go back to the doctor "You knew this patient had a risk of DKA and/or hypoglycemia, why would you sign off?" It is safer from a medical legal perspective to not sign if the patient has any conditions that could impact anything.

As we talk through it, it becomes more apparent to me that my personal issue is asking the medical person to assume liability, which they are doing when signing that form. Obviously, I have a bias with that because of my working in the field. I don't want to ask my medical professionals to assume any risk for me in this situations and I think it is unfair to ask them to. If you aren't medical, you don't know the kind of dread that can come with being asked to sign something as a professional that you know can be used against you in a court case and you have no control over what the patient may be doing in the interim between signing and using the form. At the end of the day, I am responsible for my medical condition prior to diving.

I do think there needs to be more focus during instruction on how physical things can affect divers and diving. But putting that all on the shoulders of your medical provider sits wrong with me.

 

[gcarter]

Just looked at some of the paperwork for a LOB I am going on in a few weeks and a medical questionnaire is required when we get there. This will be a first for me since my last training course.