Question So I'm 65 and on medicare which will not cover a physical. What do older divers do for the required physical? How extensive should it be?

[lowflyer]

I guess the relevance to this thread is that a full physical exam might reveal a condition that a basic "wellness" exam would not..

I agree with this in a lot of cases. It all depends on the ethics of the doctor. Some doctors do a reasonable history and physical exam during the wellness exam. In other cases the wellness exam is a joke with the patient filling out a questionnaire, and a nurse asking some questions and having you remember a few words and draw a clock, all with minimal attention by the doctor.

IMO, the wellness exam is a waste of Medicare dollars and should be replaced by the old fashioned physical exam. It would be better for the patient and less expensive for Medicare.

I will also point out that the wellness is not required by Medicare. I refused to undergo one in the past when I knew that a particular doctor's office knew how to make it a waste of time and Medicare money.

 

[DavidFL]

I have been on "traditional" Medicare (with a Medicare Supplement policy for five years. The distinction between a "wellness" exam and an annual physical is very much up to some combination of interpretation and billing codes by the medical practice and the patient involved. For the last several years I have also had an annual separate consult by a Cardiologist who is a very active diver, instructor, rebreather instructor, etc. Medicare allows for a patient to be able to visit any clinician who accepts Medicare, including specialists. I'm approaching 75 and as a result have had enough medical history that there are now several specialists with whom I can schedule a visit that completely legitimately qualifies as 'follow-up' to some past history/condition. My cardiologist consult also gets me an updated signature on the RSTC form every year. Happily, following up annually on things a cardiologist looks at is also a very good idea, in my opinion, for divers old enough to qualify for Medicare.

 

[GarBear58]

I have been on "traditional" Medicare (with a Medicare Supplement policy for five years. The distinction between a "wellness" exam and an annual physical is very much up to some combination of interpretation and billing codes by the medical practice and the patient involved. For the last several years I have also had an annual separate consult by a Cardiologist who is a very active diver, instructor, rebreather instructor, etc. Medicare allows for a patient to be able to visit any clinician who accepts Medicare, including specialists. I'm approaching 75 and as a result have had enough medical history that there are now several specialists with whom I can schedule a visit that completely legitimately qualifies as 'follow-up' to some past history/condition. My cardiologist consult also gets me an updated signature on the RSTC form every year. Happily, following up annually on things a cardiologist looks at is also a very good idea, in my opinion, for divers old enough to qualify for Medicare.

I like your line of reasoning. My doctor has been treating me for high blood pressure 150/80+- with good results and my cholesterol is moderately high which I am working on with diet and exercise. I'm not sure if any of that would qualify me to go see a cardio but it's worth the ask. At the end of the day I realize that no amount of testing will result in any guarantees. I'm simply trying to get a feel for how far others in my age group go to answering the question of "fit to dive".

 

[DavidFL]

I like your line of reasoning. My doctor has been treating me for high blood pressure 150/80+- with good results and my cholesterol is moderately high which I am working on with diet and exercise. I'm not sure if any of that would qualify me to go see a cardio but it's worth the ask. At the end of the day I realize that no amount of testing will result in any guarantees. I'm simply trying to get a feel for how far others in my age group go to answering the question of "fit to dive".

Not sure where you are in Washington State, thus not sure how many choices you might have, but the approach that worked for me was to find a Physician who is an active, engaged diver, and then try to find a reason for consults with him or her. In my case, the two "big" questions about my fitness for diving, besides my age and general physical health, revolve around a prescription medication I'm taking (an anti-coagulant) and a history of DVT/Pulmonary Embolism (the reason I'm on lifetime anti-coagulants). When asked to sign an RSTC form several years ago to address those two issues, my PCP signed off "no", so I went looking for a specialist of some kind with specific diving knowledge to "overcome" that record that my PCP said no. The stuff a laymen can find online from DAN and other sources is equivocal, basically says it depends on why I am taking the anti-coagulant. My hematologist isn't a diver. When I had the DVT/PE episodes over a decade ago, I was followed by a hematologist and a cardiologist. So, in my annual consult with the diver/cardiologist, his visit notes show that we reviewed the medication and possible side effects specifically related to diving, and he also provides an opinion related to specific upcoming diving training I am considering (TDI ER/Trimix) and provides his opinion of and the fact that we mutually discussed his opinion about the relative risks. He also signs the RSTC form. Long riff just to point out that if you find a Physician who is an active diver, he or she may be routinely seeing divers for a "suitability to dive" opinion, in which the whole paperwork exercise of choosing the initial reason for consult, and the outcome of the consult, and the appropriate codes for billing Medicare or other insurance will be understood by his/her staff which is probably as important to your original post as the RSTC form and the visit notes. When I engage with technical training instructors, by the way, given my advanced age, they want a copy of the visit notes besides just the RSTC form. As it turns out, I value that annual consult enough now that I would happily pay for it out of pocket if my various forms of insurance ever decide not to cover it.

 

[Brian2063]

I'm 45 and smoke cigars occasionally and always self certify on the medical form by answering no to all the questions, who knows our own bodies better than ourselves, and I have never trusted the medical profession, know too many people who have gone for a physical and come out needing more testing and medication. Have not had an actual physical examination since senior year high school wrestling team,even though my brother had and died from TC. The more you look for problems, the more likely you are to find them.... just like with my boat last winter, didn't like rough idle, and it ended up me rebuilding both 350 chevy motors, and well also had to build them for performance. If I could have dealt with the shake at idle/ low rpm they likely would have been just fine. instead it ended up costing me $4,500 and I did all the work except for machine shop work, block and heads.

 

[rx7diver]

... Have not had an actual physical examination since senior year high school wrestling team ...

@Brian2063,

I can't tell if you're being ironic/sarcastic.

One value of periodic physicals is to provide docs with baseline data for you just in case something medical should happen to you, whether you believe these data or not.

FWIW.

rx7diver

 

[mikeylee]

I am 65 and am getting OW certified in a few months. Those of you who “self-certify,” just exactly do you mean? I see one question on the PADI form most of the posters above have to say yes to…”are you over 45”. Also, what is the annual form that needs to be filled out? Many thanks!

 

[OMyMyOHellYes]

There's no annual form. Form i sonly required for training. And is good for any training for a year after completed (unless you have an intervening issue... But ....

The RSTC form does ask if you are over 45, but a "YES" on Question #2 does not mean you have to get a doctor sign-off. It means you have to go to page 2 and can honestly answer the 4 questions there no: smoker? high cholesterol? high blood pressure? Close blood relative die of heart attack before age 50 or have history of heart disease before age 50. If Question #2 on page one is the only one checked "YES", ONLY BOX B NEED BE COMPLETED.

If all of those in box B are "NO" and all of the other questions on p. 1 are "NO" or are not applicable, then you sign (self certify) at the bottom of page 1.

If any are "YES" it is usually just a discussion with your Dr. and his signature/concurrence that he doesn't see anything counter to diving (best case scenario as far as you're concerned.) As it's at the Dr's discretion, he may require more investigation or just say "Nope".

Some diving trainers are retarded in the extreme and will construe the "YES" on question #2 to require a doctor's sign off, but they just can't read and comprehend the common English language.

https://www.uhms.org/images/Recreational-Diving-Medical-Screening-System/forms/Diver_Medical_Participant_Questionnaire_10346_EN_English_2022-02-01.pdf

If I plan any training in the coming year, I just take it to my annual physical, already filled in and ask him to sign it and he does, even with a few "YES" anwsers..

 

[mac66]

I started diving when I was 65. Just dropped off a form at my Dr who signed it. First and only time I did that. That was 4 years ago. I now sign the waivers "no" when I dive that I have no issues.

 

[rx7diver]

I started diving when I was 65. Just dropped off a form at my Dr who signed it. First and only time I did that. That was 4 years ago. I now sign the waivers "no" when I dive that I have no issues.

@mac66,

I don't recommend this (i.e., just dropping off a form at your Dr and having him/her sign it). Do you have friends/family who would grieve if you didn't return from a dive? If so, then you owe it to them to be more deliberate about this! And to the other divers on the the dive boat you're diving from.

Wouldn't you want to know if a chest X-ray will reveal an issue with your lungs?

Wouldn't you want to know if a stress-echo test will reveal an issue with your heart?

Etc.

rx7diver