That pesky Medical Statement

[gopbroek]

Birth has a 100% risk factor of eventual death.

 

[redacted]

I have medical conditions and take medicines that make me answer "yes" on some questions in the medical forms. My Doctor luckily is a diver also and has a great concept of the medical requirements necessary for diving. Before we leave on any diving trip, I simply email him with a request for a letter. I get a letter from him that specifically states that the medical conditions and the medicines that I take will not preclude me from any diving activities. The letter is dated, original signed and on his letterhead. I have never had a problem with any operator after producing this letter.

It is a simple way to avoid problems and potential confrontations with just a little fore thought.
vann

That should work until you run into a provider who insists that the correct form (or that form's specific statement) be provided. Your way does not seem as simple or foolproof as just answering NO.

 

[RainPilot]

The RSTC form is usually only required for training, but some people are starting to require it for guided diving, too. Natalie Gibb is an example, as preiously noted.


In the theory behind the RSTC form, the signing doctor makes the decision. For example, if you take prescription medications, you do not have to disclose what they are--that is for your physician to know, and the physician makes the call. That is not, however, how it is done everywhere.

I do not know if they still do it this way, but when I was with UTD, there was no doctor sign off. As a student, you filled out a new online form for every class you took took, even if you took them only weeks apart. It was extremely detailed, and it took a long time. When you were done, the UTD personnel looked it over and decided if you were fit to dive. To my knowledge, no doctors were ever involved in that decision. Once, shortly after completing a class, I signed up for another one, and it was classroom only, with no diving. I was shocked to find out I had to go through the entire medical form again for a classroom only experience. When I came to the part where I had to list my prescription medications and the dosages, I said to myself, "Screw it! They just got that information a month ago," and I left it blank. On the next diving trip (not a class), I roomed with the UTD instructor, and he went into my toilet kit to see what medications I was taking because I had left it blank.

FWIW, UTD now has the standard medical form , requiring a physician sign-off if anything was a yes. Still needs to be done for every course, in water or not, but I suspect that's an artefact of their website structure.

 

[boulderjohn]

A simple statement that you have no known medical condition that precludes you from diving is reasonable but that is not what is normally seen.

The simple reason for that is that most people new to diving would have no idea what kinds of medical conditions would preclude them from diving. The RSTC list of conditions is designed to give them a starting point for checking with a doctor.

 

[Wookie]

I quoted this proverb recently too. However, although this is off topic, you should know that the effect of following the rule too close can be the opposite. Thus, the secrecy around the defensive minefields around Florida Keys resulted in sinking of several US and friendly ships, including a Clemson-class destroyer Sturtevant (DD240), and cargo ships Edward Luckenbach, Gunvor (Norwegian) and Bosilijka (Yugoslavian) because the captains were not informed.

Want to go dive them?

 

[Jim Lapenta]

I am glad that we spun this thread off (from the A&I discussion of the Cozumel fatality) because it has produced some informative discussion. Based on some of the comments I have several reactions, in no particular order of importance:

Several posters have referred to the 'PADI form'. While that may be the form that PADI makes available on their website, and carries a PADI logo, it is useful to keep in mind that the form is actually (clearly stated on the form at the top) the RSTC - Recreational Scuba Training Council (United States Council - WRSTC) form. So, if any SB user wishes to 'suggest' that the form should be changed, the RSTC would be the best point of contact. I happen to agree with one such post, that the form should be updated to include non-physician primary care providers such as PAs and FNPs. I have been presented with forms signed off by both types of providers, and have accepted them without reservation, even though the form specifies 'physician'. I cannot speak for other Instructors or dive operators.

In the US, RSTC members include PADI, SDI, PDIC, SSI and RAID. Notably missing from the list is NAUI, NASE and SEI. It would be good to hear from Instructors / operators working through those agencies, regarding the standards for medical clearance that those agencies apply.

The 'process' of obtaining a diver statement regarding their health, is intended - as the RSTC form indicates - to protect the diver (formatting added for emphasis):

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities.

Diving is associated with certain risks, it can be a strenuous activity, and some individuals wishing to pursue diving may not be aware of how their physical condition may increase their risks. (Of course, all of us on SB are fully aware of any and all risks that we face when diving, so that statement really applies to 'those other divers'.) The form really is for the benefit of the diver - by providing a checklist and a decision tree. If you answer 'Yes', you should seek the opinion of an independent, informed 3rd party - a medical provider. Like it or not, very few (actually, I think NONE) of us are absolutely objective in assessing our own fitness to dive. We may be able to make a valid assessment, but we are not entirely objective, even when we are right. The Medical Statement is not intended to be intrusive, although some may choose to view it that way.

The process also involves risk mitigation for dive professionals and operators. It really is a matter of liability, on two levels. The first is straightforward - if someone dies while diving, the most common reaction among family and friends is NOT - 'Wow, at least that's some consolation, they died doing what they loved.' Rather, it is, 'Who is to blame for this needless tragedy?' And, the process of assigning blame, remarkably, seems to routinely exclude the victim. There have been high profile examples of this in recent years (Wes Skiles' Widow Looking For 25 Million from Lamartek). But, there is a 2nd level. Dive professionals may be put at risk by a medical event suffered by a diver they are guiding. For example, a diver has a history of TIAs (transient ischemic attacks) associated with transient loss of consciousness, which would qualify as a Severe Risk according to the form. But, they are on vacation at a beautiful Caribbean destination, say Grand Turk, and their group is set to do an exciting wall dive - they will swim down through the Tunnels, and come out over the edge of the wall (where the bottom is several thousand feet below). The diver writes 'No' on the Medical Statement next to the question : 'Blackouts or fainting (full/partial loss of consciousness)', so they can do the dive with the group. The diver suffers a neurological event during the dive, become unresponsive and begins sinking down into the abyss (they were negatively buoyant to begin with, but were also a '45'er', and their finning was actually keeping them at a constant depth; they stopped finning as a result of the event, and started sinking). The DM leading the dive sees that they have started descending, and is faced with a dilemma, to descend and try to catch her, or not. The DM decides to try, but the unresponsive diver is well below them by the time they see there is a problem. The DM finally catches the diver, at 300 ft. At this point, the DMs air supply is quite low, and they are unable to make a normal ascent, with the unresponsive diver, to the surface. They try, but go out of air at 110 feet, release the victim, head for the surface, suffer a severe DCS hit, from which they recover but with residual paralysis. The family of the deceased diver looks to sue the dive operation and the DM for failure to provide a reasonable Duty of Care.

The Medical Statement is by no mean foolproof. Just because you have signed a statement and answered 'No' to all the questions does not mean that you will not have a medical event while diving. Rather, it seeks to make divers aware, in advance, of potential risks and provides a process for assessing those risks - evaluation by a 3rd party - where the diver may be able to identify potential issues (answering 'Yes' to a question). That 3rd party does not have to be a diver! The Medical Statement provides information to the provider to help them determine whether their patient may have Severe Risk or Relative Risk, and whether the risk can be considered temporary or not, as far as diving goes. In the example above, a diver without the history of TIAs, who honestly answered 'No' might have a first time neurological event. Nonetheless, the Medical Statement 'process' is intended to pre-identify substantive risks, and mitigate them, to the extent possible.

Any diver is free to answer 'No' to any and all statements on the form, even if s/he knows an answer to be 'Yes'. If that is what you choose to do, that is your decision. Hopefully, you - AND your family / friends / loved ones, since you may no longer be in a position to consciously care - will be willing to accept the possible consequences of your choice. You might think about also asking others that may be affected - e.g. dive professionals and operators - about what they think of your decision.

Technically SEI is not absent from the RSTC since SEI owns PDIC. The backdoor to the RSTC was open and in we walked. As for the medical form, SEI evolved from the YMCA which was always an RSTC member. As such the RSTC form has been standard for all training.
As an SDI/TDI instructor, I am now required to keep a current Doctor sign off on file with ITI HQ as of 2017 instructor year. It will be required for all SDI/TDI/EDRI instructors in 2018. I get a physical every year in November and my physician is thorough. Very thorough. Since the physical is covered by my work insurance I take the form with me and have him sign off. I just need to start scheduling it for December instead of November as it needs to be current. I just send it in with my renewal.
With my students, I am, for a number of reasons, strict as hell with the medical form. My learning agreement has some additional medical questions based on current knowledge that also must be accompanied by a sign off if they answer yes to any of them.
The RSTC form is ancient. 1989 is when it was created. There is a 2007 date on the form as well. It, however, does not reflect a number of issues we now know are potentially serious. The "head injury with loss of consciousness in the last 5 years" is one. We now know that a serious concussion may not even involve a loss of consciousness. So my learning agreement asks about ANY head injury or concussion.
There are a couple other items as well such as gastric bypass surgery since that has some side effects that could affect a diver.
It is also spelled out in the agreement that if an issue crops up during training, training stops immediately until a doc is consulted and signs off.
If it turns out that someone lied on the form and that comes out during training- class is over, no refund, bye bye.

 

[dmaziuk]

PADI accepts medical releases signed by a:

Physician Assistant (PA) or Nurse Practioner (PRN)
The P.A.’s or PRN’s in-charge Physician (M.D.) must sign or stamp the form.

Psychiatrist

If it were me, I'd take my nurse's word on the subject over my shrink's any day.

 

[gopbroek]

The simple reason for that is that most people new to diving would have no idea what kinds of medical conditions would preclude them from diving. The RSTC list of conditions is designed to give them a starting point for checking with a doctor.

I can understand a detailed questionnaire as a prerequisite for training but once certified I see no legitimate reason for each and every shop, boat or resort. It seems that while many folks are waving the safety flag the reality is an attempt to indemnify against liability by hiding behind an intrusive form.

 

[uncfnp]

Just received from PADI Training, FYI:


PADI accepts medical releases signed by a:



Physician Assistant (PA) or Nurse Practioner (PRN)
The P.A.’s or PRN’s in-charge Physician (M.D.) must sign or stamp the form.

Which is just nonsense and adds nothing to the validity of the exam. And what about the states that require no physician oversight for NP's?

 

[drrich2]

An interesting dimension that somehow gets missed in a number of these discussions is there may be risk situations that are not within the Physician's comfort zone/willingness to sign off, but even after informed discussion, are within the diver's, who still wants to dive.

Imagine that laws were passed that McDonald's, Burger King & other fast food joints couldn't serve their food to people who didn't have a signed Physician statement that it's 'safe' for them to eat cheeseburgers, french fries, pizza & so forth. Now, if you're obese and getting on a bit in years, given that heart disease is a leading killer, would a Physician sign off on that?

If he didn't, would that stop you from eating Big Macs?

There are risk scenarios where most any reasonable person wouldn't chance it, but there are many where it's much grayer, and some divers would choose to keep diving even if denied clearance. We live in a society where risk tolerance is not universally agreed upon.

Richard.