Those health forms -- Truth or Consequences?

[RJP]

How is that any different than UNDIAGNOSED medical conditions?

EMT deal with this everyday when they respond to an unresponsive accident or other medical incident victim.

Let's think this through guys...

Having NO information on which to rely is very different than relying on WRONG information that you are lead to believe is accurate. In most medical situations - hell in any situation - you're almost aways better off "knowing you don't know" versus relying on information that is wrong.

 

[Bubbletrubble]

Let's think this through guys...

Having NO information on which to rely is very different than relying on WRONG information that you are lead to believe is accurate. In most medical situations - hell in any situation - you're almost aways better off "knowing you don't know" versus relying on information that is wrong.

@RJP: I'm not disagreeing with you. But you should know that health professionals will treat a PADI/dive-op cookie-cutter health form (YES/NO laundry list of medical conditions) with a generous amount of skepticism (especially if it's all a bunch of negatives). Also, in emergent situations, the default treatment protocol goes back to the basics (Airway, Breathing, Circulation) and pretty much ignores other medical conditions -- specific exceptions being whether certain meds are onboard or drug-tox is suspected. These two factors would help mitigate any potential damage caused by incorrect info being entered on a standard health questionnaire. Perhaps TSandM might comment as she would definitely know better.

 

[RJP]

The example that RJP brings up about making important medical information available to rescuers (EMTs, paramedics, lifeguards, doctors) in the event that I'm hurt in a dive-related setting can be done by simply wearing a med-alert bracelet.

Another one to think through...

Hint: don't let the dive op see you wearing a MedicAlert bracelet on the same hand that you're using to fill out the form where you're writing "NO" next to all the conditions you "DON'T" have and then signing to denote that you've filled out the form "to the best of your knowledge."

 

[caymaniac]

Could someone at least post one of these forms, I wonder now what kind of questions I said "no" to.

 

[RJP]

@RJP: I'm not disagreeing with you. But you should know that health professionals will treat a PADI/dive-op cookie-cutter health form (YES/NO laundry list of medical conditions) with a generous amount of skepticism (especially if it's all a bunch of negatives). Also, in emergent situations, the default treatment protocol goes back to the basics (Airway, Breathing, Circulation) and pretty much ignores other medical conditions -- specific exceptions being whether certain meds are onboard or drug-tox is suspected. These two factors would help mitigate any potential damage caused by incorrect info being entered on a standard health questionnaire. Perhaps TSandM might comment as she would definitely know better.

Ironically, your point assumes the only fear is that the person may have inaccurately completed the form and the potential that any NO answer may actually be inaccurate. (False negative) What about the potential for a person to have accurately written YES to one of the conditions? What you are saying is that we should also treat that as inaccurate or at minimum as "unknown." However, the risk associated with modifying treatment decisions due to a "False Positive" on the form is essentially ZERO. "Hey Bob, says here the guy has a steel rod in his left leg." Do you then say "That information could be wrong, so let's be careful and treat him as if he doesn't have a steel rod in his leg" as you're sending him for an MRI?


All this dancing on the head of pin is just plain silly. The fact of the matter is that there is no medical UPSIDE to lying on the form. Nor is there any medical DOWNSIDE to having a TRUTHFUL YES response accurately reflected on the form.

I just can't think of a single situation - other than shear laziness or utter selfishness - where something would happen to cause you to say "Whew, that was close! Thank god I lied on that form..."

 

[Mike Boswell]

Caymaniac -

http://www.padi.com/english/common/courses/forms/pdf/10063-ver2-0.pdf

http://www.gobedivers.com/forms/medicalstatement.pdf

 

[adurso]

OK I am really confused; are there dive boats that have customers fill out the PADI or SSI forms (as posted by Mike Boswell) for a trip?

Although most of my diving is done from private vessels I have been diving a long time and have never run across such a thing. I very rarely have been asked to show a card...

 

[Bubbletrubble]

@RJP: I'll try to address each one of your points...

Ironically, your point assumes the only fear is that the person may have inaccurately completed the form and the potential that any NO answer may actually be inaccurate. (False negative) What about the potential for a person to have accurately written YES to one of the conditions? What you are saying is that we should also treat that as inaccurate or at minimum as "unknown." However, the risk associated with modifying treatment decisions due to a "False Positive" on the form is essentially ZERO.

My last post didn't "assume" a "false negative" as you describe it. I explicitly stated the possibility that a diver may have given a "No" answer to a question regarding a certain medical condition, yet I didn't exclude the possibility of "false positive" information. I was trying to share with you the notion that, when it comes to patients, health professionals are taught to operate in a "trust but verify" mode. False positive and false negative information being conveyed from patient to doctor occurs more often than you might think. If you were to spend some time around a patient with an altered level of consciousness, this would become abundantly clear.
To be clear, modifying treatment decisions due to "False Positive" information can have a negative impact on patient care. Here's one specific example: If a patient with a bacterial infection states that he has an allergic reaction to a broad-spectrum first-line antibiotic (when he actually doesn't) then the treatment team has to go to another class of antibiotic which may end up being not as effective as the first line drug. Furthermore, the side effect profiles could be significantly worse and the cost could be higher. Bear in mind that this is just one of many examples.

"Hey Bob, says here the guy has a steel rod in his left leg." Do you then say "That information could be wrong, so let's be careful and treat him as if he doesn't have a steel rod in his leg" as you're sending him for an MRI?

This statement of yours makes very little sense, but I'll indulge you. If an MRI were necessary in an emergent situation and Bystander Bob was not a reliable witness, then it would make sense to do a quick X-ray first.

All this dancing on the head of pin is just plain silly. The fact of the matter is that there is no medical UPSIDE to lying on the form. Nor is there any medical DOWNSIDE to having a TRUTHFUL YES response accurately reflected on the form.

I think the condescending tone of your posts undermines the point you are trying to make. At the heart of the conflict playing out on this thread is that you are only seeing the medical ramifications of lying on the forms. There are concomitant privacy issues to consider, too.

I just can't think of a single situation - other than shear laziness or utter selfishness - where something would happen to cause you to say "Whew, that was close! Thank god I lied on that form..."

Awww. Cut it out!
I'm sure that if you tried hard enough, you could come up with something. It would probably be something completely unintentional (from the perspective of the person filling out the form), though.
Don't get me wrong. Patients should be honest with their doctors -- doing so will likely lead to a better outcome. It would also be great if people didn't feel compelled to lie on these silly CYA forms that dive ops are using nowadays. If everyone refused to fill them out, then the practice would be dropped or revised. Fortunately, in the areas that I dive, the dive ops don't require a pre-dive medical questionnaire to be filled out...usually just a liability waiver. With a new dive op, I ask ahead of time so there are no surprises on the day of the dive.

 

[RJP]

OK I am really confused; are there dive boats that have customers fill out the PADI or SSI forms (as posted by Mike Boswell) for a trip?

Although most of my diving is done from private vessels I have been diving a long time and have never run across such a thing. I very rarely have been asked to show a card...

I've seen/heard of liveaboards asking folks to fill them out "for information only" so that they have an accurate (assuming you're not the type to lie on the form) medical profile of you handy if there's an issue.

Interestingly, was at my LDS tonight and this topic came up. Seems that there are several well known ops/shops in Caymans and Cozumel that are now asking folks to submit a form in order to dive with them.

 

[boulderjohn]

OK, let's take it from the top. Here are some quotes from your posts, with some points highlighted for emphasis.

I DO have medical training, and if you had read my previous posts, I clearly indicate that medical training or not, any diver should be cleared by his or her physician to dive. I also stated that people with known health conditions, including those which have "no potential to cause a problem" should also have their specialty physician clear them for diving.

RJP, no one is suggesting that divers should not be medically cleared by their doctors to dive, of course they should.

That is not what is being debated here, what is being debated is whether or not divers should always disclose their medical information to the dive op taking them out.

For instance, should a young person who is taking acne medication disclose this on a dive ops' medical form? I can give you a million other examples of medical issues that are irrelevant to diving safety. That is why DAN provides a template dive physical, so that physicians focus on assessing issues which are known to affect diver safety. Those conditions which do not have this potential have no reason to land on the ops' medical form.

Yep.

Your reading comprehension needs a little work RJP. I never said that it was appropriate for a diver to decide whether or not a condition is relevant, my point was that it should be a physician, not a dive shop employee, who determines this. Disclosure of personal medical information that is not relevant to an untrained person is just silly. They would kick the person taking acne medication off of their charter.

Do you or the dive op really need to know if I take acne medication? .

I am being clear, and the position that I am trying to defend is that for conditions not considered at risk conditions on the dive physical, the only person who needs to know that information and clear me to dive is my doctor.

I agree with you that lay people should not make this determination, and that includes not only divers but dive shop employees.

Yep, this is the one which would get the poor kid with acne taking accutane or some other prescription drug booted back to the dive doc.

_____ Are you presently taking prescription medications? (with the exception of
birth control or anti-malarial)

From the PADI medical form, but it is on all of them.

Where does it say that the kind of prescription medication must be identified?

...

The form does not require that disclosure.

It says that you must disclose whether or not you take any prescription medications. I count a prescription acne medication as part of "any prescription medication. " That answer will then require a medical clearance.

Look at the difference between what you said in your first posts and this last one. In the first ones, you say that everyone with any medical condition should have clearance from the doctor, but the dive operator does not need to know what the specific condition is unless it is dive related. You gave the example of a kid having to reveal that he takes acne medicine to the dive operator.

I then pointed out that the form does not require that disclosure. I take prescription medicines, but the instructors who see my forms have no idea what those medicines are. The only person I have to disclose it to is the doctor who signs the form, and he already knows.

Now that I have pointed that out, you have backtracked and said that you don't think that the kid should need medical clearance. Yet, your earlier posts said that he should.
If the kid is getting prescription medicines, then he must be under the care of a doctor. That doctor will know all about the condition already. In that case, all it will take is to send the form to the doctor and have him sign it. I just traveled to receive instruction. Anticipating that I would need the form, I had my doctor sign it, and I brought a copy. I made several copies in case I have future needs.

And you and others keep talking about dive operators. Please look at my profile. I have been around. I have never been asked for a medical clearance for anything other than instruction. (I am also required by the LDS for which I instruct.) I asked earlier for specific operators that require this clearance. One person responded with one specific operator. I checked with that operator and learned that it was not true--it was not required.

When I get a student who has a yes on a form for something like prescription medicines (which happens a lot) and I see that the doctor has signed, I don't ask what it is, and I don't care. It's none of my business.