Melanie White
Contributor
I answer no truthfully but we dont get doctors signature not required . We are 43 and 44.
Yes/No requirement for Med form
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I’m not an instructor or a captain, but as someone who has signed the occasional dive clearance form, let me put in my two PSI.
1) The doctor’s signature on those forms, in the vast majority of cases, does not provide evidence of a careful analysis of this particular patient’s safety to dive. Very few doctors (a) have training and experience of sufficient range to expertly cover all of the conditions that are listed and that a patient might have, and (b) have any idea how any of that is affected by scuba diving.
2) The signature is primarily a means of transferring legal liability from the instructor/agency to the physician should a medical event cause an injury or death during training. I’m assuming that is why agencies require it.
3) As dive professionals, I would be very careful about doing your own vetting of divers based on the few medical conditions that you might pick as relevant. There are many relevant problems that you may not account for either because patients won’t share them with you (e.g. substance abuse or major mental health issues), or because they are so common that they would exclude many divers of the age to afford trips and training (e.g. general conditioning, obesity, smoking). Also, there are case-specific details - not all asthmatics or diabetics are the same, and DAN's guidelines take that into account.
As the dive chair of my local dive club, we have had at least two discussions about setting club standards for dive experience, equipment and training for our charters. Both times, our legal counsel has strongly objected to this, on the grounds that if we vet divers, that puts the liability on us should there be an accident (“the Sea Gypsies said the deceased was qualified to do this dive”). So what do we do? We defer that liability to the boat captains, who have the final say in who can dive with them.
Similarly, if you as an instructor start saying that you are excluding divers with this or that medical condition, what happens if there is a problem related to something that you didn’t screen for? I’m no attorney, but based on our club discussions, I would think that opens the door for a smart plaintiff’s attorney to make the case that you had somehow cleared the deceased to dive from a medical point of view, and that some of that liability is now yours.
Even with the best intentions, blanket exclusions by non-medical dive professionals is potentially problematic. The diabetes debate is a good example. If you as a dive professional are setting medical standards, doesn’t that obligate you to keep up with the current literature and academy guidelines on each of these conditions? Do you really want to do that? Suppose you see someone using an inhaler and you say “no asthmatics, I don’t care what DAN says”. Do you know that they weren’t using an inhaler to swallow fluticasone for eosinophilic esophagitis? I’m not trying to be snarky, you guys know how much I respect experienced divers and dive professionals. I’m just pointing out that there are a lot of unanticipated complexities here.
There are doctors and there are doctors. I’m a pediatric ENT doctor. As far as the state of NY is concerned, I have a license that says that I’m legally OK to perform brain surgery, do psychotherapy or push chemo. So my signature on that form is as good as that of anyone else with MD plates for illegal parking. Does that mean that I’m going to sign off on a brittle diabetic, or someone recovering from coronary artery stent placement? No way. I know something about dive medicine, but you had better believe that my signature isn’t going on that form unless I’m sure that this clearance is within my own personal wheelhouse.
Also, there are captains and there are captains. Some are more intelligent than others. And taking responsibility for passengers on a long sea voyage with chronic medical conditions is different from dive instruction, so that’s really beyond the scope of the OP. Frank is one of the few boat captains that I would trust to be my endocrinologist, so if he says someone isn’t healthy enough to dive, that’s OK with me. But just be careful out there if any of you dive professionals decide that you need to get into the weeds with someone’s medical history. Trust me, that discussion can get pretty messy.
No matter what, people who want to conceal information from you will do so, even if it’s just as simple as checking “no” for everything. Yes, as instructors you have to be comfortable with who you are teaching, and Pete has every right to turn down a student if he suspects a problem. But ultimately, divers take responsibility for themselves - that’s what all the waivers are for.
1) The doctor’s signature on those forms, in the vast majority of cases, does not provide evidence of a careful analysis of this particular patient’s safety to dive. Very few doctors (a) have training and experience of sufficient range to expertly cover all of the conditions that are listed and that a patient might have, and (b) have any idea how any of that is affected by scuba diving.
2) The signature is primarily a means of transferring legal liability from the instructor/agency to the physician should a medical event cause an injury or death during training. I’m assuming that is why agencies require it.
3) As dive professionals, I would be very careful about doing your own vetting of divers based on the few medical conditions that you might pick as relevant. There are many relevant problems that you may not account for either because patients won’t share them with you (e.g. substance abuse or major mental health issues), or because they are so common that they would exclude many divers of the age to afford trips and training (e.g. general conditioning, obesity, smoking). Also, there are case-specific details - not all asthmatics or diabetics are the same, and DAN's guidelines take that into account.
As the dive chair of my local dive club, we have had at least two discussions about setting club standards for dive experience, equipment and training for our charters. Both times, our legal counsel has strongly objected to this, on the grounds that if we vet divers, that puts the liability on us should there be an accident (“the Sea Gypsies said the deceased was qualified to do this dive”). So what do we do? We defer that liability to the boat captains, who have the final say in who can dive with them.
Similarly, if you as an instructor start saying that you are excluding divers with this or that medical condition, what happens if there is a problem related to something that you didn’t screen for? I’m no attorney, but based on our club discussions, I would think that opens the door for a smart plaintiff’s attorney to make the case that you had somehow cleared the deceased to dive from a medical point of view, and that some of that liability is now yours.
Even with the best intentions, blanket exclusions by non-medical dive professionals is potentially problematic. The diabetes debate is a good example. If you as a dive professional are setting medical standards, doesn’t that obligate you to keep up with the current literature and academy guidelines on each of these conditions? Do you really want to do that? Suppose you see someone using an inhaler and you say “no asthmatics, I don’t care what DAN says”. Do you know that they weren’t using an inhaler to swallow fluticasone for eosinophilic esophagitis? I’m not trying to be snarky, you guys know how much I respect experienced divers and dive professionals. I’m just pointing out that there are a lot of unanticipated complexities here.
There are doctors and there are doctors. I’m a pediatric ENT doctor. As far as the state of NY is concerned, I have a license that says that I’m legally OK to perform brain surgery, do psychotherapy or push chemo. So my signature on that form is as good as that of anyone else with MD plates for illegal parking. Does that mean that I’m going to sign off on a brittle diabetic, or someone recovering from coronary artery stent placement? No way. I know something about dive medicine, but you had better believe that my signature isn’t going on that form unless I’m sure that this clearance is within my own personal wheelhouse.
Also, there are captains and there are captains. Some are more intelligent than others. And taking responsibility for passengers on a long sea voyage with chronic medical conditions is different from dive instruction, so that’s really beyond the scope of the OP. Frank is one of the few boat captains that I would trust to be my endocrinologist, so if he says someone isn’t healthy enough to dive, that’s OK with me. But just be careful out there if any of you dive professionals decide that you need to get into the weeds with someone’s medical history. Trust me, that discussion can get pretty messy.
No matter what, people who want to conceal information from you will do so, even if it’s just as simple as checking “no” for everything. Yes, as instructors you have to be comfortable with who you are teaching, and Pete has every right to turn down a student if he suspects a problem. But ultimately, divers take responsibility for themselves - that’s what all the waivers are for.
Here I know some divers who get a signed letter from a docter, even trimixdiving is no problem with at least 1.
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That's it. No need for me to read all the other posts (since I've been away). The ONLY thing I was ever told as a student or heard an instructor tell a class (when I was assisting) was exactly that--"If you answer YES to anything, even one question, you need a doctor's note". Sometimes I've heard that said sort of accompanied by a subtle "wink". I also have never heard any talk of or anything written about being HONEST when filling out the thing. It's just a liablilty thing, I always presumed.
KevinNM
Contributor
I have a 'friend' who has been known to do this. He's extensively discussed his medical issues with assorted doctors including some brief discussions with a couple with Duke's hyperbaric program. None of them said no, you can't dive, or I recommend you find a new hobby. You understand the risks, you accept them, mitigate those you can and you get on with your life. If something goes horribly wrong, well, the instructor has no responsibility because the vague highly improbable to ever occur issues were never disclosed to them.
In the U.K. club divers are required to submit a self certification fit to dive form annually.
The questions are very like the medical waivers you see PADI outfits using. If you answer yes then you can’t use any old doctor, you need one from this list Medical Referees - UKDMC of suitible doctors.
Since I am used to that I am a bit surprised any old doctor is presumed qualified. I suppose if it just the agencies trying to escape liability it makes sense.
Due to the new EU GDPR and helpful advances with the BSAC website which now records either ‘yes, I answered no to all the questions’ or ‘a doctor’s says I am good despite a yes answer’ I now never have to handle or store these forms. I really, really don’t want to know what they say, I just want people to be fit to dive. If they are not fit and prepared to lie I don’t think seeing the form makes a difference.
The questions are very like the medical waivers you see PADI outfits using. If you answer yes then you can’t use any old doctor, you need one from this list Medical Referees - UKDMC of suitible doctors.
Since I am used to that I am a bit surprised any old doctor is presumed qualified. I suppose if it just the agencies trying to escape liability it makes sense.
Due to the new EU GDPR and helpful advances with the BSAC website which now records either ‘yes, I answered no to all the questions’ or ‘a doctor’s says I am good despite a yes answer’ I now never have to handle or store these forms. I really, really don’t want to know what they say, I just want people to be fit to dive. If they are not fit and prepared to lie I don’t think seeing the form makes a difference.
njdiverjoe
Contributor
The only people I know who are doing this were given the all-clear to dive with no restrictions and are pretty active(run/swim /etc regularly). I don't know about everyone but the reason my friend marks "no" is because although he is in fact fit to dive, he does not want to repeat a past experience deal with a scuba professional playing doctor.
Barnaby'sDad
Contributor
Exactly. I've got zero interest in hearing the medical opinion of someone without a medical background that happened to stay in a Holiday Inn Express last night.
This is the reason I don't sign them. I'm a licensed M.D. board certified in two specialties that cover most of the questions on the medical form. I have declined signing these forms. If I were to sign one, the diver would have had to answer all the questions yes or no, and I would have done a complete history and a comprehensive physical exam.
But I still won't sign it. It may not be the diver, a trusted, well-liked patient or friend, that I'm afraid of. It's his family members that I don't know and their plaintiff's attorney that will go after me.
I would consider any medical form that doesn't have the questions on the first page answered yes or no, even if signed by a doctor, to be incomplete because I wouldn't know if the signing doctor was aware of any medical conditions that might exist. Sure, the applicant can answer no to everything, but then some responsibility rests on him/her.
PADI may obfuscate the issue, but I can superimpose my own criteria if I am to consider signing a medical form or accepting one as a boat captain or instructor (I am neither).
I'm coming late to this but I agree with the Chairman.
Years ago I had a student that was taking cave class from me. He had passed Intro to Cave and was attempting to pass Full Cave. The problem was, he couldn’t make it to a single jump in any system we went to. His SAC rate was horrible. Even in shallow, no flow caves like peacock, he couldn’t make it to the first jump. How do I teach complex navigation if we can’t make it to a single navigational decision. He was sent home with advice to work on his breathing, get more comfortable in the water.
He emails me up on the way home and tells me, “PETE! I know what the issue is... I have exercised induced asthma. All I need to do is take a few puffs off of my inhaler and I’ll be good to go”. I call him immediately, I’m like “DUDE! You have now taken 4 courses from me and on every MED FORM you have checked the box NO for Asthma. You have signed those forms”. “I can’t issue you a card until you get me a doctors note stating you’re cleared to dive”. He asks why. I tell him because it’s unsafe for him to be diving. He says, “okay, forget I said anything”. Well, that’d be great except that you put it in writing. I can see it now. You die in your next class and your wife says, “Pete knew he had asthma, here’s the email Goober sent him last month.” I’m not willing to take that risk.
So, the next day I get a letter from his doctor stating that he’s cleared to dive. I got the later so quickly (I didn’t even think he had travelled home so far out of state) that I called the doctor’s office to make sure it was legit. The doctor said he couldn’t respond to the letter due to HIPPA. I know, here’s a clearance from my student. So Doctor calls me back and says, “What’s the issue? There’s no contradictions with his inhaler and diving.” “I go, okay, great. What if the inhaler wears off when we are 2000’ in the back of the cave.” The doctor freaked out. He’s like, “What are you talking about”. I explained to him the nature of our diving, and thirds, and penetration. Then the doctor said, “Mr. McCumber, I do not want to associate myself with his risk in his condition. Please tear up that letter we sent you.”
I didn’t issue a card. He called my agency and filed a QA. I quit teaching for that agency and they issued him a card.
I don’t need the money. I’m not the instructor for every student. If there’s any risk to you at all, turn down the class. You don’t get paid enough to risk life, liberty and finances.
Years ago I had a student that was taking cave class from me. He had passed Intro to Cave and was attempting to pass Full Cave. The problem was, he couldn’t make it to a single jump in any system we went to. His SAC rate was horrible. Even in shallow, no flow caves like peacock, he couldn’t make it to the first jump. How do I teach complex navigation if we can’t make it to a single navigational decision. He was sent home with advice to work on his breathing, get more comfortable in the water.
He emails me up on the way home and tells me, “PETE! I know what the issue is... I have exercised induced asthma. All I need to do is take a few puffs off of my inhaler and I’ll be good to go”. I call him immediately, I’m like “DUDE! You have now taken 4 courses from me and on every MED FORM you have checked the box NO for Asthma. You have signed those forms”. “I can’t issue you a card until you get me a doctors note stating you’re cleared to dive”. He asks why. I tell him because it’s unsafe for him to be diving. He says, “okay, forget I said anything”. Well, that’d be great except that you put it in writing. I can see it now. You die in your next class and your wife says, “Pete knew he had asthma, here’s the email Goober sent him last month.” I’m not willing to take that risk.
So, the next day I get a letter from his doctor stating that he’s cleared to dive. I got the later so quickly (I didn’t even think he had travelled home so far out of state) that I called the doctor’s office to make sure it was legit. The doctor said he couldn’t respond to the letter due to HIPPA. I know, here’s a clearance from my student. So Doctor calls me back and says, “What’s the issue? There’s no contradictions with his inhaler and diving.” “I go, okay, great. What if the inhaler wears off when we are 2000’ in the back of the cave.” The doctor freaked out. He’s like, “What are you talking about”. I explained to him the nature of our diving, and thirds, and penetration. Then the doctor said, “Mr. McCumber, I do not want to associate myself with his risk in his condition. Please tear up that letter we sent you.”
I didn’t issue a card. He called my agency and filed a QA. I quit teaching for that agency and they issued him a card.
I don’t need the money. I’m not the instructor for every student. If there’s any risk to you at all, turn down the class. You don’t get paid enough to risk life, liberty and finances.
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