Your thoughts on Family Doctors

[JohnSnider]

FIRST! Let me say that I am not trying to stir up any problems and/or heated discussion and most of all I am not trying to belittle anyone! Hopefully, just initiating some interesting conversation....

What are your thoughts on the ability of Family Doctors to deal with diving related medical issues. This includes simple medical clearance to participate, annual physicals, treating diving problems (parasites, barotrauma, etc...).

I think this forum is excellent for getting some very valuable information from very informed people. I have a concern with family doctors. Ok, it's a bias! Let me explain....

I've had difficulty with family doctors on both a personal and professional level. On a personal level, I am a firefighter and as such take a very heightened interest in my health. After a particular nasty fire involving strange chemicals I went to my family doctor to document my "health". To say the least I was dissappointed with the service and apparent lack of knowledge (and interest) of my doctor (I have since switched doctors).

Prior to becoming a firefighter I worked as a health professional in rehabiliatation. I worked primarily with motor vehicle accident victims helping them recover from injury. I had the occasion to meet with, I'm guessing, 400 family doctors over the five years I worked in this field. I most (but not all cases), the family doctors did not seemed to be "in tune" with these types of injuries and the necessary rehabilitation/support needed.

Again, this is not meant as a "slam" against family doctors (really it's not). I believe there are a lot of illnesses that might be over the head of the average family doctor.

I'm more interested in other peoples opinions/thoughts. It's obvious by some of the threads I've read and the reply by the medical professionals here that there is a lot of specialty medicine involved! Can your family doctor provide you with the care and/or oversight you need?

Sorry for the long post, I just wanted to clarify my thoughts.

John

 

[Liquid]

Family doctors, aspecialy those who do not dive themselves, and are not interested in the subject themselves, are no authority at all in what concerns diving. Ofcourse, a Family doctors that DOES dive, and have interest in the subject, may learn on the issue on his own accord, and since he's a doctor, he can have quite a thorogh understanding of the issues. Still- whenever in a medical problem that concerns diving, I'd go to a diving doctor. Like I wouldn't want an orthopedic doctor to make my heart surgery, I wouldnt want to be examined for diving related issues by a doctor that dosen't really understand about it.

 

[jbd]

Doctors are people. Some people are very good at their jobs and some are not so good. Others are just pitiful at what they do. What must be kept in mind is that Family Practice doctors are mainly focused on general health care and common ailments that occur over a human life time. These men and women are not specialists in cardiology, neurosurgery, oncology etc etc. They are dealing with a much broader subject area just not as deep as the specialists do.

As for the situation with the doctor and your fire fighter job you may have given the doctor the impression that he may be called in to court some day due to your health. That kind of stuff opens a real Pandora's box for them.

Then again maybe the doctor didn't know much about the problem and wasn't really interested in putting much time into investigating it. Time is a very precious commodity for many doc's.

 

[JohnSnider]

Getting a little side tracked...

I keep reading through the various forum topics and on a number of occasions I've seen people recommend that you see your family doctor for whatever the scuba related issue is.

Is everyone confident in their family doctor. Time is precious and chances to see specialists even more precious. Of course, there are family doctors that have background in SCUBA (probably because they do it themselves). And again, I'm am not against family doctors I'm just trying to get opinions and thoughts....

John

 

[SubMariner]

John, I know exactly what you are saying.

Prior to moving here to Atlanta, I had a GP and a Diving Physician. Did I have complete & utter trust in my GP? Absolutely... he was my family physician for about 20 years. However, he really didn't have the background or knowledge base to deal with the physics & physiology of scuba. Thus, when I barotraumaed both my ears one year on a trip to FL, I consulted the Dive Doc rather than the GP.

We have been down here about 4 years and I think I have finally found a good GP. However, he is not a dive doc. I definitely will be consulting Scubadoc's website to find one in my area for the very reasons I outlined in my previous paragraph.

My recent bout with pneumonia really chrystalized this issue for me. Not because my GP didn't know what he was doing, but because I had to educate him (using an email that I had from Scubadoc and the recently revised Medical Questionaire from PADI) about the very specific pulmonary factors in scuba diving after that kind of a respiratory infection.

So, to reiterate... I will keep the GP, but also get a Diving Doc. Just because my life tends to involve a lot of scuba, doesn't mean it revolves around it.

~SubMariner~

 

[scubadoc]

Medical knowledge has exploded in the last fifty years and it's a miracle that any person is able to keep up with even a small portion of new data. Most good GPs have become so because they recognize their limitations, what they can and can't treat and when and where to refer their patients for maximum benefit.

I was a GP for 5 years before I realized the above and went into surgery. My knowledge of diving medicine came only through many years of intense interest in diving - the medical knowledge about diving accidents followed through attendance at many seminars and courses.

Doctors in general are not trained in diving medicine in medical school - the training comes only after residency training and for those who through their specialty become particularly interested - so it's not surprising that some GPs roll their eyes and seem apathetic to diving problems.

On the other hand, the family doctor is particularly well placed to provide the diver with good advice and often appropriate treatment, given some knowledge of the subject and particular expertise in reassuring and teaching the patient. (I believe that 'doctor' means 'teacher'). An excellent example of this is one of our Medical Regulators, a family doctor, John Reinertson.

It is not uncommon for highly trained technicians (as in rehabilitation, or EMS or ER tech) to note that a particular physician might not be up to date or proficient in some areas that they deem themselves expert. However, these same "inept" doctors have to be knowledgeable in hundreds, if not thousands of other areas of medicine.

You might say that I'm a slow learner - but it took me 14 years to reach a point that I could walk into an operating room and be allowed to operate on a human being. Most family physicians now have at least two years of residency training after graduation from a four year medical school curriculum. Of course, this doesn't make them smart (as the scarecrow found out when the Wizard gave him a diploma) and some doctors are smarter than others (or know that they are not smart enough to be family doctors and go into a specialty).

So -- please be less supercilious when you seem to be put off by the doctor. Be straightforward and let him/her know that you would like a referral to someone who knows more about diving physiology and medicine. If no referral is forthcoming - call the local hyperbaric chamber for a referral - or call DAN.

Good things!

scubadoc (down off my soapbox)

 

[Rick Murchison]

You beat me to it...
(And said it better, I might add...)
Rick

 

[Lance Gothic]

Brothers & Sisters of Diving Medicine,

This humble Knight does a personal workup prior to engaging a doctor. A medical resume'. This is as important to your treatment as is you work experience to a resume'. The pertinent topics are reviewed pending exams and participation in sports. Referals are taken and returned.
Case in point. Your M.D. or Osteopath may lack a ready knowledge of contacts for hyperbaric chambers, high altitude training, specialists in some regimen. Help them out as much as possible. It doesn't hurt to ask, hmm?

Regards,
Lance Gothic
Shibumi

 

[art.chick]

YOu guys must have a better health plan than I do! I could research the doctors in my book till I'm blue in the mask, but when it comes down to it, I need to get the diving physical out of the way by the time my class starts. I can't search out LA's best scuba docs; I have to get someone on my plan who has time in his/her schedule who is reasonably close to my office so I can slip in during my lunch hour.

When I get there, they have no idea what they are supposed to be signing off on & seem really concerned about the potential liability if they misjudge my fitness for the sport. The waiting rooms are crowded, and the doctor can't spend much time with me. One guy made an impromptu EKG the focus of the check-up; another put the emphasis on cleaning my husband's ears; still another gave me a tetnus shot because the subject of wreck diving came up in our small talk. They all wanted to feel like they persued some pertinent issue.

I did not expect them to be experts, but something about the unusualness of my request to have a diving form filled out confused them & somehow prompted them to go off on some tangent. Oh well. Most of us monitor our own health between diving physicals. We know that we don't want to be at high risk for diving maladies. The physical itself seems just like a liability/paperwork thing rather than a serious investigation. I would not want these people to get too interested under these circumstances; God knows what bizarre, non-pertinent, & time-consuming tests they will order.

 

[Viv]

I was going to stay out of this thread because as a physician I sometimes get a little sensitive about these issues. Please excuse me but I would like to bring up a few points.

Art.chick, I certainly "feel your pain." Managed care/HMO's can make all of us crazy. Let me tell you what it feels like from this side of the stethescope. This afternoon when I walk into my office I will probably be faced with a waiting-room full of people who are all in a hurry because they squeezed their visit in on their lunch break. I have never seen most of them before and may never see most of them again - they just picked me out of "the HMO book" because they need something right away (i.e.an overdue medication refill, note for work, diving physical form completed ). I went into medicine because I thought I was going to establish long term relationships with patients and assist them in maintaining good health. Due to the economics of healthcare here in the States I feel like I am working in McDonalds!! Believe me most docs are just as unhappy with this situation as you are.

As has been previously mentioned. We don't get a course in diving medicine in med school. So, try not to be so hard on the average GP. It is difficult when you are faced with a new patient whose underlying health you may not be that familiar with (even though they claim not to have any known medical problems) and you only have 15 minutes to decide if it is okay for them to engage in a sport you may not be familiar with at all! We're only human and sometimes we get nervous and start ordering tests.

I suppose this is just my rather long winded way of saying:
a) Try to find a good generalist that you like and trust and develop a good working relationship with him/her so that you maintain good health.
b) If any dive-specific issues come up then you may have to do a little more research in order to find a specialist (and they may not be on your plan ).

Thanks for letting me vent.
May you always have happy, healthy, safe dives!