Your thoughts on Family Doctors

[Rockhound]

Back in Alabama, I used an endocrinologist friend who was both a good physician and very knowledge diver. Because he bothered to study diving physiology, I felt very comfortable going to him for my diving checkup and for later injury I suffered (long story).

Here in Houston, I have a very good friend who is a Family Practice Physician. She is an excellent doctor, but knows nothing about diving or diving medicine. For that reason, I won't see her for diving related matters (actually, I've informed her that I won't see her for any reason that requires I get "nekkid". I told her that the only time she might see me nekkid was if I was drunk on tequila. She thought it was funny, my wife did not. Of course, I was drinking tequila at the time. I'm not sure if I was nekkid.)

My wife goes to her, but I have another doc. For diving matters, I have a FP physician, familiar with diving medicine, recommended by my LSD.

As the parent of a pediatric cancer patient and bone marrow transplant survivor, I sometimes I feel as though my wife and I have a battlefield degree in medicine. After these years of our son's treatment we have learned that physicians come in as many levels and shades of skill and personality as auto mechanics or nuclear physicists. For that reason alone, I would think that to generalize that a GP or FP is unsuitable for a diving checkup is a mistake. Nor would I expect someone of another specialty, say orthopedics, would be any better. I would simply suggest that each doctor be researched in detail for ANY REASON you wish to see them, not just for diving. Good GP's act as mediators between you and the world of the specialist, and good GPs know how to refer you to others for more complex questions than they can reasonably answer. If you already know the question is diving related and that your GP is unversed this this area, then you can save you both some time by "skipping a step" and going straight to someone who is knowledgeable.

Doctors provide a service and why shouldn't you be as picky in selecting your doctor as you would be selecting an interior decorator (Heck, how many people just "pick a name" from the phone book? I certainly did that when I selected my first doctor in New Orleans many years ago.)

For diving related questions, I would seek out a physician who is a diver or who is aware of diving physiology, regardless of their medical specialty (unless it is an esotoric specialty, or one very far removed from general medical practice, such as genetics or research). Such a person could be easily found by contacing your LSD or contacting a physician referral service.

We are lucky here in the Houston area, since Hermann operates and maintains a fine hyperbaric facility. I would think if I had detailed questions related to diving medicine that my doctor couldn't address, a quick call to them would provide me with the name of doctor who would agree to a consultation.


(I'm editing here for a simple clarification: A well trained GP is perfectly suited to provide a dive training physical. A specialist might be required only if you have a more difficult question. I also agree that everyone should have a GP or FP physician and should work hard at establishing a good relationship with them BEFORE they have some medical problem requiring attention.

Oh, and don't get me started on HMO's and PPO's.......after 5 denials for my child's "experimental" BMT I am still seething.....)

 

[The Chairman]

We had a family doctor give approval for a kid with Asthma, tubes in his ears AND epilepsy to learn to dive... TWICE!!! So I contacted the mother and INSISTED that this guy call DAN for advice and the matter was resolved. DAN is such a wonderful thing to have around... I think many of us just take it for granted!

 

[The Iceni]

As Rockhound rightly says
. . . we have learned that physicians come in as many levels and shades of skill and personality as auto mechanics or nuclear physicists. . . I would simply suggest that each doctor be researched in detail for ANY REASON you wish to see them, not just for diving. Good GP's act as mediators between you and the world of the specialist, and good GPs know how to refer you to others for more complex questions than they can reasonably answer.

You do have a choice of GP, Netdoc! In the UK a patient may only have one GP and he has all the patients medical records in order to help provide an enhanced service.Personally hate the idea.l of multiple second opinions inprimary care.

I take it the "doc" is not medical.

By the way, my first degree was in human physiology but I don't pretrend that means I know much about diving medicine and have had to do a lot of reading on the subject of diving over the years. I have done so only because I am interested in the subject but the point i was making was about the propoer use of specailists.

In addition, Netdoc, anectdotal, third party stories are not really very helpful.

 

[The Chairman]

I service Networks... "The Doctor for your Network is always IN"

In addition, Netdoc, anectdotal, third party stories are not really very helpful.

As the person who had to deal with the mother/son/doctor/DAN situation, I am not sure how you could label the story third party or anecdotal. I am a BSA Venture Crew Advisor for a new Crew that specializes in SCUBA. These are kids 14 thru 21. I also am finishing up the last bits of becoming a NAUI Dive Instructor as well. Out of 16 kids who started the class, 3 were advised not to dive due to medical contraindications. All three were "cleared" by their respective doctors, until I asked the parents to "re-check" with their doctors and specifically ask about diving. The one I referred to (with 3 contraindications) was cleared by the family GP TWICE... I had to insist that he contact DAN before we could continue. DAN of course, helped the physician see the error of his ways. That was my point... when the doctor does not seem to understand, DAN can help them to see the light. BTW, BSA requires a complete yearly physical to participate in SCUBA and not the mere "Health Survey" required by NAUI.

Not being a doctor, I am at a severe disadvantage when I KNOW that a kid shouldn't dive. "But my doctor said..." carries far more weight in their eyes than me saying that a particular condition effectively stops you from diving. While I get tongue tied trying to explain to a GP why a condition is a contraindication to diving, DAN has no such problems. While a GP might not listen to the medical advice from a man on the street, they WILL usually listen to DAN. I have no problem with my personal GP (Dr J. Peale) and think the world of him. Whenever I have a diving issue he calls DAN… I have not needed to be referred to another physician, which is “OK” by me.

 

[The Iceni]

Ok Net doc,

Not that I have any grouse with DAN - on the contrary - I do slightly resent comments like

"The one I referred to (with 3 contraindications) was cleared by the family GP TWICE... I had to insist that he contact DAN before we could continue. DAN of course, helped the physician see the error of his ways."

In the UK you can obtain 60,000,000 medical opinions and it is up to you whose advice you take but in our litiginous society you were right to question the GP's opinion.

However, I would suggest that you might have handled this set of circumstance a little better. For example, I think it may have been incumbent of you to have informed the children and their parents of your medical requirements before they even got to the doctor, much in the way the BSAC used to do.

The old medical questionnaire set out those conditions contraindicated to diving on the form and aked the doctor to verify that the candidate did not suffer from said conditions and explained precisley why.

At least in that way the doctor's time and the parent's money is not wasted on obviously unsuitable candidates and, in addition, you are not putting the doctor into an impossible position.

Forwarned is forarmed?

At the end of the day, regardless of what ANY doctor says, if you believe a cadidate is unfit or otherwise unsuitable to dive you must refuse to dive with/train him. You had no need, whatsoever to revert to that doctor since you had no intention of training that particular candidate.


The diver must satisfy

1) The published medical requirements

2) your own requirements, including your own opinion of the candidate's medical fitness, whether guided by DAN or not.

Is that not so?

 

[The Chairman]

These rules were gone over the very first Crew Meeting... they had to get a physical and a physician's clearance to dive per BSA's Safe Guide to Scouting. Maybe, I made the (obviously) erroneous assumption that GPs would understand the basics of hyperbaric conditions, or if they didn't know they would research their patient's issues to see how those conditions would affect them.

Unfortunately, the Class 3 Physical form required by the BSA is not as Diver specific as the "Health History" provided by NAUI, and maybe both should be given to bring to the doctor. However, I had a few kids bring me just the "Health History" anyway (it comes with their diving packet) which is not sufficient for BSA standards.

I am sorry you have taken issue with my handling of this situation. As I pointed out, much of it comes from the prestige given a doctor's opinion and how much less credence is given mine. Being a doctor, you probably have never realized how seldom your opinion is really questioned. I apologize for whatever indiscretion(s) I have committed in this regard.

So if a child who wants to dive, with a very eager parent wanting them to dive too, gets one opinion from you, that they indeed CAN dive and another from some poor schmuck (me) who is NOT a physician stating that they can't, WHOM do think they would believe??? If the physician then looks over little Johnny once more (with my concerns in writing) and THEN still holds the opinion that little Johnny can dive... in essence calling me the schmuck that we all know that I am, what do I do to NOT SEEM that I am merely out to spoil little Johnny's fun??? I call DAN (as I did), and then refer the parents to have their physician call DAN (as I also did) and let DAN (who has a somewhat better reputation than mere schmuck) explain to the GP how Little Johnny has no business SCUBA diving. After this dialogue with DAN, the physician told Little Johnny's parents to keep him dry. Go figure.

As for putting the Doctor into an impossible situation, I feel just the reverse. After I sent the kid back with specific issues (and my phone number) he flat out told the mom and dad that I was NOT a physician, and did not know what I was talking about. Hence, I look like an even bigger scmuck that I really am.

So to sum it up...

*Parents want their Little Johnnys and Janes to do anything they want to do, and some are willing to lie about it.
*BSA's Guide to Safe Scouting requires a FULL physical for any high adventure program. SCUBA is considered high adventure.
*Parents hold a doctor's opinion about their child's suitability to dive WAY, WAY, WAY over mine (no, it's not fair).
*DAN evens the playing field... they can get the GP's attention where I am merely ignored, impugned, and otherwise relegated to being the schmuck that I am.

Finally, again I apologize if I have affronted you with what I perceive to be the unvarnished truth of the situation. The question was asked about what was thought about GPs, and I have given mine (even schmuck's can have opinions). Sorry it does not fit your requirements.

BTW, I do hope you realise that this was niether anecdotal nor third party. It was a real situation that I had to deal with to the best of my obviously inept abilities. IF the proof is in the pudding then the GP finally agreeing with me must be worth something.

 

[The Iceni]

I think we have both upset each other enough, Netdoc. Can we call a truce?

Perhaps I am far too prickly!

Over this side of the water not even doctors hold sway over little Jimmy's desire to do as he likes. He has only to lie on the form over here. No medical at all is required, at least for adults. This seems very stupid to me.

Over here it is really down to the organiser himself.

It sounded a bit like you were gleefully using your customers to teach the doctor his job as he was clearly so bad at it, which it seems he indeed was! Twice I can accepot but three times?

It seems he most certainly learned his lesson!

You said "in addition, you are not putting the doctor into an impossible position." but I think you may indeed be if you do not give him an indication of the basic requirements for such a specialist area and expect him to know, for instance, the real risks of pulmonary barotrauma in an asthmatic, for example. No-one learns that at medical school as far as I am aware but if I were told beforehand that asthma is contraindicated, and the resons why, I can make a reasonable assessment.


Apology gladly accepted.

Will you accept mine for being so over defensive? By the way, keep up with the good work.

I am learning a lot from this forum.

 

[The Chairman]

I feel that I am not communicating efficiently. In trying to be brief in my first post, I left out a myriad of details that you could not have known about. As you did not have enough information to go on, your apology is hardly needed but accepted nonetheless.

The full physical is not required for Diver certification over here... it is required by the BSA (Boy Scouts of America) for members engaging in SCUBA or other high adventure programs. Wherever the two standards vary, I have to go with the stiffer one to keep both agencies (BSA and NAUI) happy. Another difference is the minimum age… only 12 for NAUI, but a much better 14 for the BSA. I do not feel those under 14 or 15 should engage in this sport. Still, keeping track of the requirements of the two agencies is a handful.

I will be requesting that the NAUI "Health History" form be given to the physician as well, as that contains most of the contraindications to diving on the flip side. I would rather the physician get it right the first time, rather than having to go back and forth. I owe that little gem to you, and will be interested to see if that keeps little Johnnies who shouldn't dive out of the program.

It was not glee that I was trying to express but a feeling of incredulity. In fact, when I talked with the mother after the second approval, I expressed my concern that the doctor had seemed to overlook these issues. Ultimately, it was an appeal to her responsibilities as his mother to make sure that he was safe that finally got through to her. I was committed to not having this child go through training, but he was just as insistent to complete it, and at first had the doctor on his side. I am glad that reason (and DAN) finally prevailed. No hard feelings here and I understand how you feel when your profession seems to be attacked for no reason.