As a (British) GP can I offer my tuppence worth? This is a copy of my post on a related thread.
The concepts of medical fitness to dive (as a risk assessment) and the highly specialist skills of a diving physician (giving specialist advice and/or treatment) are two entirely separate things.
In the UK we still (just) have family doctors who at least have access to a record of our patients' illnesses and treatments. I can say will utter confidence that most GPs will know when an applicant's medical fitness is doubtful and when to refer to a specialist.
On the other hand he will also know when an applicant is medically fit.
Viv said elwhere
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.
That sounds awful but I see this impersonal, production-line over here too. I can also understand John's concerns but what he describes is the deliberate deskilling of doctors. I am an immediate care doctor, trained in ACLS, ATLS etc but as a self-employed GP I am not welcome at RTAs etc. and yet I am required to spend an increasing amount of my time dealing with paperwork and trivia. It is a turf war. (Life is cheap so why should trusts pay for expensive doctors when a cheap-and- cheerful ambulanceman will do - in the UK our "paramedics" get all of six weeks training).
I am certain society will regret the passing of the traditional (family) physician. Someone has to do the routine, minor stuff or we have the situation where the specialists will be seeing all manner of conditions outside their speciality, to say nothing of the doctor's role as his patient's advocate!
Sadly, as I say, life is cheap and society is run by insurance companies.
Dr Vikingo said
I'm not sure that I can agree with the statement, "Then I discovered it was self certification in any case and up to the individual diver whether or not to disclose."
I don't know about Scotland, but most major training agencies in the US & greater Caribbean will query the applicant about medical history before accepting them. Additionally, many dive ops around the world will ask one to sign a medical release form prior to taking them out. In both instances, these often ask questions about medications & psychiatric illness.
I agree. In changing the medical system to self-certification I believe the BSAC has thrown the baby out with the bathwater. In my professional opinion the certificate is not worth the paper it is written on. It bypasses the one person all life insurance companies use - the GP!
Human nature being what it is, not all are sensible and mature.
