Question So I'm 65 and on medicare which will not cover a physical. What do older divers do for the required physical? How extensive should it be?

[Nick_Radov]

@mac66,
Wouldn't you want to know if a chest X-ray will reveal an issue with your lungs?

Wouldn't you want to know if a stress-echo test will reveal an issue with your heart?

Why those tests specifically? Why not a HbA1c test, or a coronary calcium scan, or a full body MRI, or a bone mineral density test? There are a lot of lung conditions that can't be diagnosed with a chest x-ray. There are a lot of heart conditions that can't be diagnosed with an exercise stress echocardiogram. Doctors shouldn't be wasting time and money ordering tests at random unless they are indicated by evidence-based clinical practice guidelines.

 

[rx7diver]

Why those tests specifically? Why not a HbA1c test, or a coronary calcium scan, or a full body MRI, or a bone mineral density test? There are a lot of lung conditions that can't be diagnosed with a chest x-ray. There are a lot of heart conditions that can't be diagnosed with an exercise stress echocardiogram. Doctors shouldn't be wasting time and money ordering tests at random unless they are indicated by evidence-based clinical practice guidelines.

@Nick_Radov,

I wasn't suggesting these tests. (I am not a physician.) My statements were simply to illustrate a (obvious?) point. A dive doc would best know what diagnostics are appropriate.

rx7diver

 

[Nick_Radov]

@Brian2063,

I can't tell if you're being ironic/sarcastic.

One value of periodic physicals is to provide docs with baseline data for you just in case something medical should happen to you, whether you believe these data or not.

FWIW.

rx7diver

In general there is no proven value to periodic physicals for healthy patients who aren't managing some sort of medical condition. This has been extensively studied and periodic physicals don't seem to produce better outcomes.

Evidence Brief: Role of the Annual Comprehensive Physical Examination in the Asymptomatic Adult - NCBI Bookshelf

There are a limited set of periodic screening tests which are recommended for everyone based on actual scientific evidence. But those are different from physicals.

Preventive care benefits for adults | HealthCare.gov

Learn what preventive services for adults — like shots and screenings — are covered by Marketplace insurance

www.healthcare.gov

 

[rx7diver]

In general there is no proven value to periodic physicals for healthy patients ...

@Nick_Radov,

I don't think there is agreement about this. My eldest brother is a physician (actually, a surgeon turned ER doc as he nears retirement). Both he and my own GP are huge proponents of periodic physicals. I'll follow their advice, thank you, and I strongly recommend their advice to my almost-adult daughters. Others are free to do as they choose.

rx7diver

 

[kinoons]

There is a compelling argument that yearly visits are not required as @Nick_Radov notes. When someone is “healthy” it is difficult to improve on their state.

Recently many cancer screening exams have come under fire for not actually improving all cause mortality. I don’t believe that cardiac calcium scans have been proven to improve all cause mortality.

Randomized trials have shown that cardiac cath for chronic cardiac artery blockages do not improve pt’s symptoms compared to a sham procedure. Neither does knee arthroscopy.

Aspirin is no longer recommended for primary prevention of heart disease for healthy individuals.

The risk of periodic visits to primary care is the medicalization of a healthy individual who did not need treatment who now gets it, which is by definition only harm.

More and more I am moving to the less is more stance with my medical practice.

 

[Barryattle]

In general there is no proven value to periodic physicals for healthy patients who aren't managing some sort of medical condition. This has been extensively studied and periodic physicals don't seem to produce better outcomes.

https://www.ncbi.nlm.nih.gov/books/NBK82767/
There are a limited set of periodic screening tests which are recommended for everyone based on actual scientific evidence. But those are different from physicals.

Speaking as a family doc, evidence-based medicine geek, and diver over 65, @Nick_Radov is absolutely correct (and, alas, @kinoons about lack of evidence for most cancer screening tests improving all-cause mortality, though that doesn't mean they're useless - e.g., preventing younger women from dying from cervical cancer is worthwhile even if it doesn't significantly lower their all-cause mortality). In the "annual physical," the value comes primarily from time to catch up on things like overdue immunizations and recommended screenings (hence why the Medicare Annual Wellness Visit covers those and not a "physical") that often don't get done in problem-focused visits. Cardiac stress tests in asymptomatic people have similarly been shown to be of no benefit. Does that mean that, if you're an older, out-of-shape smoker that you should just "dive in"? No - you should gradually work up to the level of exertion your diving would require; if you get any symptoms, then get evaluated. If getting basic OW cert., if you have issues in the pool sessions, get evaluated before you do an open water dive.

Is there increased risk of cardiac arrest with diving, as with other exertion? Sure - and cardiac arrest underwater is pretty unforgiving. But doing things that have been shown not to improve outcomes is unlikely to help. On the other hand, do NOT ignore symptoms that could suggest a problem. And if you have a history of heart disease, etc., then you should get evaluated by someone knowledgeable about both your condition(s) and diving. In the case of an older male with a long smoking history, I would suggest consulting with diving medicine doc as there may be evidence about risk evaluation for smoking-related conditions that most docs (myself included) wouldn't know. And Medicare may not cover that.

 

[happy-diver]

Man if I got diagnosed with a terminal illness it'd be back on the piss and fags and see who's left on the list

No one needs that crap and the grandkids will get over it quick because grandpa smells a bit funny anyway

 

[Tom Winters]

I had a pair of fragrant grandpas who passed in the 1950’s and 60’s.

I still remember those, ah, aromas. Grandkids never forget that…

Geez, now I wonder what smells I emit these days now that I’m older than they were when they passed.

 

[Sure Squintsalot]

Even the other advanced PADI certifications might require a doctor's note if you check Box 10 on their Diver Medical Form. I made the mistake of doing just that for their Nitrox course.

They should really make you have a medical directive or will before you dive; now that's useful paperwork.

 

[TMHeimer]

I'm 69 and haven't had a special examination for diving in my 18 years doing it. I always dive solo now (usually to 20-30 feet) and am not concerned about something like a heart attack. Besides just taking it slow & easy underwater, I spend a total of about 10 weeks away from my wife each year where I am alone most of the time. I could easily die at that time-- more readily than on a 45 minute dive.