That pesky Medical Statement

[pepperbelly]

Colliam those are very good points.
When I said I may just check no it is not to get around it to do something I shouldn't.
My doctor knows I dive. When I turned 50 he had me take a treadmill cardio stress test just to be sure I wouldn't drop on the softball field.
He and I both looked into the meds I take for my mild hypertension and the meds don't have an effect that would keep me from diving. My bp is under control and I may be able to come off the meds now that I have quit smoking.
I know I am safe to dive as does my doctor. Checking no may just be easier, although on my last trip I checked yes and listed my meds and they took my word it is under control.

 

[kelemvor]

It seems like an okay form to have during training, especially open water training. It seems superfluous to have such a form for boat operations. Having a form where any answer of yes requiring a doctor signature practically forces the customer to lie unless they're in perfect health. I guess it's a little easier for doctors who are divers and can sign for themselves. For the rest of us, we have to wait for the doc to become available for an appointment and then fork over the cash for the appointment. Depending on your insurance, that copay for a 10 minute appointment to get the signature can be significant. If you're on a trip out of town, your options are probably limited to Emergency Room.

What's more, signing a medical waiver for a boat ride is not standard so it will be surprise. Imagine you had traveled down to Key Largo for a weekend of diving to encounter such an operator. It's not like they have doctors on staff you can just pay to sign the form. That means unless you'd been there before or did a ton of research you're SOL for that weekend. It would be worse if you had to fly down and get a hotel room only to be turned away.

I can think of three options at this point.

1. Lie on the form.
2. Go find another operator.
3. Forget about the money you just spent on travel and hotel (and other costs). Thank the operator for having your best interests in mind. You might consider tipping them as a more tangible way to express your gratitude.

I think #2 is the ideal solution, but #1 is probably much more likely.

For operators like Blue XT Sea that require a medical form each time, I hope that you're very up front about it when booking or providing information over the phone. It's an unusual requirement, and takes both time and money to fulfill.

 

[redacted]

I am glad that we spun this thread off (from the A&I discussion of the Cozumel fatality) because it has produced some informative discussion. Based on some of the comments I have several reactions, in no particular order of importance:

Several posters have referred to the 'PADI form'. While that may be the form that PADI makes available on their website, and carries a PADI logo, it is useful to keep in mind that the form is actually (clearly stated on the form at the top) the RSTC - Recreational Scuba Training Council (United States Council - WRSTC) form. So, if any SB user wishes to 'suggest' that the form should be changed, the RSTC would be the best point of contact. I happen to agree with one such post, that the form should be updated to include non-physician primary care providers such as PAs and FNPs. I have been presented with forms signed off by both types of providers, and have accepted them without reservation, even though the form specifies 'physician'. I cannot speak for other Instructors or dive operators.

In the US, RSTC members include PADI, SDI, PDIC, SSI and RAID. Notably missing from the list is NAUI, NASE and SEI. It would be good to hear from Instructors / operators working through those agencies, regarding the standards for medical clearance that those agencies apply.

The 'process' of obtaining a diver statement regarding their health, is intended - as the RSTC form indicates - to protect the diver (formatting added for emphasis):

The purpose of this Medical Questionnaire is to find out if you should be examined by your doctor before participating in recreational diver training. A positive response to a question does not necessarily disqualify you from diving. A positive response means that there is a preexisting condition that may affect your safety while diving and you must seek the advice of your physician prior to engaging in dive activities.

Diving is associated with certain risks, it can be a strenuous activity, and some individuals wishing to pursue diving may not be aware of how their physical condition may increase their risks. (Of course, all of us on SB are fully aware of any and all risks that we face when diving, so that statement really applies to 'those other divers'.) The form really is for the benefit of the diver - by providing a checklist and a decision tree. If you answer 'Yes', you should seek the opinion of an independent, informed 3rd party - a medical provider. Like it or not, very few (actually, I think NONE) of us are absolutely objective in assessing our own fitness to dive. We may be able to make a valid assessment, but we are not entirely objective, even when we are right. The Medical Statement is not intended to be intrusive, although some may choose to view it that way.

The process also involves risk mitigation for dive professionals and operators. It really is a matter of liability, on two levels. The first is straightforward - if someone dies while diving, the most common reaction among family and friends is NOT - 'Wow, at least that's some consolation, they died doing what they loved.' Rather, it is, 'Who is to blame for this needless tragedy?' And, the process of assigning blame, remarkably, seems to routinely exclude the victim. There have been high profile examples of this in recent years (Wes Skiles' Widow Looking For 25 Million from Lamartek). But, there is a 2nd level. Dive professionals may be put at risk by a medical event suffered by a diver they are guiding. For example, a diver has a history of TIAs (transient ischemic attacks) associated with transient loss of consciousness, which would qualify as a Severe Risk according to the form. But, they are on vacation at a beautiful Caribbean destination, say Grand Turk, and their group is set to do an exciting wall dive - they will swim down through the Tunnels, and come out over the edge of the wall (where the bottom is several thousand feet below). The diver writes 'No' on the Medical Statement next to the question : 'Blackouts or fainting (full/partial loss of consciousness)', so they can do the dive with the group. The diver suffers a neurological event during the dive, become unresponsive and begins sinking down into the abyss (they were negatively buoyant to begin with, but were also a '45'er', and their finning was actually keeping them at a constant depth; they stopped finning as a result of the event, and started sinking). The DM leading the dive sees that they have started descending, and is faced with a dilemma, to descend and try to catch her, or not. The DM decides to try, but the unresponsive diver is well below them by the time they see there is a problem. The DM finally catches the diver, at 300 ft. At this point, the DMs air supply is quite low, and they are unable to make a normal ascent, with the unresponsive diver, to the surface. They try, but go out of air at 110 feet, release the victim, head for the surface, suffer a severe DCS hit, from which they recover but with residual paralysis. The family of the deceased diver looks to sue the dive operation and the DM for failure to provide a reasonable Duty of Care.

The Medical Statement is by no mean foolproof. Just because you have signed a statement and answered 'No' to all the questions does not mean that you will not have a medical event while diving. Rather, it seeks to make divers aware, in advance, of potential risks and provides a process for assessing those risks - evaluation by a 3rd party - where the diver may be able to identify potential issues (answering 'Yes' to a question). That 3rd party does not have to be a diver! The Medical Statement provides information to the provider to help them determine whether their patient may have Severe Risk or Relative Risk, and whether the risk can be considered temporary or not, as far as diving goes. In the example above, a diver without the history of TIAs, who honestly answered 'No' might have a first time neurological event. Nonetheless, the Medical Statement 'process' is intended to pre-identify substantive risks, and mitigate them, to the extent possible.

Any diver is free to answer 'No' to any and all statements on the form, even if s/he knows an answer to be 'Yes'. If that is what you choose to do, that is your decision. Hopefully, you - AND your family / friends / loved ones, since you may no longer be in a position to consciously care - will be willing to accept the possible consequences of your choice. You might think about also asking others that may be affected - e.g. dive professionals and operators - about what they think of your decision.

One point that was left out of the above post is that the medical clearance for was designed for use with diver training courses to protect the training agency. It was not designed for use with recreational dives supported by dive operators. Their use in this case is apparently their decision. It is not being mandated by their affiliated agencies.

From the RSTC medical form:

This is a statement in which you are informed of some potential risks
involved in scuba diving and of the conduct required of you during the
scuba training program. Your signature on this statement is required for
you to participate in the scuba training program offered
by_____________________________________________________and
Instructor
_______________________________________________located in the
Facility
city of_______________________, state/province of _______________.
Read this statement prior to signing it. You must complete this
Medical Statement, which includes the medical questionnaire section, to
enroll in the scuba training program. If you are a minor, you must have
this Statement signed by a parent or guardian.

My personal objection to the medical form for general use with recreationaql dives is the way it is administered by many ops that require it. Their requirement is often not make known until you walk up to the dive op that has accepted your reservation and money. At that pont I do know how to complete that form so I will be allowed to dive. The downside is I have to be careful to not reveal my hearing lose or any other minor problem that is not a contraindication of diving as I do not know what the dive op response woulkd be.

In fact, if I do have a choice of ops (and we usually do), I tend to select one that does not use that particular elaborate medical clearance form. Most simply have the diver verify in their liability release form that you are medically fit for the diving.

While medical incidents may be an added in-water risk (albeit rare) to dive professionals, it is not at all clear that the RSTC form is in any way effective in reducing that risk. I suspect it is really designed to be used after the fact in the event of court action. In the mean time, those professionals that choose to use that form can deal with any loss of business that may result. It does not look like I am the only potential customer who dislikes that form and what it may cause.

 

[Lorenzoid]

"Surprise" is the most annoying aspect of this whole issue. I almost wish there WERE a "standard." I have made it a practice to get an annual physical. I want to know if I'm healthy enough for the activities I do. If there were minimum health standards and a standard form that was accepted worldwide, it would be easy, and it would give me peace of mind. But with different requirements from different dive ops, and no guarantee that a note my doctor signed at the time of my annual physical will be accepted, it is tempting to just check "No" to all questions.

 

[Colliam7]

One point that was left out of the above post is that the medical clearance for was designed for use with diver training courses to protect the training agency. It was not designed for use with recreational dives supported by dive operators. Their use in this case is apparently their decision. It is not being mandated by their affiliated agencies.

A very good point. Operators may have elected to use the form / process for the very same reasons that training agencies adopted it. And, it becomes a matter of 'their business, their rules'.

There was an interesting discussion in a SB thread (DIVING OVER 50 YEARS OLD) last Fall, where an operator in a fairly remote location asked for feedback on the idea of requiring a physician-signed Medical Statement for all divers over a certain age (50). His reasoning was that the location is quite remote, they have very limited medical facilities, as well as transportation options, and having to assist a diver with a medical event essentially overwhelmed the operation not to mention island resources. There was a lot of hostile reaction. And, of course there were some assertions that this was age discrimination, that some users would never use that op if such a policy was enacted, etc. But, what the operator was proposing made good sense, when looked at from his perspective. If I am running a business, I want to maximize my operational efficiency (and revenue), and dealing with divers who have significant medical events is not the best way to do that. Better to go for the low hanging fruit - divers with money, AND either good health, or documentation of adequate health (e.g. by a health care provider) that poses minimal risk of going south while they are diving with my operation.

 

[tursiops]

Just received from PADI Training, FYI:


PADI accepts medical releases signed by a:

Licensed Physician/Doctor including:
- Medical Doctor (M.D.)
- Doctor of Osteopathic Medicine (D.O.)
- Bachelor of Medicine Bachelor of Surgery (M.B.B.S.)

Physician Assistant (PA) or Nurse Practioner (PRN)
The P.A.’s or PRN’s in-charge Physician (M.D.) must sign or stamp the form.

Psychiatrist

PADI does NOT accept Medical Releases signed by:

· Psychologists
· Chiropractors
· Veterinarians
· Traditional healers

 

[vann evans]

I have medical conditions and take medicines that make me answer "yes" on some questions in the medical forms. My Doctor luckily is a diver also and has a great concept of the medical requirements necessary for diving. Before we leave on any diving trip, I simply email him with a request for a letter. I get a letter from him that specifically states that the medical conditions and the medicines that I take will not preclude me from any diving activities. The letter is dated, original signed and on his letterhead. I have never had a problem with any operator after producing this letter.

It is a simple way to avoid problems and potential confrontations with just a little fore thought.
vann

 

[JamesBon92007]

Colliam those are very good points.
When I said I may just check no it is not to get around it to do something I shouldn't.
My doctor knows I dive. When I turned 50 he had me take a treadmill cardio stress test just to be sure I wouldn't drop on the softball field.
He and I both looked into the meds I take for my mild hypertension and the meds don't have an effect that would keep me from diving. My bp is under control and I may be able to come off the meds now that I have quit smoking.
I know I am safe to dive as does my doctor. Checking no may just be easier, although on my last trip I checked yes and listed my meds and they took my word it is under control.

Who, exactly, assesses the situation and decides that the meds are working and that it is "under control?" Is it someone that most people would consider to be qualified to make such a decision?

 

[Colliam7]

Just received from PADI Training, FYI:


Physician Assistant (PA) or Nurse Practioner (PRN)
The P.A.’s or PRN’s in-charge Physician (M.D.) must sign or stamp the form.

Interesting - I always see a 'stamp' on Medical Statements signed by a PA or FNP, but really didn't think about the need for it.

Thanks for contributing the information to the discussion.

 

[tarponchik]

Loose lips sink ships.

I quoted this proverb recently too. However, although this is off topic, you should know that the effect of following the rule too close can be the opposite. Thus, the secrecy around the defensive minefields around Florida Keys resulted in sinking of several US and friendly ships, including a Clemson-class destroyer Sturtevant (DD240), and cargo ships Edward Luckenbach, Gunvor (Norwegian) and Bosilijka (Yugoslavian) because the captains were not informed.