Heretical thoughts on the diver's medical form

[raftingtigger]

I've noticed some liability waivers include language to the effect of "I have had an opportunity to seek legal advice before signing." You don't have to get your lawyer to actually sign off, or even affirm that you talked to one, just represent that you were not put in a position of having to make a snap decision without the chance to run it by a professional. Of course, that's usually not true; even when I book in advance, I rarely get a copy of the waiver until I'm on-site ready to go. At the earliest, I get it right after I've paid. So while part of me likes the idea of self-certification of fitness to dive, part of me thinks that would result in a lot fewer people actually even talking to their doctors, and that might be a bad thing. After all, just look at how many people, having never actually consulted a lawyer, believe those waivers aren't enforceable anyway.

Like a lot of people, I was diagnosed with asthma as a child but grew out of it; I haven't had any symptoms whatsoever since well before I reached adulthood. But the RSTC form asks if you've "ever" had it, which I think is ridiculous. I told the truth a few times and got my doctor's signature, but other times I've just said "no." I would much rather sign something that says I understand the risk and accept it, and release everyone on earth from any liability forever if I get hurt or killed while diving due to complications from asthma.

My husband, on the other hand, has a history of spontaneous pneumothorax. When we were planning our Caribbean honeymoon before I was certified, we decided to try scuba diving. We'd each dabbled in it before; I did a discover dive ten years earlier, and he'd taken a course in high school (prior to his lung collapse). So we were each filling out the forms, but his doctor wouldn't sign off on his, and urged him to see a specialist. The pulmonologist was willing to run some tests to get a better sense of the risk, but warned him that they couldn't rule out the possibility of additional blebs too small for the machine to pick up, any of which could kill him underwater. We decided to stick to snorkeling. Had we been able to sign away the risk without a doctor's input, we probably would have. And maybe that would've turned out fine. Or maybe I'd now be a widow.

It's tempting to throw everything at the feet of personal responsibility, but most people just don't have enough information to properly weigh the risks. What I would really like to see is a slight modification of the forms to better reflect the latest medical understanding (I think the alarm over a history of spontaneous pneumothorax is better supported than the alarm over a mere history of asthma.) Perhaps the form could also be modified so that the physician doesn't certify that the diver is fit to dive, but rather that they have discussed the risks with the patient/diver.

The way I envision the form is to lay out the medical dangers of diving in layman's terms. This encourages the diver to seek out proper evaluation for critical issues like your husband's spontaneous pneumothorax. That would be one of the listed critical (diving prohibited in all but a few cases) conditions. Without knowing this before signing the form the layman probably would not know the difference between your childhood asthma and his long ago spontaneous pneumothorax. Both seem resolved to you.

 

[dmaziuk]

If only one could grow out of "I am over 45 years of age" question...

 

[boulderjohn]

I had an interesting experience with older forms about a decade ago, an experience that showed some of the uncertainty with the forms.

I was going to be in Florida for a while, and I arranged ahead of time to take TDI trimix classes there. Knowing that I would be far from my doctor, knowing I had a couple YES answers on the RSTC form, and knowing SDI/TDI were part of the RSTC, I made sure to have a medical form signed by my doctor before I left home. When I handed it to the TDI instructor, he refused it. This was a TDI class, so I had to use the TDI medical form. No exceptions. He handed me a blank copy of the TDI medical form.

"Oh, crap!" I thought. "What do I do now?"

Then I examined the TDI form and saw to my relief that the second page, where the doctor signs, was 100% identical to the RSTC form, so all I had to do was mark of the first page of the TDI form, the one with all the different conditions, and attach the second page of my RSTC form. When I did marked that first page, though, I no longer needed the second page at all, because on the TDI form, I was fine to dive without a doctor's consent. The YES items on the RSTC form were not on the TDI form at all.

 

[boulderjohn]

People also need to read carefully to see what the form actually said. On the old RSTC form, I had to deal frequently with this choice on the front page:

"Back, arm or leg problems following surgery, injury or fracture?"
​

A large number of students read that as "Have you ever had surgery, injury, or fracture to your back, arm or leg?" Some of them would write "YES" and complain about having to see a doctor because they had a sprained ankle 20 years ago. "Do you currently have leg problems because of that injury?" I would ask. "No? Then you are good to go."

 

[lowflyer]

I have some experience diving and am an M.D. IMO any medical form proposed is ludicrous. The only purpose I see in current forms is to absolve dive operators and PADI or other agencies from liability. So instead just ask a diver to sign a form stating he knows of no medical contraindication to diving, thus reducing the BS in the various current forms and putting the onus on the diver himself if he gets injured or dies.

If the purpose of the form were really to protect the diver, the agencies would require a total evaluation by a specialist in dive medicine, just like the FAA requires an exam of pilots by a Designated Pilot Examiner (except now for sport category pilots). Of course no one wants that to happen.

Since the current medical form game is all about shifting liability and little about medical issues, I will not sign these forms unless I have a recent complete history and physical on record and on top of that know the diver and his family to not be litigious, though that's impossible to know for sure.

 

[Rose Robinson]

I'm posting this in the Basic forum since it applies to all divers, and needs to be understandable to all divers. If it is better in the Medicine section, then it can get moved.

The current diver's medical form - or more precisely - the physician sign off, isn't worth the paper it is signed on. I'm a very experienced diver, and a medical professional, that is asked to sign these forms occasionally. In my case it is apparently healthy divers whose primary physician that can no longer sign them (ie. Kaiser, they will no longer sign any physicals) . So I have to take the diver's word for everything. All I get to do is see the obvious. In my own case I have prior issues that are not progressive and have been fully cleared. If I mention them, even though they have no effect and are more than 30 years past, I have to go find a provider to sign the form (I can no longer have my PCP do it - I'm covered by Kaiser). There is a LOT of incentive for divers to be less than forthcoming on these forms, so unless the signer really knows the diver, they are worthless.

This isn't to say that medical fitness to dive isn't important - it IS REALLY important. We need to change from a required medical sign off (which is only required if the diver has either clear medical issues OR is totally honest on the form) to self-regulation with adequate and understandable information so that the diver will seek evaluation by the appropriate level of medical provider if there are issues. This will take the onus off the dive operator and put it where it belongs - on the diver themselves.

A very rough draft of what I'm envisioning could look like this:

Cardiovascular: After carefully reading the information below I have

O No known cardiovascular issues that will impact my diving
O I have cardiovascular issues and have addressed them with a medical provider and I need the following precautions:_________________________________________________________________
​

Blurb on cardiovascular fitness and diving and a layman's explanation of what is fit enough. An example could be the diver can climb X flights of stairs without resting.

Do this for all the important body systems.

Have one for Covid-19. This is a critical issue. Young, previously healthy, and no longer (or never) symptomatic divers can still have damage that could cause problems with the pressure changes. This needs a strong discussion here.

Have a section on short-term issues ('colds', 'allergies', fatigue, etc)

Finish it off with a signed statement that the diver has had an opportunity to discuss any medical issues with a diving medical provider and self-certifies that they are medically fit to undertake the dives with the above listed precautions.

The dive operator is much more likely to get useful medical information this way. If someone is clearly unfit, the operator can still decline to take them.

I have added a poll. Please vote, but DO NOT consider whether you think the dive industry would use a new form or not.

Raft,

As a medical professional, why would you even consider taking anyone's word for anything.

Secondly, this form should only be signed, after a complete medical examination/physical has been performed, and a patient medical history has been reviewed.

The Diver's form is designed only as a checklist to cover all possible conditions, as many addendums as needed can be added by the examining professional or professionals.

Divers wanted an unregulated industry, controlled by divers. Getting what you asked for is not always the best choice!

Rose.

 

[boulderjohn]

OK, not an attorney, but the problem may be one of "informed consent."

In past lawsuits, attorneys have succeeded in getting liability waivers invalidated on the grounds that the client did not understand what he or she was signing because not enough time was allowed for the signer to examine the clauses and fully weigh their import. I know of one diving case in particular in which the attorney claimed the waiver was not valid because the person signing it did not have the opportunity to consult with an attorney. (The case settled, so that claim was never adjudicated.)

I would guess that the agencies are concerned about the same thing with the medical waiver. If the diver signed a simple "I'm fit to dive" statement and died from a medical event, an attorney would say that the client was not trained in medicine and thus did not know his or her condition was any reason to be concerned. Making a list of potential medical concerns is at least a step to heading off that argument.

 

[wnissen]

I have some experience diving and am an M.D. IMO any medical form proposed is ludicrous. The only purpose I see in current forms is to absolve dive operators and PADI or other agencies from liability. So instead just ask a diver to sign a form stating he knows of no medical contraindication to diving, thus reducing the BS in the various current forms and putting the onus on the diver himself if he gets injured or dies.

If the purpose of the form were really to protect the diver, the agencies would require a total evaluation by a specialist in dive medicine, just like the FAA requires an exam of pilots by a Designated Pilot Examiner (except now for sport category pilots). Of course no one wants that to happen.

Since the current medical form game is all about shifting liability and little about medical issues, I will not sign these forms unless I have a recent complete history and physical on record and on top of that know the diver and his family to not be litigious, though that's impossible to know for sure.

Yes, the current form seems to be the worst of both worlds. The only person with any medical knowledge is a general practitioner who is unlikely to understand diving. The diver and DM have no medical knowledge but are going to bear any mortal consequences if things go sideways. The diver has every incentive to hide absolutely everything from the DM. The shop and PADI have every incentive to disqualify as few divers as possible. I think your low-BS form is probably best.

 

[dmaziuk]

Yes, the current form seems to be the worst of both worlds. The only person with any medical knowledge is a general practitioner who is unlikely to understand diving.

Which is why Australians certify their GPs for Diving Medicine/Dive Standards for Medicals and require medical clearances from them.

 

[TMHeimer]

I have some experience diving and am an M.D. IMO any medical form proposed is ludicrous. The only purpose I see in current forms is to absolve dive operators and PADI or other agencies from liability. So instead just ask a diver to sign a form stating he knows of no medical contraindication to diving, thus reducing the BS in the various current forms and putting the onus on the diver himself if he gets injured or dies.

If the purpose of the form were really to protect the diver, the agencies would require a total evaluation by a specialist in dive medicine, just like the FAA requires an exam of pilots by a Designated Pilot Examiner (except now for sport category pilots). Of course no one wants that to happen.

Since the current medical form game is all about shifting liability and little about medical issues, I will not sign these forms unless I have a recent complete history and physical on record and on top of that know the diver and his family to not be litigious, though that's impossible to know for sure.

Agree with you. Not sure what you meant by you will not sign these forms..... You mean for yourself as a vacationing diver or for folks you are looking after as a DM? Either way, don't these forms have to be signed for any diving to take place?