What if you had to have a current dive medical annually that stated you were fit and healthy with no conditions that could cause an issue? Maybe all persons over 45 pass a full stress test annually?
Unfortunately, for at least the last 15 years, in order to gain access to various private lake, cave and mine diving sites, that is exactly what I've had to do - with a certified diving physician. Cost was between US$80-100 for each annual check. Use of the PADI medical selfevaluation was not accepted.