Medical form for dive op?

[tridacna]

I'm not sure why this model isn't more common. All I want from a boat is a ride to a location I give them, and for them to swing on the anchor a couple hours while I go do my thing. If I'm not back in 2 hours, call the Coast Guard to recover the body.

This is true only if your relatives decide not to sue. You’re not the problem. They see a $$$$ payday.

 

[Divin'Papaw]

Great summary @drrich2 and thought provoking.

6.) Utility. Let's say you have a history of mild to moderate hypertension, well-controlled, and you've spoken with a physician before, maybe had a medical clearance before, nothing's changed and yet the dive op. policy is clearances are only good for a year. You know you can get another letter...and have to make an appointment, pay a co-pay, basically jump through hoops for an over-reaching bureaucratic demand rather than a legitimate health concern.

Do you feel bound to honor that?

Let me serve as a specific test case. Richard's example above applies to me. I have mild, very well controlled high blood pressure. I am in great shape but it is due to bad genetics. I have been on meds since I was in my early 40s and my blood pressure is very well controlled. I monitor it very closely and see my doc every 6 months. Also, the meds I am on are NOT contraindicated for diving or any other physical activity. My doc has me on absolutely no physical limitations.

On the standard medical form, I would have to select YES for high blood pressure given how most of the forms are worded. I would then either not be able to dive or have to provide a medical clearance signed by my doc. To get the medical clearance I'd have to jump through the hoops to have my doc complete that each and every year. Could I do that? Certainly. However, I refuse to do so. I am under absolutely no limitations from my doc and that is all I need to know. He knows I am an active diver and very much supports and encourages that as well as all of my other physical activities (biking, lifting, hiking).

Any operator that would require me to complete a full medical is, in my opinion, over-steeping the boundary between their need to know and my privacy. Asking me to confirm that I am fit to dive is fine. I am happy to sign off on that because I know for a fact that I am. But asking me to provide a full medical form is overreach. That is my personal opinion. YMMV. I will never use an operator that requires a full medical. I would only reconsider that position if this became standard practice in the locations that I do all of my diving. IF that were to occur, I love diving enough that I would probably acquiesce. However, given where I do all of my diving, I do not anticipate that happening.

 

[tursiops]

The topic of dive shop medical questionnaires for dive trips (rather than dive courses), and the extent to which people deem it morally obligatory to fully disclose truthfully in accordance to the questions on some of the more intrusive ones, have long been contentious issues on ScubaBoard. It draws on quite a range of perspectives and values. I'll try to illustrate that. My comments are only regarding adults. This is long-winded, but these themes are worth explicit description.

1.) Customer informed consent. The belief participants in an activity ought to be informed of reasonably foreseeable substantial risks they might not reasonably be expected to know. If you are a diabetic with poor glycemic control and often hyperglycemic (high blood sugar), and during the dive your body expels more water than usual via induced urination, might that raise your blood sugar and impair your mental capacity? If you have an asthma attack at depth, you can't call for help and body can get you an inhaler; panic could get you killed.

While no dive operator can spoon feed you every conceivable risk, it's reasonable to point out diving presents special demands that can exacerbate medical risks.

I think we all agree with 1.).

2.) Dive Op. informed consent. The guide is likely dive master or instructor credentialed and trained to handle common and even some uncommon problems of dealing with a group of fairly healthy divers. He's not trained to monitor a 350-lbs hyperglycemic diabetic who started the dive with a glucose of 400 then peed a lot, and now on dive #2 might be a little stuporous...

Just how much right the guide, and the dive op., have to restrict services from/discriminate against (depending on your point of view) divers with various problems, and to what extent they're obligated to be 'reasonable' (whatever that is) in this, is controversial.

I think we'd all agree they have a legitimate interest. Some of us might not agree on case-by-case examples.

3.) Personal autonomy. When a risk exists, whose right is it to make the call whether you can dive or not? If you believe it's your moral right, you favor 3.). You might still discuss concerns with a physician, etc..., but at the end of the day, you will decide whether to dive or not.

Some of us, including me, favor 3.). In the current state of the dive tourist industry, the only way you can keep the decision yours rather than the dive op.'s, their insurance company or a physician (e.g.: medical release letter) is to maintain secrecy that you have a medical condition.

There's controversy here. Many of us would criticize that hypothetical diabetic for putting the guide and other divers at risk, but consider someone with mild to moderate hypertension well-controlled with medication to be fine.

4.) Paternalism. This is where insurance companies and fear of lawsuits come in, but there are other people who think like this. If a certified adult diver has a medical condition creating moderate risk, has opportunity to consult a physician or what-have-you, is of informed decisional capacity and wants to dive anyway, should a dive op. knowingly let him do it? Or is there a paternalistic 'duty of care' to refuse service?

To avoid the 'get the guide in trouble and cut everyone's trip short with your rude medical crisis' boat trip argument, let's say our guy is solo shore diving in Bonaire (or his buddy knows the situation and agrees).

I say 'no.' I might relent in the most glaring of cases (where the dive sounds like literal suicide), but strongly prefer letting adults be adults.

This is not unlike the discussions over efforts to close some Florida caves to diving to save people from themselves, after someone dives recklessly and dies in one. If the lives of consenting people who act fools (in others' judgment) is the price of freedom to enjoy recreational diving for others, is that okay?

This is contentious. The insurance companies, and fear of getting sued, are about risk mitigation for companies, not concern for the diver. A form with everything checked 'no' shields from them from being shown knowingly complicit in providing services to people at heightened risk. That's not absolute protection from lawsuits, but it's a nice thing to have!

5.) Gatekeepers. This is sort of the opposite of 3.) and another version of 4.). If you have a medical condition, and it's not of such nature and severity as to be a clear cut contraindication to diving (e.g.: not poorly controlled epilepsy), are you morally obligated to submit to the judgment of a medical professional as to whether you can dive (as opposed to just using his advice to inform your decision)?

Some people are 'rule followers' by disposition, and deferential to perceived authority figures. Some are more skeptical and need to be personally persuaded the imposition on their perceived rights is justified, and the exercise of authority is wise.

6.) Utility. Let's say you have a history of mild to moderate hypertension, well-controlled, and you've spoken with a physician before, maybe had a medical clearance before, nothing's changed and yet the dive op. policy is clearances are only good for a year. You know you can get another letter...and have to make an appointment, pay a co-pay, basically jump through hoops for an over-reaching bureaucratic demand rather than a legitimate health concern.

Do you feel bound to honor that?

7.) Perspective - old adage 'Where you stand on an issue depends on where you sit.' I'm a recreational diver. I have no professional credentials and don't train divers or conduct dives. Those who do may have their view influenced by perspectives I can only imagine.

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They say those who don't learn from history are doomed to repeat it. These medical questionnaire threads are a case study in that. Experience teaches we won't all agree on this. I tried to be fairly objective covering the concerns.

I would prefer that someone else's medical issues do not impact negatively on my diving and dive trip. Some of that is unavoidable, but some comes from ego-driven lying about one's health. That crosses my line, when you purposely affect me negatively.

 

[tursiops]

On the standard medical form, I would have to select YES for high blood pressure given how most of the forms are worded. I would then either not be able to dive or have to provide a medical clearance signed by my doc. To get the medical clearance I'd have to jump through the hoops to have my doc complete that each and every year. Could I do that? Certainly. However, I refuse to do so. I am under absolutely no limitations from my doc and that is all I need to know. He knows I am an active diver and very much supports and encourages that as well as all of my other physical activities (biking, lifting, hiking).

The current form asks if you have high blood pressure; it does not ask if you have high blood pressure if you are unmedicated. Reading the form narrowly, rather than trying to read too much into it, you could comfortably answer you do not have high blood pressure. Also, the HBP question is only applicable if you are over 45. the form is all about risk factors -- not YOU specifically -- and it is the age plus HBP that is the issue, not just one of them alone. It is much better than the old form, which asked "High blood pressure or take medicine to control blood pressure?" to which a Yes meant a required doctor's signature.

 

[ThatDogDontHunt]

I would prefer that someone else's medical issues do not impact negatively on my diving and dive trip. Some of that is unavoidable, but some comes from ego-driven lying about one's health. That crosses my line, when you purposely affect me negatively.

I agree with the sentiment, but also realize it is a silly practice.

Would anyone be happy to require everyone boarding an airplane submit a medical questionnaire that could be examined by the gate attendant so that you will not be inconvenienced by the heart attack in 4f?

Should we also require it on public transit? When I lived in the big city, subway delays due to "a medical emergency" were routine weekly occurrences. If the ticket taker had been empowered to invasively question and screen all passengers then this could have been prevented and my rides would not have been interrupted.

This could also be extended to activities like night clubs and local pickup hockey. And the golf course.

My obtuse point is that there is an infinite number of daily activities that this concept could be applied to. If it is good for scuba then it is also good for all of these?

Scuba is not that special. Why do we think it requires (or are willing to put up with) special rules?

 

[mcohen1021]

It's been a really long time since I've seen the medical form to be honest

 

[boulderjohn]

The practice or requiring medical statements for diving is relatively new, but it is a growing practice. I was in Cozumel in June, and I had to submit one. I had to submit one for cave diving in the Yucatan. The only real concern I have about it is when they spring it on you without warning. If you live in the USA, it is hard to get a doctor in Mexico to sign off.

It's less common in the US than elsewhere. Australian dive ops ask for a completed medical form, if I recall

Before we went to Australia (about 6-7 years ago), we were warned over and over and over again on the threads in the Australia section that medical forms were absolutely required in Australia. We were diving with two different operations while there, and we brought two copies each. Neither of them required it. In one case, the DM who took our information looked at our forms like she had never seen one before. "What is this for?" she asked.

All I want from a boat is a ride to a location I give them, and for them to swing on the anchor a couple hours while I go do my thing. If I'm not back in 2 hours, call the Coast Guard to recover the body.

What you think a boat is required to do for you and what the law thinks a boat is required to do for you are apparently not the same thing. If there is a fatality, and the boat crew did not do what was required of them by law, not only will they be sued, they will face legal penalties as well.

The nature and consequences of those penalties will vary by location. In the famous case of Gabe and Tina Watson in Australia, the dive operation was fined heavily for failing to conduct a checkout dive for the two prior to the first real dive. In Florida a few years ago, a boat crew was severely punished when a diver died. Among other things, the captain was cited for not personally supervising the diving operations from the deck and not properly training the crew on rescue procedures (and they did botch the rescue).

 

[mcohen1021]

The practice or requiring medical statements for diving is relatively new, but it is a growing practice. I was in Cozumel in June, and I had to submit one.

New since 1989 perhaps. I saw the checklist back then. So I disagree, not new. Maybe RE-newed.

 

[boulderjohn]

New since 1989 perhaps. I saw the checklist back then. So I disagree, not new. Maybe RE-newed.

Well, new to me I guess. I had dived for about 20 years in roughly 35 locations around the world (check my profile) with an uncounted number of operations before I was first asked to provide a medical for diving rather than getting instruction. That was evidently a sheltered existence. Perhaps you could supply the names of some of the places where you have been required to provide a medical statement for diving since 1989.

 

[tursiops]

I agree with the sentiment, but also realize it is a silly practice.

Would anyone be happy to require everyone boarding an airplane submit a medical questionnaire that could be examined by the gate attendant so that you will not be inconvenienced by the heart attack in 4f?

Should we also require it on public transit? When I lived in the big city, subway delays due to "a medical emergency" were routine weekly occurrences. If the ticket taker had been empowered to invasively question and screen all passengers then this could have been prevented and my rides would not have been interrupted.

This could also be extended to activities like night clubs and local pickup hockey. And the golf course.

My obtuse point is that there is an infinite number of daily activities that this concept could be applied to. If it is good for scuba then it is also good for all of these?

Scuba is not that special. Why do we think it requires (or are willing to put up with) special rules?

Argumentum ad nauseum. You can take anything to the extremes and show it is silly. Like drinking water...too much is a medical emergency, so you'd argue don't drink any at all?

If I spend $2k to get to a liveaboard and $3k for the dive boat -- times 2 for me and my wife -- and then the trip gets turned around because some egotistical self-centered idiot refused to disclose a recent heart valve replacement, do I have a right to be upset? You betcha. He was willing to take the risk....but he also had a huge negative effect on 20 other passengers.....did he have that right? He should not have been on the boat. Now, if someone on the same trip -- minus the idiot -- is in great health and never the less has a heart attack, then that's life. He did nothing purposeful to negatively affect me, unlike the idiot.

This is rather unlike your examples. Flying on an airplane is not typically a life-threatening activity, unlike diving. Riding on subways, night clubs, hockey matches.....I'm not out $10k and my week of vacation if something goes awry.