Medical form: practical/ethical quandary

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I think the fundamental question is being ignored. Why should diving be different than any other activity that requires decent health to avoid a fatality? Medical questionnaires should not be required at all, IMHO. A driver's license does not require medical certification stating that the holder is cleared to drive on all roads because there is little or no possibility of a heart attack, seizure or other major medical problem while driving and such problems do occur with great regularity. Between summer, 2005, and winter, 2007, a count and evaluation of 49,868 passenger vehicle accidents precipitated by an acute medical yielded the following apparent causes:
Seizure 35%
Black Out 29%
Diabetic Reaction 20%
Heart Attack 11%
Stroke 3%
Other 4%
Google 811219.pdf for further information
 
In fact you can just bring MD signed second page w/o first one.

Maybe yes and maybe no.

I just looked at the PADI medical statement (which appears to be promulgated by RSTC and adopted by PADI). The medical statement includes the questionnaire and has the following statement (emphasis added by me):

You must complete this Medical Statement, which includes the medical questionnaire section, to enroll in the scuba training program.

Most students would not understand that they don't need to complete the medical questionnaire and can simply provide a form signed by an MD. In fact, I would suspect that many instructors (particularly the newbies) would read the form literally and say, no, you must complete the questionnaire. PADI requires it.

Now let's look at some of the questions.

Could you be pregnant, or are you attempting to become pregnant?

Many women don't want to disclose their pregnancy until, say, the third month (and certainly not first to a dive boat operator or instructor). But let's leave that aside on the questionable assumption that a woman one month pregnant or one day pregnant is disqualified from diving. What about the attempting part? Is that not truly invasive of privacy?

Here's another question.

Are you presently taking prescription medications? (with the exception of birth control or anti-malarial)

Ironic on two counts. First, the concern about invading the privacy of a woman (after inquiring about her sex life). Second, some anti-malarial drugs would be far more likely to present issues under pressure than, say, a statin.

Now as to prescription drugs. I was taking Zyrtec (a long-acting antihistamine) when it was a prescription drug. It went generic and went to over-the-counter status (as cetirizine). There was no change in the drug, and there were no medical studies to show its effect on divers under pressure. Yet the answer went from being a YES to a NO on that drug.

The questionnaire asks "Have you ever had" (their boldface, not mine) any of several conditions, including

Frequent or severe attacks of hayfever or allergy?

The answer is yes when I was a child and young adult. I haven't had frequent or severe allergy attacks for 30 years now. But a yes answer earns me a trip to the doctor for medical clearance.

Frequent colds, sinusitis or bronchitis?

My older son used to get colds all the time as a toddler. Twenty years later that disqualifies him from diving without a medical sign-off?

Recreational drug use ... in the past five years?

Recreational drugs, such as marijuana, stay in your system for five years? If the only YES answer is based on my having smoked marijuana once four years ago, I need to get a medical exam? But if I got totally blotto a week ago, it's OK.

On top of the form it says, "Participant Record (Confidential Information)." Confidential? Who says? Are there laws preventing the disclosure of this information as there are with doctors and hospitals (such as HIPAA)? NO! Yeah, sure you can sue someone and maybe win, but at great cost and with uncertain ability to collect.

My point is that the questionnaires are seriously flawed, and we can't change them. We have to deal with the questionnaires as they are, and if they are flawed in a particular diver's circumstances (e.g., once having smoked marijuana in the last five years), then I find no fault in the diver rejecting any "ethical" responsibility to answer an idiotic question intelligently.

I agree that there is a need for beginning SCUBA students to be aware that medical conditions can affect their safety, but the correct approach would be to inform students more accurately of the risks that certain medical conditions pose and not requiring the student to answer each and every question. It would be sufficient to say that any YES answer requires a medical sign-off.

And I certainly don't agree that a dive op needs to ask any of these questions from a certified diver.
 
Maybe yes and maybe no.

I just looked at the PADI medical statement (which appears to be promulgated by RSTC and adopted by PADI). The medical statement includes the questionnaire and has the following statement (emphasis added by me):



Most students would not understand that they don't need to complete the medical questionnaire and can simply provide a form signed by an MD. In fact, I would suspect that many instructors (particularly the newbies) would read the form literally and say, no, you must complete the questionnaire. PADI requires it.

Now let's look at some of the questions.



Many women don't want to disclose their pregnancy until, say, the third month (and certainly not first to a dive boat operator or instructor). But let's leave that aside on the questionable assumption that a woman one month pregnant or one day pregnant is disqualified from diving. What about the attempting part? Is that not truly invasive of privacy?

Here's another question.



Ironic on two counts. First, the concern about invading the privacy of a woman (after inquiring about her sex life). Second, some anti-malarial drugs would be far more likely to present issues under pressure than, say, a statin.

Now as to prescription drugs. I was taking Zyrtec (a long-acting antihistamine) when it was a prescription drug. It went generic and went to over-the-counter status (as cetirizine). There was no change in the drug, and there were no medical studies to show its effect on divers under pressure. Yet the answer went from being a YES to a NO on that drug.

The questionnaire asks "Have you ever had" (their boldface, not mine) any of several conditions, including

Frequent or severe attacks of hayfever or allergy?

The answer is yes when I was a child and young adult. I haven't had frequent or severe allergy attacks for 30 years now. But a yes answer earns me a trip to the doctor for medical clearance.

Frequent colds, sinusitis or bronchitis?

My older son used to get colds all the time as a toddler. Twenty years later that disqualifies him from diving without a medical sign-off?

Recreational drug use ... in the past five years?

Recreational drugs, such as marijuana, stay in your system for five years? If the only YES answer is based on my having smoked marijuana once four years ago, I need to get a medical exam? But if I got totally blotto a week ago, it's OK.

On top of the form it says, "Participant Record (Confidential Information)." Confidential? Who says? Are there laws preventing the disclosure of this information as there are with doctors and hospitals (such as HIPAA)? NO! Yeah, sure you can sue someone and maybe win, but at great cost and with uncertain ability to collect.

My point is that the questionnaires are seriously flawed, and we can't change them. We have to deal with the questionnaires as they are, and if they are flawed in a particular diver's circumstances (e.g., once having smoked marijuana in the last five years), then I find no fault in the diver rejecting any "ethical" responsibility to answer an idiotic question intelligently.

I agree that there is a need for beginning SCUBA students to be aware that medical conditions can affect their safety, but the correct approach would be to inform students more accurately of the risks that certain medical conditions pose and not requiring the student to answer each and every question. It would be sufficient to say that any YES answer requires a medical sign-off.

And I certainly don't agree that a dive op needs to ask any of these questions from a certified diver.

A million times "YES". Finally, some logic has been brought to this discussion.
 
The problem is that there is no other option. Disclosing my medical history to a non-medical person (dive instructor, operator, dive-buddy, etc) is something I am not willing to do. We are left with two choices. Lie or not dive. I choose to lie.



Exactly! It is none of their business. I could just as easily forge a doctor's note.



IMO...Hogwash!! Maybe during initial training getting educated on what medical conditions effect diving and vice versa is important. But not during a random trip where a dive op is doing nothing more than covering their ass. If it is so important to the industry then a medical exam should be required by the agencies to keep your card current. It is not, so the forms are just a weak attempt to shift liability and they know it.



Exactly! And the forms should have a checkbox and sign off to that effect.
I am going to assume that all of you answering that it is none of the dive op's business what your medical history is and that it is okay for you to then lie on your questionnaire are lay people without medical training. Full discloser in that I am a general internal medicine doctor. My perspective is different.

Asking if you have or ever had problems with allergies or asthma is whether or not you have in asthma a condition that might probably disqualify you from diving period. Sinus issues and allergies are well discussed and issues with clearing ears and potential sinus blocks would possibly disqualify you from diving.

Taking prescriptions medications indicate some underlying medical condition. Diving with well controlled hypertension is okay, having a prior history of heart disease is probably okay but might need further testing before clearance is given.

Prior chest surgeries almost always disqualifies a candidate no matter what the time frame or how far in the past.

History of depression or more importantly anxiety and panic would probably disqualify a diver. Ask yourself would any of you like to be the buddy when your partner lied about this and then had a full panic attack under water on their first dive?

Diabetes is a relative contraindication but if you are on insulin in my opinion that should automatically disqualify you. That being said I did know a diver who dives with insulin and an insulin pump. But I personally would have significant reservations clearing a diver on insulin and would personally have that diver consult DAN as a specialist for a second opinion and consult.

Many of the responses also seem to imply that a medical form is an ongoing prerequisite for continued diving. You actually fill it out once just to determine if you are physically fit to start basic Open Water classes. Once you certify it is implied that one, your medical history does not change and two, if it does you may need to recertify based on that medical condition. For example, if you certified many years ago but then in your 50's had a heart attack you are now disqualified from diving for the immediate time after and based on how severe and what type may or may not be able to resume diving.

Those are only some but not a complete list of medical conditions the questionnaire is designed to help identify individuals with health conditions that would disqualify them from even starting to learn how to dive. You need to be aware of these medical issues before you get under water. There are countless threads with questions on the buddy system and one of the overriding principles is how important it is to have clear communication before you do your first dive. Why is this any different?

For those of you who think you know better than a medical profession what is appropriate and what is not it is a little like the blind leading the blind. Sometimes you don't know what you don't know. And you are still going to argue with someone who has much more training, education, and experience that you still know more than a doctor or medical professional.
 
For those of you who think you know better than a medical profession what is appropriate and what is not it is a little like the blind leading the blind. Sometimes you don't know what you don't know. And you are still going to argue with someone who has much more training, education, and experience that you still know more than a doctor or medical professional.

You're sort of missing the point.

I trust my doctor's opinion about whether or not I'm fit to dive, however once he has cleared me to dive, I see no reason to share the specifics of my lifetime medical history with every dive op that happens to want a medical form filled out (and there are plenty of them).

As long as both me and my doc think I'm OK to dive, nobody else has a "need to know" anything specific.

However on the flip side, I've refused to teach a few people who have showed up with signed medical forms, but who looked like I'd have to call 911 just from the exertion of walking into the building, so in that case, yes, I think I know more (or at least have a lower risk tolerance) than at least a few doctors.

flots.
 
So why all those statements? Why do you have to write "yes" or "No" instead of "Y" or "S"? It is related to a concept called informed consent. It is why you have to put your initials next to every clause in almost all liability waivers.

Let's say you take a class with no such requirement. You know you have some health issues, but you don't think they matter for scuba diving. You go diving and learn that they really did matter. You die because of a heath reason, just as my nephew's mother-in-law died after a heart attack while in an AOW class. Your relatives learn that your health issues were the primary cause of death. Your family sues, arguing that a wise instructor should have not allowed you to dive with that health issue. Your family would almost certainly win that lawsuit.

OK, let's move it up a step and make you sign a statement saying that you have no medical issues that will prevent you from diving. You sign it. When you die, the family still sues, arguing you are in no position to decide whether or not your health issue was relevant. You did not provide an INFORMED consent. The family will win.

OK, so to prevent that, the instructor provides a list of issues of concern and has you sign that you are OK to dive. You sign it. When you die, the family still sues, arguing you did not fully read nor understand the list of items. Maybe that's your fault, but they will say that the instructor hurried you and you did not have time to give it a good reading. The family will probably still win the suit.

OK, so to prevent that, the instructor has you write "yes" or "no" next to every item on the list. You clearly see that there are issues, but you don't think it's any of your business, so you write "no." You sign it. When you die, the family still sues, arguing you were under time pressure and wrote it without giving it proper thought. In a case I mentioned earlier, the plaintiff argued that the liability waiver that was signed was not valid because it was signed the same day as the class. The student should have had time to take it home consider it carefully, and even consult with an attorney. Now your family is getting less and less likely to win, but it is still possible.

OK, so to prevent that, the instructor has you take it home ahead of time, take whatever time is needed to consider, and write "yes" or "no" next to every item on the list. You clearly see that there are issues, but you don't think it's any of your business, so you write "no." You sign it. When you die, the family still sues, arguing you were under time pressure and wrote it without giving it proper thought. In a case I mentioned earlier, the plaintiff argued that the liability waiver that was signed was not valid because it was signed the same day as the class. The student should have had time to take it home consider it carefully, and even consult with an attorney. Now your family is very unlikely to win any case whatsoever.
 
It is wise to consider the content of the form and, if you have issues leading to checking a 'yes,' to consult with your personal Physician to learn what your relevant risks are for diving, if any, and what, if anything, can be done to mitigate those. So if you believe the purpose of the questionnaire is to alert you to potential risks of scuba diving, you can take advantage of that opportunity without checking yes on the form.

So, let's say you take this form to your Physician, and having been educated about and having considered the issues. you decide that you are fit to dive within a reasonable margin of safety, by your standards. Maybe your Physician agreed, and maybe he/she did not (after all, gotta keep those malpractice suit risks down, right?). Regardless of whether your Physician thinks you should dive, you think it's reasonable for you to do so, and you want to.

At this point, the decision is up to you. Not your Physician. Not the charter boat dive op. Not some random insta-buddy on a dive boat. You.

If you show up at a charter boat op. and you check 'Yes' on a question, though, you forfeit being able to make that decision yourself. Now, you've got to have a Physician's letter. Signing such a thing will transfer a burden of liability onto the Physician (likely not a diver), who has a vested interest in protecting himself from taking on avoidable liability. So he may not do it. And the dive op. can now easily refuse you service.

So, if you check 'No' to everything, you retain free will to make your own decision, and you have the option to consult a Physician and make it an informed one.

If you check 'Yes,' you give other people the option to veto your free will-driven choice.

Richard.
 
You're sort of missing the point.

I trust my doctor's opinion about whether or not I'm fit to dive, however once he has cleared me to dive, I see no reason to share the specifics of my lifetime medical history with every dive op that happens to want a medical form filled out (and there are plenty of them).

As long as both me and my doc think I'm OK to dive, nobody else has a "need to know" anything specific.

However on the flip side, I've refused to teach a few people who have showed up with signed medical forms, but who looked like I'd have to call 911 just from the exertion of walking into the building, so in that case, yes, I think I know more (or at least have a lower risk tolerance) than at least a few doctors.

flots.
How do you know they didn't lie on their health forms then didn't lie about their fitness to the doctor!
 
I just checked with PADI Training. You do NOT need to fill out the medical questionnaire if you provide a doctor's signature on page 2 of the form. The purpose of the medical questionnaire is to allow the instructor to decide if you need to get a doctor's signature. Received from PADI today:

Thank you for your inquiry and the opportunity to assist you. The purpose of the RSTC Medical Statement is to determine if the student is required to obtain a physician’s clearance prior to participating in any dive training activities. This is determined if they answer “Yes” to any of the questions on the statement. If your student provides you with a medical release signed by a physician indicating he is fit for diving, then it’s not necessary to have him also complete the Medical Statement since he’s already received a release by his physician.

Best regards,

 
It would be really nice if the medical questionnaire had a space for previously cleared with either "no change in condition" or "historical information only" that would negate the need for a new physical.

Since I have gotten positive feedback from some of the more respected medical people on SB for this idea how do we go about petitioning RTSC for a change in their form?
 
https://www.shearwater.com/products/swift/

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