PADI medical statement form
Hi.
I am a resort physician in the Maldives. Included in my job description is to conduct a diving medical exam on guests who have a pre-existing medical condition/s.
I fill-up the PADI recreational ScubaTraining Council medical Statement Form, wherein it indicates the Physician's Impression. there are 2 boxes:
- I find no medical conditions that I consider incompatible with diving
- I am unable to recommend this individual for diving
In addtion to this is a space for Remarks, and then the Physician's name, address, and signature, and date of examination.
It has been my practice to write as side notes the past medical history of the patient and examination findings.
For instance, A 30 yo, male, had a history of disc herniation and underwent a surgical procedure for this two(2) years prior to his consultation with me. He has no residual neurologic conditions at the time of evaluation with me, and he claimed to have no pain. After history taking and examination, I tick the first box and write on the REMARKS space my recommendation: may go on diving but will have to wear or don the diving paraphernalias (oxygen tank in the water/sea). At the same time explaining to the patient this endorsement.
Lately, I have been questioned by a dive center manager of why I have to write on the remarks space such a recommendation when a guest has a pre-exixting condition that may or may not have complications with the diving activity. She has pointed out that i should not write on the remarks space. She implied that it should be a fit to dive and not fit to dive recommendation only. No other notes should be recorded on the form.
I have converged with other resort physicians in the Maldives. This procedure of filling-up the diving medical forms is being done.
In reference to this incident, I am inquiring from you, since you are more experienced and updated on diving medicals, if there is a protocol that i should follow regarding filling-up the medical statement form.
Regards,
Dear colleague,
I agree with you that in specific cases, there may be good reasons to add individual advice regarding diving circumstances / limitations. However, PADI has stated that no 'conditional medical statements' should be accepted by its members. Possibly, this is why the resort manager is asking you to refrain from including any remarks.
From the PADI Europe training bulletin 2007 / 02:
----------
Conditional Medicals
Q: Can I accept a medical form when the physician gives approval for the person to dive with a depth limitation?
A: No. The medical form must not impose any restrictions on the diver. The physician gives approval by marking the box on
the form next to the statement “I find no medical conditions that I consider incompatible with diving.” If the doctor
adds a comment that the diver must not exceed a certain depth, it becomes a “conditional” medical and, therefore, is
unacceptable.
-----------
My solution is to include all individual advice regarding a diver in my own administration and to provide the diver with a personal written summary, but to fill out a medical form without remarks. I explain to the diver why I'm not including the remarks on the form.
Best regards,
Peter
Diving Physician, the Netherlands / PADI instructor
Hello Peter,
Would that approach make you venerable to litigation? If you have a depth restriction (for whatever reason) then you have found a condition that is incompatible with diving (to depth).
PADI wants the doctor to take the responsibility of 'certifying' the diver as 'fit to dive' but my personal approach is a risk management strategy for passing medicals. If PADI will not accept the conditional diving medical then that is there problem not yours.
Regards Glen
Hello Glen,
The quote from the training bulletin was just to reference an official PADI statement regarding conditional medicals in general. Depth limitations are indeed rarely appropriate in a diver somehow otherwise 'fit to dive', although I can maybe think of a few exceptions if I put my mind to it.
To the best of my knowledge and at least in our law system, if you sign the medical statement form without remarks for administrative (PADI) reasons, but include restrictions / advice in a separate medical record file with a note that these were discussed with the diver, this will hold up in court just fine if the diver decides to do otherwise and suffer consequences. Of course, I am happy to add that I do not have practical experience with such a lawsuit.
Regards,
Peter
Hi Peter,
Would make for an interesting legal case I am sure......not sure we would win in Australia but then again thats not necessarily a reflection of sensible legal practice in this country.
Regards Glrn
Hi Neives,
I absolutely agree with Glen. The dive trainers would love this issue to be black and white, but of course it is not. I think your approach is fully justified. You write those notes as you see it and it is up to the dive training organisation to decide if they want to train the diver. That is not your job.
The alternative is that they refuse to train anyone who answers positively to any question on the RSTC - and cut you out of the equatuion completely. This is clearly not in the divers interests, or theirs. What the dive operator is trying to do in fact, is get you to assume all the medical risks of saying 'YES' when you really mean, "YES, but under the following circumstances..." perhaps you should have a beer with them a sort out a compromise that you are both happy with.
Mike Bennett
Hello Nieves,
There are two issues here:
1) Patient confidentiality
2) Risk Assessment and making the patient aware of the risk.
I think you are covered for the first point by the person making the request for the medical giving implied consent for the information. I would suggest that anything added to the medical should be strictly related to the diving (which you seem to have done) and thats what the remarks section is for.
The second point is that if you have made the person aware and put it in writing then the risk switches from you to the person you are advising. If they fail to follow your recommendations and hurt their back then thats their issue not yours.
As for the Dive Centre Manager making the comments 2 things: 1) The medical should be independant of the diving commercial aspects (ie don't pass people fit just so they can do a course when they are not fit) 2) She should not be interfering with how you do the medical in the first place. She is not qualified to pass judgement on how you do diving medicals.
I would suggest that you politely explain that you don't tell her how to run her diving operations and she should not interfere with you doing your diving medicals.
Regards Glen
Thank you Glen.
Best Regards,
Nieves