Be Honest With Your Diving Doc

by Rosemary E. Lunn

Header image courtesy of DAN Europe

News has broken in the last couple of days that probably one of the most important documents in sport diving has been revised. We now have a new Recreational Scuba Training Agency (RSTC) medical declaration form, and the notes for physicians have been thoroughly reworked too. 

The process has taken three years and involved the likes of Nick Bird M.D., Oliver Firth M.D., the late Professor Tony Frew, Alessandro Marroni M.D., Simon Mitchell M.D., Associate Professor Neal Pollock Ph.D., and Adel Taher M.D..

The resulting document is succinct. The 30+ questions have been cut to 10 with the aim of reducing unnecessary and avoidable referrals, while doing a better job of screening those medical issues truly associated with diving injuries. 

It certainly demonstrates a willingness by the diving doctors and relevant bodies to make this key document work for our global community.

This international collaboration of volunteer diving experts also demonstrates that, in the main, hyperbaric doctors involved with diving are ardent fans of our sport. Probably their most common complaint is that they dive a desk more often than they would wish, but I think we would all say that too. When a patient walks into their consulting room, the last thing they want to do is inform the patient “I am very sorry, but you cannot go diving”. The doctor wants you to leave with a medical that enables you to embrace diving. In rare cases, however, they have ended up signing what is effectively a death warrant, because their diving patient has been less than truthful with them. That’s really not big, clever, or funny. 

Now I can understand divers getting frustrated with their local doctor, a General Practitioner or Family Practitioner when it comes to diving medicine. Although I am not medically trained, I do have a far greater knowledge of diving medicine than personnel at my local surgery. I am not boasting, just lucky I get to work with some extraordinary professionals who have improved my education in this field, and I am a curious cat by nature. I always want to know more. 

“A GP saying you should or shouldn’t dive again ain’t worth squat in most situations. A proper dive doctor that does a dive medical is much more relevant”

Post, ScubaBoard 10JUNE 2020

A classic case in point about the lack of diving medicine education springs to mind. A friend of mine took an unprovoked hit. The chamber medical staff thought he might have an undiagnosed PFO (patent foramen ovule) and recommended that he get this checked out before he thought about recommencing diving. The diver toddled off to his GP and asked to be referred to a cardiologist to check if there was a shunt or perhaps a hole between his right and left atrium. His doctor responded with “what is a PFO”? My friend was aghast. Yup. Scary stuff. So I can understand a diver being a tad reticent about discussing dive medicine with their local doctor. 

This doesn’t give anyone carte blanche to be economical with the truth when consulting their diving doctor though. It can have fatal consequences. We had a tragic case in the UK where a 70 year-old was taking a rebreather class at an inland quarry. 

The Coroner’s Report stated that a diver “was undertaking a `re-breather’ course with an instructor and was diving at Stoney Cove, Stoney Stanton in Leicestershire on the 25 September 2018 when his instructor noticed that something was wrong with the diver. They made an emergency ascent to the surface and attracted the attention of centre staff who immediately pulled the diver out of the water and called the emergency services. Unfortunately, after resuscitation attempts failed, the diver was declared deceased at the scene. He was an experienced diver and had been diving since about 1992.” 

It transpires that the diver had cut short a dive in 2015 because he had experienced breathing difficulties. He had therefore been investigated by a consultant cardiologist for symptoms of immersion pulmonary edema. The conclusion was that the diver should not dive again “not only for the sake of his safety but for the sake of the safety of the rescuer”. The cardiologist confirmed this in writing to the diver’s GP on 27 December 2017. 

However when the diver went for a diving medical on 30 January 2018, he was passed fit to dive by a highly experienced doctor. This was not the fault of the doctor because they worked with the data they were provided with. This doctor is an Occupational Health Physician, a UK Sport Diving Medical Referee and an HSE Approved Medical Examiner of Divers. In other words, a doctor educated in diving medicine. The doctor passed the diver as ‘fit to dive’ for two years based on the information given to them by the diver in the medical questionnaire and the doctor’s physical examination of the diver.  They did not have access to or knowledge of the cardiologist’s letter. 

As a direct result of the diver being less than honest with the truth with the diving doc, he contributed to his own death. 

And then there is one case I remember while I was working in the Red Sea as a fulltime dive pro. I would regularly get to visit Dr. Adel Taher at the Sharm-el-Sheikh hyperbaric centre with potential divers. 

The first thing that is completed on any diving course is the paperwork, and part of that is of course the medical declaration form. It was quite normal for at least one student to need to get a medical signed-off prior to training. 

One morning I took a family to the chamber. The parents and their offspring were due to start an open water course. One of the children had a medical issue. I got lucky because on that particular day the diving doctor on call was a pediatrician. (Dr. Adel does employ some remarkable staff at the chamber). This man wasn’t just a normal child doctor, he was a consultant at one of the Cairo hospitals. A rare thing, and just the combination of medicine expertise we needed in this instance. 

The pediatrician is a kind and knowledgeable man. After examining the child he thoroughly explained in a very gentle manner to the parents that “at this time he could not sign off their child as ‘fit to dive’. However, the good news was that he thought the child would grow out of the condition, and in two to three years the child would be ok to dive. He recommended that at that point, the family consult a diving doctor for a medical.”

The family took me to one side and asked if I could arrange a second opinion because they believed the doctor was incorrect and didn’t know his stuff. I was a bit stunned to say the least. You can’t just pull, as if by magic, a diving doctor who is also a consultant pediatrician out of a hat. This experience has stayed with me, and I have pondered about it over the years. 

In hindsight, I have come to two conclusions, and I could of course be wrong in my private thoughts. Either as a white English family they saw a dark-skinned Arab and were prejudiced in their thoughts, or they saw an Egyptian doctor and considered his training and knowledge to be third world. “What does he know about my child’s condition? How can he think they cannot be fit to dive?”

I was embarrassed and angry, and put in the horrible position of diplomatically explaining to the parents that the diving doctor was not out to ruin their holiday. He was not out to spoil their fun. He was in fact giving the very best advice he could to keep their daughter safe and well. And he gave them positive advice for the future. They just didn’t want to hear any of it. 

Rule of diving: Diving docs are not out to ruin your fun. They also don’t want to sign your death warrant. Just be honest with them and they will keep you as safe as they can. 

Dive Deeper:

RSTC Medical declaration Form

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Dive industry “Fixer,” Rosemary E Lunn (Roz) is Business Development Director at The Underwater Marketing Company. This British firm specializes in providing marketing, communications, social media and event management for the tecreational and technical diving industry. Rosemary is a PADI IDC Staff Instructor, BSAC Advanced Instructor, Trimix and CCR diver. Before moving into the public relations field, she worked as a professional recreational instructor in the United Kingdom and abroad, on History Channel and National Geographic documentaries, and as a safety diver and model underwater.

She established TEKDiveUSA and organised Rebreather Forum 3 on behalf of AAUS, DAN and PADI. In 2008 Rosemary co-founded EUROTEK, the European advanced and technical diving biennial conference. She has organised the last six events: 2008, 2010, 2012, 2014, 2016 and 2018. Roz is a respected and prolific diving author, an Associate Member of the Women Divers Hall of Fame, and an SSI Platinum Diver. She takes an active role in the scuba diving industry and sits on the SITA Board (Scuba Industries Trade Association) and the BDSG (British Diving Safety Group).