In this episode of The Dive Locker Podcast we discuss when dive professionals can refuse to teach a student with a physician signed medical form.

Welcome To The Show!

Welcome to The Dive Locker Podcast, the podcast for dive professionals where we bring you the latest in diving industry resources that make you excellent at teaching techniques, risk management and dive business.

It is great to have you here. Now since you’re a dive professional you are no doubt using the RSTC generated Medical Statement, the majority of you are at least. So as you know, a student for any certification course must fill out the statement and if there are any YES answers the student must get a physician’s approval to dive and to participate in your class. Sounds pretty cut and dry right? Well not in every situation.

What happens when a student gets a properly signed medical form by a physician but your still not comfortable teaching that student with the particular medical conditions he or she has? What about if the physician writes something in their remarks observations paragraph or attaches a letter or note telling you what the student can or can’t do? Or, what if the student tells you that he or she had to go to several physicians before one would sign it? Hmmm. These are all interesting situations and we are going to go over when you can and should say yes or no to someone that presents a physician signed medical form.

RSTC Diver Medical

So the more teaching experience you get the more medicals are going to pass through you. And the more unique situations with medicals are also gonna pop up. Just so we’re all on the same page you will use the RSTC diver medical form for use with beginner courses and continuing education courses.

This Diver Medical use to be called the Medical Statement. And the most recent revision by DAN, WRSTC, RSTC and UHMS has really made a fantastic change to the way we screen students for fitness to dive. For more on these changes listen to Episode 31 with Dr. Nick Bird as he describes the new medical form.

But sometimes there are issues. Issues that you don’t get a good feeling about. These come in a variety of situations. For example once I had a student who forged his physician’s signature.

Another time a student who had all no’s but then took his shirt off to put on a wetsuit and there was a scar from his throat to the bottom of his abdomen. He had open heart surgery and did not list that anywhere.

So yes, there are some that lie to cover up. You may catch them or you may not. My thing is that I stress repeatedly in my classes the need for absolute truth and accuracy on these forms because there is nothing to see underwater that is worth risking your life over.

So I do everything in my power today to strongly emphasize students being truthful on their medical forms.

When You’re Uncomfortable Teaching a Student With a Medical Condition

But the heart of this episode is what if the student is truthful, gives a positive yes response to a condition and then gets a physician’s signature that allows them to take your class. But you’re not comfortable with that.

Maybe its that the person is presenting signs and symptoms or acting in a behavioral manner that you know will be not only challenging for them or the other student or for you, but more importantly safety becomes questioned. We get challenging students all the time, I’m talking where that student could actually challenge the safety of themselves and or others.

Last year a student presented with severe anxiety and depression – medication for it ongoing counseling and more – the physician signed and then noted scuba diving could be a positive activity for this Patient. I did not feel comfortable with the level of issues this student was presenting to me. So we had a very open dialogue about what she will be going through and how her actions can impact others. She agreed that diving was not for her until she resolved her issues to a more manageable level. She also said her doctor who signed her form loved to dive, thus thought it would be good for the patient. This clearly wasn’t the right thing to engage in.

Now, you say but Tec you’re not a physician how can you question that – are we not to interfere? Well wait a minute, when a student presents a yes, you don’t get to play physician and say “oh you don’t need a physicians signature, that’s nothing”. But you can refuse to accept thus teach a student with a physician signed medical form. You are granted this by certification agencies because you must be comfortable teaching someone diving courses. If your not comfortable teaching someone you must articulate
the reason or reasons why. But you can say no, even if the student has a signed medical.

Strategies for Proper Medical Screening

Now here are a couple other strategies that I apply. First, I consult with Divers Alert Network Medical Line that number is 919-684-2948 put this in your phone. I always consult with them on complex cases. And I also invite the student to contact them as well and talk directly with them about their issues. Many times the medics have been very persuasive and helped a student make the right decision to not take a class OR to see a diving physician.

Which is another strategy. Sometimes I see a clearance to dive signature given by a physician at an urgent care or clinic or pediatrician or family practitioner and I wonder did that doctor actually go to the UHMS.org website to research this students condition as it relates to diving. Because in some cases they have approved someone with a Severe Risk condition.

Now let me explain that and how the doctors are to evaluate the yes answers on the patients medical history.

So if I believe a physician did not really read over the UHMS Diving Medical Guidance Form, then I refer to a diving physician. I have our local ones info ready to give to students. You can find them on the DAN Physician Network. This is great for sending students that you think could benefit from a physician with specialized knowledge in diving, and alternobaric maybe even hyperbaric medicine. So that is another strategy to help a student be properly screened.

And the final strategy that I do, is contact the risk management department of the training agency I’m certifying with. Often, the training agency will give you advice. And in some cases they can assist you when the answer is a NO, They are quick to say let the student be mad at us not you. That is really helpful when you have the agency giving you advice and even supporting your decision. So definitely use the training agency when you have a questionable medical.

What Are Conditionals?

Now what if you have a student with a yes, who gets a physicians signature and approval to dive but that doctor writes on the form or supplements it with a note or letter that gives you instructions? Well, this is called a conditional. And they are normally a no go. But it depends on what the doctor has written. If the doctor writes a note along with approval that says “patient agrees that if symptoms return, he will discontinue diving activities”. Well that is a conversation between the doctor and patient, it is on the patients shoulders to comply with what the physician has said. And it does not impact you , the pro, at all.

On the other hand if the note says, “patient shouldn’t do deep diving” “patient shouldn’t be in water for extended periods” “patient shouldn’t be in cold water”. Well there is no definition for deep or extended periods or cold. What are we talking about. You see, that could change the way you perform your classes. And since we have standards, these conditionals can become problematic for you. So whenever your faced with a conditional feel free again contact your training agency. Their risk management department should be able to tell you if that is a true conditional or not.

Now sometimes a conditional could say diver should not dive past 80 feet. But they are signing up for your Open Water Diver course, your limited to 60 feet on that. So could you do it, well some say yes, some say no. And I lean a little toward the no. Because that conditional exist beyond the divers training with you, but then they are on their own. Will they follow those instructions or not? Most conditionals make me uncomfortable. So again, get some advice from your training agency if you are uncomfortable.

Physician Shopping

And then what if your student tells you they had to see a few physicians before one would sign their form. Oh, why is the question. It could be that no one was comfortable or it could be the policy of some medical practices to not give approvals to dive. So it would be good to find out why and then, utilize the strategies of DAN medics and diving physicians to assist you in the screening process.

ADA

And finally we’ll close with this. ADA, is the Americans with Disabilities Act. They fight for people who have been discriminated due to their physical condition. You might have someone who is morbidly obese, and they receive a yes from their physician. But you are just uncomfortable teaching this person.

If you say no, they might fire back with ADA compliance issues. Again, you should consult with your training agency when your not comfortable so that they can assist you in your decision and keep you out of ADA issues. They would help you state that operationally, you are concerned that you would physically not be able to get the individual out of the pool in an emergency. And the rental wetsuits are not going to fit, and we can’t have you take the class without exposure protection.

There has to be a well articulated message that states these things. Plus, other professionals can come to your defense saying it is not because your morbidly obese, it is because your obesity makes you not fit to dive. Again, going back to that one physician might feel scuba is a nice activity to help someone lose weight and be active. But another physician might understand the multiple risks associated with obesity and diving and be able to make it a medical concern, not an ADA compliance issue.

In Conclusion

So there you have it. You do possess the right as a diving professional to refuse to teach any student. Even students who have received an approval to dive by a physician. But the thing is you want to articulate your rationale, you want to use your resources like DAN’s Medic consults, and DAN Physician Network as well as consulting with your training agency. And especially remember that you must be consistent in the way you handle these situations. Have the same process in place each time so that it does not appear you’re playing favorites.

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Thanks For Listening!

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