Thank God we insist on a medical [Archive]

Andy Wade

23-11-2004, 22:14

:=Prior to BSAC ditching dive medicals in fovour of self assessment our branch experienced new members who had medical problems picked up on dive medicals which meant they couldn't dive. As a consequence when BSAC went over to self assessment our branch voted to keep the medical for new divers. Thank god we did because we have had 2 people fail the medical since, both for high blood pressure. The second one, last week, was so bad his doctor sent him straight to hospital. He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.
:=Not only am I thankful for those 2 people who will now live longer as a consequence but also for all my members who will not have the probability of dealing with a life threatening incident whilst diving.
:=Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think
:=
:=Derek Perry
:=D.O. Kensington Cosmos S.A.C.

Question 1:

Have you suffered at any time from diseases of the heart and
circulation including high blood pressure, angina, chest pains and palpitations?

Now if their blood pressure was so bad they needed to be sent straight to hospital, can they honestly put their hand on their heart and say they have had no warning symptoms?

I know someone who had a heart attack, and was told after an ECG at the hospital that it was probably his third attack.
He had never noticed any symptoms of the first two attacks.

I've also had high blood pressure but I had no inkling of it until a recent medical exam.

.

Martin

23-11-2004, 22:36

:=Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think

No. I don't think so. these two may well have made fantastic divers. They may have enjoyed it, and may have been assets to your branch. Granted, they have high blood pressure, but then a very, very large portion of the population do.

The big problem with the medical system is that it does not have a box which says "THe doctors says I would be at HIGHER RISK of an adverse incident whilst diving, but I wish to ignore that advice and dive anyway."

In my opinion, it is not for a parenteral medical system to decide who may and who may not dive. It is for the system to advise them such that they may make a decision. It would then for the insurance companies to risk assess them, and if they were 'un-insurable' then it is up to the individual whether they wish to take on the personal liability.

I would rather that, than have people telling porkies on their forms, and there are a large number of folk out there who are telling porkies on their forms, I am certain!

IMO, your branch is wrong to 'insist' on a full medical. however, they would be well within reason to 'recommend' it.

Get a grip. Yes, they 'might' have dropped down dead on a dive trip. someone did on a trip I was running last year. he could, however, have died doing something he really enjoyed, after a fab dive, or he could die walking down the high street, or in the car on the way to work.......... The Procurator Fiscal's enquiry is a lot of stress, though.

Khaled Alwassia

24-11-2004, 05:21

Derek,
There are many ways at looking at the situation, in my opinion the fact that your club picked up 2 persons with medical problems is a very strong argument for the full dive medicals. I am for example am not medical trained to a level which would allow me to judge any of the questions answer with any real certainty.
I have had to assist on live threatening resuces and again agree with you that doing any and everything to NOT expose club members to such an event, especially if one is unsucessful, is the way to go.

On the other hand it may be an idea to conduct realistic risk assessments and come up with specific dive restrictions for the different medical conditions.

If we go back about 10 years we will remember that many more medical conditions resulted in a outright disqualification.

Medical sience has progressed since then and we know today that it is acceptable to dive dispite certain medical conditions as long as we follow the special guidelines developed for such cases.

Having made now an agrument for both sides I think that a yearly medical is a good thing for anyone, even non divers. My brothers Lukemia was pick up during such a yearly medical.

Like always prevention is better than finding a solution but do we need to be so rigid when looking to prevent any and everything?

Well that are just me thoughts.

Khaled

derek perry

24-11-2004, 05:40

He queried with the doctor that he didn't feel unwell, or have any symptoms. The doctor has told him that he wouldn't have any particular symptoms and that he may not have had any at all until the day he dropped dead.
Secondly
Another reason we kept medicals was for exactly what you are suggesting. That someone lies on the form. A very good reason for keeping the medical!!!!!!!!!!
It might cover you legally but you might still be put in the situation of rescuing that person at a later date.

Derek

:=Prior to BSAC ditching dive medicals in fovour of self assessment our branch experienced new members who had medical problems picked up on dive medicals which meant they couldn't dive. As a consequence when BSAC went over to self assessment our branch voted to keep the medical for new divers. Thank god we did because we have had 2 people fail the medical since, both for high blood pressure. The second one, last week, was so bad his doctor sent him straight to hospital. He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.
:=Not only am I thankful for those 2 people who will now live longer as a consequence but also for all my members who will not have the probability of dealing with a life threatening incident whilst diving.
:=Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think
:=
:=Derek Perry
:=D.O. Kensington Cosmos S.A.C.

Question 1:

Have you suffered at any time from diseases of the heart and
circulation including high blood pressure, angina, chest pains and palpitations?

Now if their blood pressure was so bad they needed to be sent straight to hospital, can they honestly put their hand on their heart and say they have had no warning symptoms?

derek perry

24-11-2004, 05:59

It seems to me that your argument is based on the fact the 2 people are no longer diving and that we have lost assets to the club, rather than probably saved their lives.
My argument is that
1/ we have 2 very grateful people (Their words) that due to our policy will live longer and happier lives, all be it maybe without diving. As for being assets to the club, what does that matter when you are talking about someone?s life?

2/ my members have not been put in the possible position of having to rescue these people.

3/ you seem to under the impression that we won't now let them dive. Not true.
We do not ban these people from diving. It is their choice. The first chose not to continue diving and the second is hoping to return to diving once his condition is under control and diving referee permits.

I feel it is you that needs to 'Get a grip' as you seem more concerned with peoples enjoyment and the fact we have stopped them enjoying diving than actually taking a realistic look at life and it's risks. Life is actually more important than diving (though my wife would argue I don't really think that way)

2 very grateful people is all the argument I need to convince us we are right.

Derek

:=:=Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think

No. I don't think so. these two may well have made fantastic divers. They may have enjoyed it, and may have been assets to your branch. Granted, they have high blood pressure, but then a very, very large portion of the population do.

The big problem with the medical system is that it does not have a box which says "THe doctors says I would be at HIGHER RISK of an adverse incident whilst diving, but I wish to ignore that advice and dive anyway."

In my opinion, it is not for a parenteral medical system to decide who may and who may not dive. It is for the system to advise them such that they may make a decision. It would then for the insurance companies to risk assess them, and if they were 'un-insurable' then it is up to the individual whether they wish to take on the personal liability.

I would rather that, than have people telling porkies on their forms, and there are a large number of folk out there who are telling porkies on their forms, I am certain!

IMO, your branch is wrong to 'insist' on a full medical. however, they would be well within reason to 'recommend' it.

Get a grip. Yes, they 'might' have dropped down dead on a dive trip. someone did on a trip I was running last year. he could, however, have died doing something he really enjoyed, after a fab dive, or he could die walking down the high street, or in the car on the way to work.......... The Procurator Fiscal's enquiry is a lot of stress, though.

John Williams

24-11-2004, 07:47

He queried with the doctor that he didn't feel unwell, or have any symptoms. The doctor has told him that he wouldn't have any particular symptoms and that he may not have had any at all until the day he dropped dead.

I trust that the GP has now been changed!

If you go to a Doctor complaining of "unwell" then the *Standard* tests should have been carried out ...including a Blood Pressure Test.

There is no way that this symptom can be misinterpreted. You either have high blood pressure or you dont. The fault here probably lies with not doing the test in the first place!
(and if it does not then I apologise to the GP - but point out that if there was no problem during routine health checks there was no reason to expect it to be picked up in a Sports Medical either - the fact that it was is merely coincidence).

Things like High Blood Pressure should be screened for during "Well Person Clinics" which every UK citizen is invited to attend periodically (more often if at risk for any reason).

With the current emphasis on the way that Heart Desease is crippling the nation things like BP are high on the list of things GPs are being asked to check. They do not even need to do it themselves...they have competent practice nurses to do it for them!

The move to self-cert assumed that:

1) Competent GPs would pick the things being asked about on the form

2) Sensible people attend GP clinics for an "annual service" when invited to do so (rather than simply waiting for something to go wrong - as a diver who presumably gets your DV services regularly I KNOW that you understand that being alive to go diving is just as important as having kit that works!)

Perhaps there should be a box on the form that says "Have you had all regular health checks that your GP has requested in the last 5 years?"

With a requirement to go get up-to-date before the self-cert can be signed.

About the lying...that is a training/education issue for you and your branch to tackle (not a responsibility that you should dodge)

What was PROVED before we moved to self-cert was that GPs with little or no knowledge and training in Diving Medicine used to get medicals wrong. The self cert system allows them to revert to their areas of expertise by screening for the simple things that show warnings. And then they refer to a specialist - just as they would refer to a diabetes/heart/kidney/orthopaedic/etc specialist if they found something that told them to do that.

By "insisting" on a full medical - you are forcing people proved to be ignorant of the specialist issues to make a judgement in an area they are not usually qualified or competent to do so in (and this is not fair on the GP - or the patient). You would not expect your GP to manage renal failure for you would you? There are far more people out there who have been referred to the care of Renal specialists than there are, or ever will be, divers (healthy or not). Why expect your GP to have expertise in an area of medicine that he has less experience of than others he refers?

I trust that you are medically qualified enough to gainsay the entire UK Sports Diving Medical Committee before making such proclamations within your branch?

John

Nigel Hewitt

24-11-2004, 09:41

He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.

You're kidding yourself trying to justify a position that is wrong by appealing to non-evidence. You are using emotive words and going against the medical advice. This is politician speak. From the title onwards you are using verbal tricks.

Why should he die on your dive? High blood pressure doesn't kill people suddenly blocked cardiac arteries do. When did you last have an angiogram? I went diving the weekend before my heart attack and it was a good dive. Even climbing the ladder with 40Kilos of twinset.

Now I have medicals every year, there are lots of boxes on the form I can't tick now. You're the kind of person that would say "Heart attack? It's obvious you can't dive." Well surprise: It isn't.

nigelH

martin

24-11-2004, 09:47

I think it would be somewhat interesting to get a survey done of all the branches to find out what policies they are implementing. Frankly, some of them seem to be laws unto themselves. At the very least, it become obvious that branches need better education about the new medical system, it's validity and use.

:=He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.

You're kidding yourself trying to justify a position that is wrong by appealing to non-evidence. You are using emotive words and going against the medical advice. This is politician speak. From the title onwards you are using verbal tricks.

Why should he die on your dive? High blood pressure doesn't kill people suddenly blocked cardiac arteries do. When did you last have an angiogram? I went diving the weekend before my heart attack and it was a good dive. Even climbing the ladder with 40Kilos of twinset.

Now I have medicals every year, there are lots of boxes on the form I can't tick now. You're the kind of person that would say "Heart attack? It's obvious you can't dive." Well surprise: It isn't.

nigelH

iainmsmith

24-11-2004, 12:05

Why should he die on your dive? High blood pressure doesn't kill people suddenly blocked cardiac arteries do.

Cerebro-vascular accidents (strokes and transient ischaemic attacks) can and do kill...especially if they happen underwater. High BP is often associated with those conditions which do increase the risk of a heart attack. If someone is asymptomatic, they may well not realise that they are at risk of such.

When did you last have an angiogram? I went diving the weekend before my heart attack and it was a good dive. Even climbing the ladder with 40Kilos of twinset.

Now I have medicals every year, there are lots of boxes on the form I can't tick now. You're the kind of person that would say "Heart attack? It's obvious you can't dive." Well surprise: It isn't.

Now who is being emotive? I'm the sort of person who would say, "Heart attack...what does the medical referee say?"

IMO, the old-style medical's major benefit was a public health benefit, in that it actually made people go and see their GPs...something which men especially are particularly bad at. I do, however, know of a further example of a relatively young person who had an unsuspected condition picked up due to a compulsory medical which, after further investigation and referral, resulted in a decision that they should not dive.

Iain

iainmsmith

24-11-2004, 12:15

:=He queried with the doctor that he didn't feel unwell, or have any symptoms. The doctor has told him that he wouldn't have any particular symptoms and that he may not have had any at all until the day he dropped dead.

I trust that the GP has now been changed!

John,

Would you care to state your medical education and the qualifications which allow you to question the professional competence of a doctor?

If you go to a Doctor complaining of "unwell" then the *Standard* tests should have been carried out ...including a Blood Pressure Test.

You will, however, note that the individual in question did NOT have symptoms and did NOT feel unwell. This is a very common situation - people are often unaware that they have a high BP unless it is found in passing or at a routine medical. There is, however, no obligation whatsoever for anyone to have a routine medical - it may be advisory, but there is currently no requirement to attend. This is where the old system did have an advantage - one _had_ to have a medical done.

The move to self-cert assumed that:

1) Competent GPs would pick the things being asked about on the form

If you have no reason to go to the doctor, they don't have the opportunity to see one. I certainly don't see my GP annually. There's nothing wrong with me, so why would I waste his time? Maybe as I get older, I'll become more concerned that there might be something going on that I'm not aware of, but after seven years of pre and post-graduate medical education, I'm rather more aware of the sorts of things that can creep up than is Joe Public. Then again, I'm entirely human enough to acknowledge that if I don't feel unwell, I'm unlikely to make the effort to see a doctor (and part of me would regard it as wasting his time if I feel well)

2) Sensible people attend GP clinics for an "annual service" when invited to do so

Bit of an insult to the huge number of people who don't. As an example, diabetes and hypertension are both much widerspread in the population than most people realise, specifically because many perfectly sensible people _don't_ go to their doctors for an "annual service" because they feel well.

Perhaps there should be a box on the form that says "Have you had all regular health checks that your GP has requested in the last 5 years?"

I have. My GP has requested precisely none.

About the lying...that is a training/education issue for you and your branch to tackle (not a responsibility that you should dodge)

I agree that honesty on these forms should be encouraged, but you're deluded if you think that individuals will not continue to persuade themselves that, "Actually, it's not that big a deal - it doesn't cause me any problems - that question doesn't _really_ apply to people like me - it's for those who are _really_ unwell." and mark the box accordingly.

What was PROVED before we moved to self-cert was that GPs with little or no knowledge and training in Diving Medicine used to get medicals wrong.

Please cite your evidence for the above statement. If you are referring to the paper by Glen et al, refered to in the FAQ regarding self declaration on the BSAC website (full text at: <a href="http://bjsm.bmjjournals.com/cgi/content/full/34/5/375" >http://bjsm.bmjjournals.com/cgi/content/full/34/5/375</a>), it showed nothing of the kind. It showed the in the sample population of 2962 individuals, "no signficant unexpected abnormalities were found" which would not have resulted in "required further investigation" by questionnaire.

You might like to consider that individuals involved in a study are more likely to answer honestly than if they know that a particular response is likely to put a halt to their diving (albeit temporarily).

You might also like to consider that asymptomatic but serious conditions are relatively uncommon. Glen et al do not discuss the ability of the questionnaire to detect such in this small minority.

The paper's conclusion (for those who have completely misunderstood) were not that GPs were getting it wrong, but that an annual questionnaire would be as effective in picking up conditions requiring further investigation/referral.

However, what everyone needs to remember is that nothing in medicine is absolute. We have had two examples cited in this thread where the questionnaire fell down. I know of a third.

The self cert system allows them to revert to their areas of expertise by screening for the simple things that show warnings. And then they refer to a specialist - just as they would refer to a diabetes/heart/kidney/orthopaedic/etc specialist if they found something that told them to do that.

Oh dear. I think you may wish to offer an apology to the largest specialty in medicine. GPs deal with an awful lot more than "the simple things".

By "insisting" on a full medical - you are forcing people proved to be ignorant of the specialist issues to make a judgement in an area they are not usually qualified or competent to do so in (and this is not fair on the GP - or the patient).

As above, if you're going to question the competence of an entire branch of the medical profession, please cite your evidence.

You would not expect your GP to manage renal failure for you would you?

Who do you think normally manages it? Who do you think normally manages high blood pressure, diabetes, arthritis and a host of other conditions.

Why expect your GP to have expertise in an area of medicine that he has less experience of than others he refers?

The GP was never required to make an absolute decision regarding fitness to dive - the guidance was available in the notes supplied with the form, including the occasions when referral to a specialist was indicated...not unlike every other medical condition that presents to them!

I trust that you are medically qualified enough to gainsay the entire UK Sports Diving Medical Committee before making such proclamations within your branch?

I think you need to be very clear on what the UKSDMC's rationale was, not what you think it was. From their website (with my comments in square brackets):

"The current system has faults. The medicals are rarely performed by doctors with diving medicine expertise [but UKSDMC guidance was available and, if in doubt, referral could be made], and have little predictive value for the future. You are really being certified fit to dive immediately after being seen by the doctor, and the best guess is that you probably will not run into problems for the next 1, 3 or 5 years depending on the type of certificate issued"..."The routine medical examination added little [to the questionnaire]"

As you suggest above, what the questionnaire in its current form does not do is ensure that people have actually seen a doctor since they last filled it in. Hence they may well be unaware of conditions which have developed/progressed since their previous assessment.

Iain

edward haynes

24-11-2004, 13:00

Derek

I was around during the debate on medicals and from what I can remember one of the biggest *drivers* was the cost.

Now we can spend thousands on kit, but the ?30 (at the time) for a medical, that could last 5 years was being sited by ex-members as the reason they were leaving and joining SAA who had switched to self-declaration.

It was (and probably still is) a factor prospective members consider when checking diving out.

Not PC, but it's the real world.

Edward

will swift

24-11-2004, 13:28

He queried with the doctor that he didn't feel unwell, or have any symptoms. The doctor has told him that he wouldn't have any particular symptoms and that he may not have had any at all until the day he dropped dead.
Secondly
Another reason we kept medicals was for exactly what you are suggesting. That someone lies on the form. A very good reason for keeping the medical!!!!!!!!!!
It might cover you legally but you might still be put in the situation of rescuing that person at a later date.

Derek

:=:=Prior to BSAC ditching dive medicals in fovour of self assessment our branch experienced new members who had medical problems picked up on dive medicals which meant they couldn't dive. As a consequence when BSAC went over to self assessment our branch voted to keep the medical for new divers. Thank god we did because we have had 2 people fail the medical since, both for high blood pressure. The second one, last week, was so bad his doctor sent him straight to hospital. He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.
:=:=Not only am I thankful for those 2 people who will now live longer as a consequence but also for all my members who will not have the probability of dealing with a life threatening incident whilst diving.
:=:=Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think
:=:=
:=:=Derek Perry
:=:=D.O. Kensington Cosmos S.A.C.
:=
:=Question 1:
:=
:=Have you suffered at any time from diseases of the heart and
:=circulation including high blood pressure, angina, chest pains and palpitations?
:=
:=Now if their blood pressure was so bad they needed to be sent straight to hospital, can they honestly put their hand on their heart and say they have had no warning symptoms?

Very persuasive information from the doctor, which makes me think that the self-cert should be worded such:

. Have you suffered at any time from diseases of the heart and
circulation including high blood pressure, angina, chest pains and palpitations*

* Please note that diseases of the heart may be asymptomatic

derek perry

24-11-2004, 16:02

John I think you have misunderstood some of my poet. Let me clarify

:=He queried with the doctor that he didn't feel unwell, or have any symptoms. The doctor has told him that he wouldn't have any particular symptoms and that he may not have had any at all until the day he dropped dead.

I trust that the GP has now been changed!

If you go to a Doctor complaining of "unwell" then the *Standard* tests should have been carried out ...including a Blood Pressure Test.

The whole point I was making that when the doctor tested him as part of the medical and found he had such high blood pressure he queered it because he DID NOT feel unwell or show any symptoms. She stated that there are no symptoms for high blood pressure, you either have it or not.

There is no way that this symptom can be misinterpreted. You either have high blood pressure or you don?t. The fault here probably lies with not doing the test in the first place!
(and if it does not then I apologise to the GP - but point out that if there was no problem during routine health checks there was no reason to expect it to be picked up in a Sports Medical either - the fact that it was is merely coincidence).

As I've said the doctor did do the test and it will be picked up in a sports diver medical because that?s part of the medical and this example proves it.

Things like High Blood Pressure should be screened for during "Well Person Clinics" which every UK citizen is invited to attend periodically (more often if at risk for any reason).

Who do you know goes to "well person clinics". This guy felt fit and well and hadn't been to the doctor for years.

With the current emphasis on the way that Heart Desease is crippling the nation things like BP are high on the list of things GPs are being asked to check. They do not even need to do it themselves...they have competent practice nurses to do it for them!

Only if you go to the doctor and most don't bother unless it is necessary. No symptoms then not necessary.
The move to self-cert assumed that:

1) Competent GPs would pick the things being asked about on the form

Only if you go to the doctor

2) Sensible people attend GP clinics for an "annual service" when invited to do so (rather than simply waiting for something to go wrong - as a diver who presumably gets your DV services regularly I KNOW that you understand that being alive to go diving is just as important as having kit that works!)

I don't know one person in my circle of friends and work colleagues who go to the doctor for an Annual Check up.

Perhaps there should be a box on the form that says "Have you had all regular health checks that your GP has requested in the last 5 years?"

Yes sensible idea, but doesn't get around the liar.

With a requirement to go get up-to-date before the self-cert can be signed.

About the lying...that is a training/education issue for you and your branch to tackle (not a responsibility that you should dodge)
I take it therefore you either have a polygraph in your branch equipment or some expert who can tell when someone is lying. How can you possibly tell otherwise.
As for ducking the issue yes I must confess the additional requirement we have put in place, supplying the forms (sometimes by post) supplying details of diving doctors who do the medical (NOTE WE RECOMMEND A DIVING DOCTOR)the extra waiting we have to do and the checking of the medical form are all dodging the issue aren't they? No accepting a piece of paper signed by a complete stranger and letting them get on with it, THAT?S dodging the issue. Not doing anything, Thats dodging the issue. Not discussing it in open forum, That's dodging the issue.

What was PROVED before we moved to self-cert was that GPs with little or no knowledge and training in Diving Medicine used to get medicals wrong. The self cert system allows them to revert to their areas of expertise by screening for the simple things that show warnings. And then they refer to a specialist - just as they would refer to a diabetes/heart/kidney/orthopaedic/etc specialist if they found something that told them to do that.

Simple things that show warning, yes but High blood pressure doesn't show a warning!!

By "insisting" on a full medical - you are forcing people proved to be ignorant of the specialist issues to make a judgement in an area they are not usually qualified or competent to do so in (and this is not fair on the GP - or the patient). You would not expect your GP to manage renal failure for you would you? There are far more people out there who have been referred to the care of Renal specialists than there are, or ever will be, divers (healthy or not). Why expect your GP to have expertise in an area of medicine that he has less experience of than others he refers?

Why have you gone there, not even an issue in this discussion. We are looking for general fitness to dive not a hear6t expert to give you the all clear. As previously stated we recommend a diving doctor anyway. As for fairness on the GP, they are competent so I think you are seriously belittling GP's here. Who are the main people who refer patients onto the same experts, GP's. I've never known anyone go straight to a heart specialist with a chest pain, usually GP or outpatients who then refer them on.

I trust that you are medically qualified enough to gainsay the entire UK Sports Diving Medical Committee before making such proclamations within your branch?

No just experienced in life and our results have proved beyond all doubt that in our opinion we are right to maintain this policy. The two people concerned are more than pleased and thankful that we have this policy as are all our members, new and old. By raising this as a discussion we can make people think about this subject and maybe consider wher they stand. Not to raise it would be dodging the issue and I'd hate anyone to accuse me of that.

As a footnote, we dive with numerous other branches and this subject often comes up. Most state their branch has the same policy

Derek

derek perry

24-11-2004, 16:33

:=He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.

You're kidding yourself trying to justify a position that is wrong by appealing to non-evidence. You are using emotive words and going against the medical advice. This is politician speak. From the title onwards you are using verbal tricks.

Why should he die on your dive? High blood pressure doesn't kill people suddenly blocked cardiac arteries do. When did you last have an angiogram? I went diving the weekend before my heart attack and it was a good dive. Even climbing the ladder with 40Kilos of twinset.

Now I have medicals every year, there are lots of boxes on the form I can't tick now. You're the kind of person that would say "Heart attack? It's obvious you can't dive." Well surprise: It isn't.

nigelH

Absolutely not. We are currently working with our latest member to, hopefully, get him back to fitness so he can dive. We previously worked with the first known 'aids diagnosed BSAC diver' in the UK (BSAC advised fact). So we are not against people with medical conditions diving, as implied in your reply.
You are right that I can't say he would have died on a dive and maybe I should have used the word possibly not probably. If you want to hang me for that then so be it.
But then let me take you to task when you stated
'You're the kind of person that would say "Heart attack? It's obvious you can't dive'
That's non-evidential and very emotive isn't it? Exactly what you accused me of.
Can I also point out that whilst I am the D.O. and was the driving factor behind our branch policy it was agreed at the Branch AGM and in fact met no resistance, just open discussion.
We based it on evidence of people finding life changing illnesses through the Dive Medical and a well published example of a Come and Try Diver who hid the fact he had had open heart surgery and died in the pool from. Before you say it, yes I know we don't have medicals for come and try but it is an example of someone you don't know lying on a self declaration form. And yes the open heart surgury was a factor in his death

My driving force behind this is the health and welfare of members and our policy has proved itself on at least two occassions since self declaration.

Derek

derek perry

24-11-2004, 16:36

Thanks Edward
I didn't want to go to this area as I didn't know if it had been a factor or not, although I suspected something like this was behind it

Derek

I was around during the debate on medicals and from what I can remember one of the biggest *drivers* was the cost.

Now we can spend thousands on kit, but the ?30 (at the time) for a medical, that could last 5 years was being sited by ex-members as the reason they were leaving and joining SAA who had switched to self-declaration.

It was (and probably still is) a factor prospective members consider when checking diving out.

Not PC, but it's the real world.

Edward

Nigel Hewitt

24-11-2004, 18:10

>But then let me take you to task when you stated

>>'You're the kind of person that would say "Heart attack? It's obvious you can't dive'

>That's non-evidential and very emotive isn't it? Exactly what you accused me of.

Well yes. Isn't it obvious that it was deliberate? I do read what I write (although the number of times it says 'edited by...' at the bottom as the grammar failed a re-read after posting....)

Can I also point out that whilst I am the D.O. and was the driving factor behind our branch policy it was agreed at the Branch AGM and in fact met no resistance, just open discussion.

I'm perplexed. Surely the DO's authority comes from the NDO. They are supposed to be the mouthpiece of the official position unless they make it clear they are speaking as an ordinary branch member and going against policy.

I know my branch refers several people for real medicals. We do not make a big deal of it so nobody feels pressured to lie on the self declaration form. If the answers are truthful I suspect your cases might have been picked up.

Whilst I respect you examples I am worried that a branch can deviate so far from the official BSAC line. The difference between BSAC an a private, local club is that we are a group of members of the greater body organised locally. If you feel free to change the rules what happens to our nationally agreed structure?

nigelH

Mike Halligan

24-11-2004, 18:17

Very persuasive information from the doctor, which makes me think that the self-cert should be worded such:

. Have you suffered at any time from diseases of the heart and
circulation including high blood pressure, angina, chest pains and palpitations*

* Please note that diseases of the heart may be asymptomatic

OK, so I have asymptomatic hypertension. I've had it for some years and it was picked up on a periodic medical. I can still truthfully answer that I haven't _suffered_ from asymptomatic hypertension. I _suffered_ during some of the diagnostics and my wallet suffers still from prescription charges and loss of work time dealing with regular checks, but I have experienced no pain.

The Medical Referee is a boon and my GP provides very well for me, but what possible use to me is the self-declaration?

Mike

derek perry

24-11-2004, 19:31

:=>But then let me take you to task when you stated

:=>>'You're the kind of person that would say "Heart attack? It's obvious you can't dive'

:=>That's non-evidential and very emotive isn't it? Exactly what you accused me of.

Well yes. Isn't it obvious that it was deliberate? I do read what I write (although the number of times it says 'edited by...' at the bottom as the grammar failed a re-read after posting....)

:=Can I also point out that whilst I am the D.O. and was the driving factor behind our branch policy it was agreed at the Branch AGM and in fact met no resistance, just open discussion.

I'm perplexed. Surely the DO's authority comes from the NDO. They are supposed to be the mouthpiece of the official position unless they make it clear they are speaking as an ordinary branch member and going against policy.

I know my branch refers several people for real medicals. We do not make a big deal of it so nobody feels pressured to lie on the self declaration form. If the answers are truthful I suspect your cases might have been picked up.

Whilst I respect you examples I am worried that a branch can deviate so far from the official BSAC line. The difference between BSAC an a private, local club is that we are a group of members of the greater body organised locally. If you feel free to change the rules what happens to our nationally agreed structure?

nigelH

Nigel

I hear what you say but there is already a precedence set by BSAC regarding branches making their own rules. During the debate on ages for children joining BSAC the national council always stated branches were free to set their own age minimum for joining a branch provided it was not younger than the national age minimum.
By that precedence there are no rules preventing a branch from insisting on a dive medical when a person first joins a branch as a new diver.
Whilst I am the representative of the NDO I am also an individual with views and concerns. I clearly stated the national policy for medicals in our debate on the subject but recommended the policy we now have. My members are free to ask for this to be changed at any time but I know this is highly unlikely in the light of what has happened.
This has nothing to do with us being a branch insisting on rules for rules sake. We are concerned for the safety and health of our members, new and old and reducing possible risks for them. Now this new member knows their condition and hopefully can control it. They will make sure everyone knows what can be done to assist if anything were to go wrong. This makes diving safer for him and everyone else, which is my number one concern.

Derek
PS; copy and paste your post into word before posting, that way you won't have to keep editing it as you can use spellchecker first.

Keith Lawrence(BSAC)

24-11-2004, 19:34

I'm perplexed. Surely the DO's authority comes from the NDO. They are supposed to be the mouthpiece of the official position unless they make it clear they are speaking as an ordinary branch member and going against policy.

Whilst I respect you examples I am worried that a branch can deviate so far from the official BSAC line. The difference between BSAC an a private, local club is that we are a group of members of the greater body organised locally. If you feel free to change the rules what happens to our nationally agreed structure?

As a club we set certain rules for somebody to be a member of the BSAC, as members of BSAC clubs are also members of the BSAC nationally then it follows that the rules for joining the local branch must match, as a minimum, the rules for joining the organisation.

However, as independant bodies club are free to make their own rules for admittance to their club, provided these do not override the rules of the BSAC nationally. Many clubs do this, we have closed branches, youth branches, special branches, military branches - all of them with additional rules that apply to membership of their own club.

Regarding medicals we acted nationally on the advice given to us by the UKSDMC, we therefore removed the requirment for a medical for membership of the BSAC nationally. If clubs wish to insist on a medical on initial application they are free to do so, this is not against any national policy. Where we do lay down hard and fast rules is in diver training, it is here that clubs may not add or subtract to the DTP as laid down by the NDO.

It is a subtle but important difference between conditions for joining a club and conditions put upon training. e.g. If a club insisted "you must be an AD able to stand on one leg holding a twinset above your head with one hand" as a condition of membership of their club then that is acceptable, a club can make whatever condition of membership its members wish. What they CANNOT do is make the "...able to stand on one leg..." a condition of awarding the AD diving grade, that is a clear deviation from the DTP.

So if a club wishes to make a medical a condition of membership of their club then nationally we have no problem at all with that - it is a choice solely for the members of that club to make.

HTH

Keith L

Philip Smith

24-11-2004, 20:10

:=What was PROVED before we moved to self-cert was that GPs with little or no knowledge and training in Diving Medicine used to get medicals wrong.

Please cite your evidence for the above statement. If you are referring to the paper by Glen et al, refered to in the FAQ regarding self declaration on the BSAC website (full text at: <a href="http://bjsm.bmjjournals.com/cgi/content/full/34/5/375" >http://bjsm.bmjjournals.com/cgi/content/full/34/5/375</a>), it showed nothing of the kind. It showed the in the sample population of 2962 individuals, "no signficant unexpected abnormalities were found" which would not have resulted in "required further investigation" by questionnaire.

Furthermore, the sample of 2962 individuals was taken from the SSAC medical database and were therefore people who had either passed a medical and joined, or had been referred to a SSAC medical referee. The study had no knowledge of any applicants who were advised not to dive by their GP. I outlined other flaws in their study in a letter to the journal which is linked to at the foot of the on-line article. The authors' response is there too.

You might like to consider that individuals involved in a study are more likely to answer honestly than if they know that a particular response is likely to put a halt to their diving (albeit temporarily).

Actually, the individuals did not know that they were to become part of a study; they were routine applicants to the SSAC under the old medical system. However, your point is valid, in that when they completed the questionnaire under the old system, they knew the next step in the process was to see their GP, so there was an incentive for honesty.

The paper's conclusion (for those who have completely misunderstood) were not that GPs were getting it wrong, but that an annual questionnaire would be as effective in picking up conditions requiring further investigation/referral.

And their analysis does not sustain this conclusion.

Phil S

Nigel Hewitt

24-11-2004, 22:13

So if a club wishes to make a medical a condition of membership of their club then nationally we have no problem at all with that - it is a choice solely for the members of that club to make.

OK. Clear.

nigelH

Edward Haynes

24-11-2004, 22:15

Hi

I would like to add one other comment about joining a members? club. New or renewing members need to be accepted by the management committee, as recommended in the Model Bye-Laws.

If your branch isn't doing this it *may* not qualify for exemption under the new disabilities discrimination legislation, if someone made a claim.

In other words if a member of the public only has to fill out an application form and pay their money, then it's not a members club.

Think about how your branch deals with membership renewals and new members.

Edward

martin

25-11-2004, 08:22

iainmsmith

25-11-2004, 09:24

Even a Formal medical Examination is not conclusively going to rule out any medical conditions. whilst it might be easier to tell prikies on the self declaration, Taylor, O'Toole and Ryan clear showed that it is also possible for experienced and committed divers to fool their doctors!

David McD. Taylor, MD; Kevin S. O'Toole, MD; Christopher M. Ryan, PhD: Experienced, Recreational Scuba Divers in Australia Continue to Dive Despite Medical Contraindications : Wilderness and Environmental Medicine: Vol. 13, No. 3, pp. 187?193.

An Iiteresting paper. Note that Table 4 of this article refers to "relative or absolute contraindications". A "relative contraindication" is a factor which makes someone less suitable for diving, but does not definitely exclude them (that would be a relative contraindication). A history of epilepsy, for example, is only a relative contraindication according to the UKSDMC standards. There are circumstances where, depending on the nature of the epilepsy and the length of time since the last fit someone may be allowed to dive. This would show up in the above paper as a diver "continuing to dive despite medical contraindications". Additionally, conditions listed are very trivial. For example, "joint surgery or trauma". This means that if you've ever broken a bone, then you dive despite a contraindication.

Looking through the list of conditions, I was interested to see one individual who had a history of chronic obstructive airways disease...but who didn't have it any more at the time of the questionnaire! This is strange, as COAD doesn't go away! This condition, however, would have required referral under the old scheme.

"a number of divers commented on how easy it was to avoid the detection of medical conditions during the diving medical examination."

I guess if someone has made the decision to deliberately evade detection of a condition, there isn't a lot one can do if it is not clinically evident.

However, I have to disagree with your conclusion that Taylor et al "clearly showed that it is possible for experienced and committed divers to fool their doctors".

I quote: "some divers develop contraindicated conditions as they age yet continue to dive through ignorance or neglect. In Australia, there is no requirement for repeat medical assessment for fitness to dive"

The divers in the study were generally experienced and had been diving for some time. Many of the conditions listed tend to occur with increasing age. It is highly likely that the divers did NOT have those conditions at the time of their initial medical assessment, and having not had a further diving medical since, have had no opportunity to "fool their doctors".

Iain

matt

25-11-2004, 11:53

In other words if a member of the public only has to fill out an application form and pay their money, then it's not a members club.

Think about how your branch deals with membership renewals and new members.

OK you have me thinking but please expand. You have told us how we might not be a members club. Could you possibly suggest a way to ensure that we are a members club?

Regards
MattS

janos

25-11-2004, 12:57

OK you have me thinking but please expand. You have told us how we might not be a members club. Could you possibly suggest a way to ensure that we are a members club?

In our club, membership applications and renewals must be approved by the committee. The committee has delegated this task to our membership secretary.

Laters,
Janos

Andy Wade

25-11-2004, 13:12

:=In other words if a member of the public only has to fill out an application form and pay their money, then it's not a members club.

:=Think about how your branch deals with membership renewals and new members.

OK you have me thinking but please expand. You have told us how we might not be a members club. Could you possibly suggest a way to ensure that we are a members club?

Regards

A proper 'members club' has to have people apply in writing and be approved as a member by the club committee, otherwise it's just an 'open club' and anyone can join. If you also give them a list of the club rules when they join, it means that they agree to abide by the rules when they are a member.
If you have a clubhouse, members are on a list and they have to sign guests in.
Just go to any golf club and you'll see what I mean.
Don't try wearing jeans or a T shirt though... ;-)

Andy Nye

25-11-2004, 15:04

All new members to the club have a medical by their GP, Self dec after that .

Andy.

**** What we have to remember here is , that a medical is like a cars MOT... You can be ok at time of examination ,,, but a mile up the road, something may blow and your fail ****

matt

25-11-2004, 15:51

Thanks Andy / Janos

A proper 'members club' has to have people apply in writing and be approved as a member by the club committee, otherwise it's just an 'open club' and anyone can join. If you also give them a list of the club rules when they join, it means that they agree to abide by the rules when they are a member.

Right, lets see how we map up to that.
All club members have to fill in an application form - that would appear to be a written application. The membership secretary approves applications on behalf of the committee. The club rules are printed on the club noticeboard and the application form states that all members must abide by the club rules.

If you have a clubhouse, members are on a list and they have to sign guests in.

We do that to comply with licensing legislation anyhow.

Just go to any golf club and you'll see what I mean.
Don't try wearing jeans or a T shirt though... ;-)

Sort of what I was worried about. We have a boating club near by, which has a diving section. You can only get in on the reccomendation of a current member and then only if no one else objects.

One of our club goals has always been open access, making the sport accessible to as many people as possible. Apart from my personal objections to prejudice, I understand access can be an important issue when it comes to grant applications.

Regards
MattS

Andy Wade

25-11-2004, 17:15

Thanks Andy / Janos

:=A proper 'members club' has to have people apply in writing and be approved as a member by the club committee, otherwise it's just an 'open club' and anyone can join. If you also give them a list of the club rules when they join, it means that they agree to abide by the rules when they are a member.

Right, lets see how we map up to that.
All club members have to fill in an application form - that would appear to be a written application. The membership secretary approves applications on behalf of the committee. The club rules are printed on the club noticeboard and the application form states that all members must abide by the club rules.

:=If you have a clubhouse, members are on a list and they have to sign guests in.

We do that to comply with licensing legislation anyhow.

:=Just go to any golf club and you'll see what I mean.
:=Don't try wearing jeans or a T shirt though... ;-)

Sort of what I was worried about. We have a boating club near by, which has a diving section. You can only get in on the reccomendation of a current member and then only if no one else objects.

One of our club goals has always been open access, making the sport accessible to as many people as possible. Apart from my personal objections to prejudice, I understand access can be an important issue when it comes to grant applications.

Couldn't you create a rule or a phrase in your constitution that says all full diving members must comply with the branch diving regulations, that should cover any medical or training issues.
Also, you could state in your constitution that any person is eligible for membership but add the caveat that all diving members must comply with diving rules.
I don't think it would be seen as unreasonable by any grant bodies, rather a mandatory safety issue and that you are seen to be informing all your members of any safety issues in writing.
This would mean that the social members can join willy nilly (under your general rules - like licensing regs etc), but divers have to toe the line on diving regs. It doesn't actually stop anyone joining the branch, so you should be OK with grant applications whilst still covering your backs where people say they didn't know what the rules were.
All you have to do is give each member a copy of the rules and constitution when they join or rejoin/renew.

I think this should work OK, but Edward may be able to pick holes in it......

You'd also have to get it passed at an AGM or EGM.

.

Mike Halligan

25-11-2004, 18:14

I would like to add one other comment about joining a members? club. New or renewing members need to be accepted by the management committee, as recommended in the Model Bye-Laws.

If your branch isn't doing this it *may* not qualify for exemption under the new disabilities discrimination legislation, if someone made a claim.

In other words if a member of the public only has to fill out an application form and pay their money, then it's not a members club.

Think about how your branch deals with membership renewals and new members.

Edward is correct, for now. Disability Discrimination Act (3) applying from 1 October 04 allows exemption for Private Members' Clubs. He is also correct that there must be a vetting system to impose the necessary exclusivity. His term "*may* not qualify" is well chosen.

However, the Private Members Club is itself under indirect threat from this Government's proposals for the social law on alcohol and gambling. They may well lead to the dissolution of some and conversion of many into unincorporated members' associations.

Also, the next stage of Diversity Rights legislation is already at the consultation stage. DDA3 is not even the beginning of the end.

Regards,

Mike [as Accessibility Adviser]

derek perry

27-11-2004, 01:39

Hi all

I think we have just about done this one to death (excuse pun considering the subject)
The whole idea was to highlight the failings of the self declaration system and raise awareness of the ability of branches to set their own standards to safeguard their current and new members. I think this has been done and it was interesting how some people are so anti anyone who dares to question the BSAC line.
One thing my branch is able to do, if there were an inquest into any incident, is show evidence that we do go beyond the minimum recommended to try and safeguard our members. Always good to have an ace up the sleeve

Happy safe diving

Derek

Prior to BSAC ditching dive medicals in fovour of self assessment our branch experienced new members who had medical problems picked up on dive medicals which meant they couldn't dive. As a consequence when BSAC went over to self assessment our branch voted to keep the medical for new divers. Thank god we did because we have had 2 people fail the medical since, both for high blood pressure. The second one, last week, was so bad his doctor sent him straight to hospital. He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.
Not only am I thankful for those 2 people who will now live longer as a consequence but also for all my members who will not have the probability of dealing with a life threatening incident whilst diving.
Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think

Derek Perry
D.O. Kensington Cosmos S.A.C.

05-12-2004, 15:53

I think we have just about done this one to death (excuse pun considering the subject)

Sorry Folks but I have to disagree. We have not yet discussed age speciffics. Remember in days of old (the good ones), Medicals were done every (I think) 5, 3 and 1 years depending on age. A 24 yr old fit male of 70kg had to have a medical every 5 yrs, because he would have been deemed fit. However, I, a fit man of 88kg, now would be having yearly medicals because I would be older, less fit and possibly succeptable to a wider range of age related illnesses either asymptomatic or symptomatic.

I would therefore like to suggest that for divers under 45 yrs of age that are asymptomatic, have no family history of certain illnesses and are fit, should continue as a matter of policy to be truthful and continue to fill in the celf certification form. Divers over the age of 45 should undergo a yearly medical. We owe it to ourselves our families and dive buddies to be fit to dive. I know you are all saying that I could have a medical, then 6 months down the line have asymptomatic hypertension which will not be picked up until 6 months later. But here's the point, it will be picked up. Using self certification forms for diving untill the day you stop will not pick up ailments associated with age. While I was in the army I used to have a free chest x ray every year. You never know what lies within. Nip things in the bud so to speak.

I agree that the ratio of divers to times when ailments have been found in divers are few but if one person is helped hasn't the system of having a medical worked?
Regards,
PG
Cambs

Nigel Hewitt

05-12-2004, 16:55

I agree that the ratio of divers to times when ailments have been found in divers are few but if one person is helped hasn't the system of having a medical worked?

NO. If we want to screen people it is not the job of diving clubs to do the job. Why should somebody else have to pay so my cardiac hypertension gets picked up? Diving medicals are an expensive addition to a hobby that already sinks too much of a family budget. The "If one person is helped" argument can be used to justify all manner of wacko ideas.

One of the important things is to emphasise that self declarations must be honest and that if you do have to miss an item it is no big deal to go and get it signed off. Never imply that failing to tick all the boxes is bad.

nigelH

Andy Wade

05-12-2004, 17:01

:=I think we have just about done this one to death (excuse pun considering the subject)

Sorry Folks but I have to disagree. We have not yet discussed age speciffics. Remember in days of old (the good ones), Medicals were done every (I think) 5, 3 and 1 years depending on age. A 24 yr old fit male of 70kg had to have a medical every 5 yrs, because he would have been deemed fit. However, I, a fit man of 88kg, now would be having yearly medicals because I would be older, less fit and possibly succeptable to a wider range of age related illnesses either asymptomatic or symptomatic.

I would therefore like to suggest that for divers under 45 yrs of age that are asymptomatic, have no family history of certain illnesses and are fit, should continue as a matter of policy to be truthful and continue to fill in the celf certification form. Divers over the age of 45 should undergo a yearly medical. We owe it to ourselves our families and dive buddies to be fit to dive. I know you are all saying that I could have a medical, then 6 months down the line have asymptomatic hypertension which will not be picked up until 6 months later. But here's the point, it will be picked up. Using self certification forms for diving untill the day you stop will not pick up ailments associated with age. While I was in the army I used to have a free chest x ray every year. You never know what lies within. Nip things in the bud so to speak.

I agree that the ratio of divers to times when ailments have been found in divers are few but if one person is helped hasn't the system of having a medical worked?

Personally I think everyone should have an annual medical, and for us that means a proper diving one.
Some of the 'adverts for diving fitness' squeezing tightly into suits should be looking to lose weight and having more regular checks, especially those pushing the envelope of deco and depth.
Some people have never had a medical in their life.
Just because diving equipment and techniques improve with every year doesn't mean that the human element does. In fact as we push deeper and longer we need to make sure that we can cut the mustard physically.

I strongly disagree with an annual chest x-ray though, as I think this would be detrimental to your health, although I do think everyone should have one to start with.
If you have no chest problems and are examined by a Doc every year, then there's no need for an x-ray anyway.

(Ex JJSADC)

matt

05-12-2004, 17:32

Diving medicals are an expensive addition to a hobby that already sinks too much of a family budget.

Hmmm. Without getting into the rights and wrongs of self cert I will say that the practical result for me has been just another form to fill in each year. I find it convenient to maintain a doctor signed medical because France, Spain and Malta all require one.

BTW my diver medical is often the only time I will see a Doctor. Possibly not sensible, but with a busy life and the receptionists habit of only providing inconvenient appointments, I resort to a doctor only when I can ignore symptoms no longer.

Unfortunately for some of the people compelled to now seek out a referee, the change to self cert has increased the medical cost. We had no end of interested doctors willing to provide sport diver medicals for a token fee, and able to clear the most common queries. Now anyone that ticks a self cert box is sent to a UKSDMC doctor charging a great deal more.

The "If one person is helped" argument can be used to justify all manner of wacko ideas.

I am not altogether comfortable with the idea of people starting to dive without seeing a doctor. Two close friends chose not to start training after certain risks were pointed out during their medical. Both of these people would have been able to complete a self cert.

Regards
MattS

derek perry

05-12-2004, 18:50

Actualy Matt we use one of the diving doctors on the rear of the medical form who will, provided they are satisfied, certify you if you 'e' mail your symptoms / problem to them, for just a ?5 donation to the lifeboat fund. You send the cheque and form off, they send it back complete. Obviously if it is a serious queery thy will call you in for an examination. This is used by current members renewing under the self declaration system, who highlight problems.
Details are
Dr J Eden
<a href="mailto:doctor@e-med.co.uk">doctor@e-med.co.uk</a>
www.e-med.co.uk/diving_medicals

Derek

:=Diving medicals are an expensive addition to a hobby that already sinks too much of a family budget.

Hmmm. Without getting into the rights and wrongs of self cert I will say that the practical result for me has been just another form to fill in each year. I find it convenient to maintain a doctor signed medical because France, Spain and Malta all require one.

BTW my diver medical is often the only time I will see a Doctor. Possibly not sensible, but with a busy life and the receptionists habit of only providing inconvenient appointments, I resort to a doctor only when I can ignore symptoms no longer.

Unfortunately for some of the people compelled to now seek out a referee, the change to self cert has increased the medical cost. We had no end of interested doctors willing to provide sport diver medicals for a token fee, and able to clear the most common queries. Now anyone that ticks a self cert box is sent to a UKSDMC doctor charging a great deal more.

:=The "If one person is helped" argument can be used to justify all manner of wacko ideas.

I am not altogether comfortable with the idea of people starting to dive without seeing a doctor. Two close friends chose not to start training after certain risks were pointed out during their medical. Both of these people would have been able to complete a self cert.

Regards
MattS

howard lewis

13-12-2004, 09:18

Prior to BSAC ditching dive medicals in fovour of self assessment our branch experienced new members who had medical problems picked up on dive medicals which meant they couldn't dive. As a consequence when BSAC went over to self assessment our branch voted to keep the medical for new divers. Thank god we did because we have had 2 people fail the medical since, both for high blood pressure. The second one, last week, was so bad his doctor sent him straight to hospital. He was told if this hadn't been picked up he would have been dead within 5 years, (probably on one of our dives!) He is only in his mid 30's.
Not only am I thankful for those 2 people who will now live longer as a consequence but also for all my members who will not have the probability of dealing with a life threatening incident whilst diving.
Food for thought for all those branches that don't insist on a medical and for BSAC to have a re-think

Derek Perry
D.O. Kensington Cosmos S.A.C.
I think you are right to insist as our club does that a new member has a proper medical. We learnt by bitter experience that this is the right course to take. We as a club have had to go one further and insist on the first medical being carried out by the persons own doctor. We used to have a local doctor come to the club and carry out up to 10 medicals in an evening and therefore make it cheaper, however one person had a problem that only their doctor could know about. We were lucky in that during pool training it was discovered but if they had gotto open water it could have been far more serious.