Scuba diving medical examinations in practice: a postal survey

To assess variability of opinion regarding fitness to dive among doctors currently doing diving medical examinations.

Anonymous, reply-paid postal survey containing 15 clinical scenarios for which respondents were asked to declare the prospective scuba diver fit, unfit, fit after investigation or to offer specialist referral.

All 81 doctors in Queensland, identified as members of the South Pacific Underwater Medical Society, who had completed approved training in underwater medicine, and who were doing diving medical examinations in June 1998.

Variability in responses, and agreement with our interpretation of the action recommended by Australian Standard (AS) 4005.1-1992, the medical standard for fitness to scuba dive for recreational divers.

52 of the 81 questionnaires were returned (64% response rate). There was a wide variety of opinion about fitness to dive for all 15 hypothetical cases, with 70% consensus about unfitness in only four cases (one of which should have been referred according to AS guidelines) and fitness in only two cases (both of which should have been referred according to AS guidelines). No case was considered either fit or unfit by all respondents. Only 17.6% of responses recommended specialist referral, although the AS guidelines suggest that 10 of the 15 cases should be referred. One doctor failed 13 of the 15 potential divers outright and another passed seven outright and failed only four. For each case that the AS guidelines firmly indicate as unfit to dive, at least one respondent passed the hypothetical prospective diver as fit.

There is no consensus among doctors who perform diving medical examinations as to what constitutes fitness to dive; current guidelines need to be improved.