On the one hand, any licensed physician is allowed to attest a prospective diver’s fitness to dive, even without a relevant further qualification. On the other hand, s/he should certainly not do so after merely reading this short CME article. Not for nothing does the fitness to dive manual comprise more than 200 printed pages, which a doctor should know before attesting anything.
There is no such thing as “unfitness to dive.” Aviation physicians have the right to bar a would-be pilot from flying a plane; the reason is that such an undertaking may put others at risk in case of a crash. Diving medicine specialists cannot bar persons from diving because recreational diving puts only the divers themselves at risk. Diving is always the diver’s own responsibility. A medical certificate attesting fitness to dive mainly serves to protect diving schools and tour operators. Making such a certificate a requirement will have a single positive effect in that recreational divers are obliged to submit to a diving medical consultation, in which they will receive extensive and individual information on what their personal risk factors are. Such advice is the main task of a diving medicine specialist; the paper certificate is an optional extra.
What the CME article is unforgivably lacking is any mention of psychological contraindications. Most life-threatening diving incidents are caused by psychological slips. Diving medicine specialists should elicit information on how someone deals with stress, how willing they are to experience fear, and how they handle high-risk behavior. A diagnosis of a “phobic patient” is a relative contraindication, as is that of a “carefree/careless person.” Hyperventilation in a scuba diver having a panic attack under water is not a good scenario. Personality disorders require critical evaluation. Further contraindications include depression, suicidality, manic hubris, psychotic symptoms with misjudgment of reality, and addictive behaviors including and excluding substances. It goes without saying that recreational divers should be sober and not currently be taking psychotropic drugs.
In my view, the psychological situation of recreational divers is more important than their lung function or cardiac output when the objective is to prevent diving accidents by means of giving high-quality advice.
Dr. med. Ralf Cüppers
Arzt für Psychotherapeutische Medizin, Flensburg
Conflict of interest statement
The author declares that no conflict of interest exists.
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