Postal survey of fitness-to-dive opinions of diving doctors and general practitioners

(Sames C, Gorman D, Mitchell S. Postal survey of fitness-to-dive opinions of diving doctors and general practitioners. Diving Hyperb Med. 2012;42(1):24-29.) Aim: To determine the consensus and concordance with published standards and expert opinion among New Zealand's designated diving doctors (DDDs) and general practitioners (GPs) regarding medical fitness-to-dive. Methods: A postal survey canvassed doctors' opinions regarding fitness to dive of 20 'real-life' applicants with potentially relevant medical conditions. In 17 cases, a 'desired response' was identified as expert opinion and the relevant published Standard concurred; the remaining three cases were excluded from analysis. Consensus was measured between the groups of doctors, and concordance measured against the 'desired response'. The performance of the DDDs was also correlated with both the number of diver medical assessments conducted annually and time since completing a diving medicine course. Results: Seventy-seven of 98 DDDs (79%) and 75 of 200 GPs (38%) responded to the questionnaire. The mean concordance was 60% and 50% for DDDs and GPs respectively. Consensus between DDDs and GPs was generally high, but was low between these groups and the 'desired response'. DDDs' concordance was negatively correlated (r = -0.3) with time since undertaking a diving medicine course, but was positively correlated (r = 0.2) with their annual number of dive medical assessments. Both groups were more likely to differ from the 'desired response' by considering an 'unfit' diver as 'fit' than the converse. Conclusions: There is poor concordance between doctors assessing fitness to dive and both published recommendations and expert opinion when there is a relevant medical condition. This supports the current New Zealand practice of centralised audit of occupational diver medical fitness prior to certification.