title: Medical assessment of fitness to dive - comparing a questionnaire and a medical interview-based approach.
abstract: BACKGROUND
  In Queensland, most entry-level recreational diving students have to complete two diving medical forms (the Recreational Scuba Training Council (RSTC) or similar, and the appendix to Australian Standard 4005.1), as well as undergoing a medical consultation by a medical practitioner experienced in diving medicine. This provides an opportunity to evaluate the performance of the health questionnaire compared to the medical interview.
  
  
  METHODS
  We conducted a retrospective analysis of 1,000 consecutive entry-level scuba-diving students assessed by one doctor (CM). Using the medical consultation as the reference standard, we analysed the number of incorrect or inconsistent answers in each of the forms. The main outcome was the number of individuals who were found 'unfit to dive' following the medical, but who appeared fit according to their responses on the RSTC form.
  
  
  RESULTS
  Of the 1,000 students, 3.7% failed the medical, 9.4% gave inconsistent answers and 29.9% gave incorrect answers. 63.2% had answered 'no' to all the questions on the RSTC form, and nine of these students (1 in 70) were assessed at the medical as 'unfit' for scuba diving, (0.9% of the total). Logistic regression could not identify factors that reliably predict those at high risk of failing the medical consultation after passing the RSTC questionnaire.  Those who gave incorrect responses were more likely to fail (8.4% versus 2.0%, P < 0.0001).
  
  
  CONCLUSIONS
  One in 70 candidates failed during the medical consultation after indicating they had no relevant medical problems on a questionnaire.  Face-to-face medical interview does identify individuals who are at risk while diving, where two commonly used medical screening forms do not. The practical significance of these conclusions remains unclear.
authors.affiliation: General practitioner in Cairns, Mcleod Street Medical, 67 McLeod Street, Cairns, Queensland 4870, Australia, Phone: +61-(0)7-4052-1583, E-mail: cmeehan@mcleodstmed.com.au.
authors.forename: Catherine
authors.initials: C
authors.lastname: Meehan
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett