Medical examinations for seafarers are one of the few medical examinations that allow you to work in any position in the maritime sector, in any country in the world, regardless of your nationality, the flag your boat sails under, the country of the owner or the country in which the company is registered. In such an international system and legislation, with the applicable international law, as well as the laws of the flag under which the boat is sailing and the laws of the country issuing you the certificate of fitness for work, which are not compatible in certain details, it is sometimes not easy to comply with everything that makes the assessment of seafarers’ fitness for work and the certificate of fitness for work valid. The essence of the examination of seafarers should be to assess whether a seafarer is able to perform his work for a period of two years without endangering himself or herself the ship or the crew, and that he or she is able to respond to the requirements of sudden strain in the event of a maritime accident. The certificate that the seafarer receives means just that and is not a “bill of health”. In a system where the interests of shipowners, states, insurers and agents are intertwined, and each can impose its own conditions that the seafarer must meet, it is important that the seafarer is properly assessed and that the process of clinical decision making is correct.