DISCLOSURE
Barry Parker looks at the factors to consider when a medical condition may compromise a patient’s fitness to drive
Unfit to drive I
T’S CLEAR from the calls we receive on our advice line that matters related to medical confidentiality continue to be a source of concern and challenge to members. Confidentiality lies at the
heart of the trusted doctor-patient relationship and it is rightly taken very seriously by doctors but cannot be absolute. Information may have to be disclosed in order to protect the public interest, even when consent has been refused by the patient. Tis is seen clearly in cases where patients present with medical
conditions that may impair their fitness to drive. Te ability to drive can be of huge importance to patients, tied in with their occupation, independence, social interaction, family life and identity. Tough some patients will immediately understand and be
happy to follow their doctor’s advice to stop driving when faced with a disqualifying medical condition or treatment, others may find it more difficult to accept. Tey may disagree with the advice and consider that they are still competent to drive, or they may seek to cope with the condition by offering to restrict driving in some way.
Public risk Clearly, whilst patients may be willing to accept any risk to themselves in driving, the risk inevitably extends to other members of the public. Doctors who are accustomed to acting as patient advocates may find themselves in the uncomfortable position of having to act against their patient’s wishes and to breach their confidentiality in such circumstances.
12 Te decision on whether or not a patient may drive with a
temporary or permanent medical condition or treatment is a matter of clinical judgment, bearing in mind the detailed guidance provided by the DVLA. Some conditions, such as a clearly documented loss of visual acuity, may be relatively straightforward, but others such as alcohol misuse or fainting episodes may be more difficult to assess. It is therefore important to record as precisely as possible the history provided and any examination findings, together with the reasons for the decision on fitness to drive. In some areas of the UK it is possible to refer patients to a specialist centre for a formal driving assessment to help decide on matters in borderline cases. Under the provisions of the Road Traffic Act 1998, a person who
has a medical condition or treatment that may impair his fitness to drive has a legal obligation to notify the matter to the DVLA. Failure to do so is an offence that may attract a fine of up to £1,000, and in the event of an accident a driver may face prosecution. Te first step for doctors is therefore to explain clearly the nature of the medical condition or treatment and how this may affect driving. Te patient should then be advised to stop driving and of their legal obligation to self-report to the DVLA. In May 2016 the DVLA published a revised edition of its
Accessing fitness to drive – a guide for medical professionals. Tis document is available online (access at
tinyurl.com/jkkoklf) and can be accessed to demonstrate the regulations to the patient if need be. Tis conversation should then be recorded in detail in the medical records.
SUMMONS
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