“Doctors accustomed to acting as advocates may find themselves in the uncomfortable position of having to act against their patient’s wishes”


Refusal to comply Te situation becomes challenging when, despite the doctor’s best attempts, the patient refuses to agree to self-reporting and signals an intention to continue driving. In these circumstances, the GMC provides specific and helpful supplementary guidance (go to tinyurl. com/h2uuv2b). It may be that the patient will welcome referral for a second opinion on fitness to drive if this is suggested, and the doctor may wish to raise this and to offer to arrange it. However, it is important that the patient agrees and accepts that driving is prohibited in the meantime whilst awaiting the second opinion. If a patient continues to drive when they may not be fit to do so,


then every reasonable effort should be made to persuade them to stop. Discussing the matter with relatives, friends or carers could be helpful but only if the patient consents to this approach. Should all attempts fail to persuade the patient to stop driving,


or the doctor discovers that the patient is continuing to drive against advice, then this should be disclosed to a medical adviser at the DVLA. Tis should be done in confidence and include all relevant medical information which relates to the patient’s fitness to drive. Before taking this step, however, it is important that the doctor


tries to inform the patient of the decision to disclose personal information to the DVLA and perhaps further discuss the matter. Having made the disclosure, the doctor should then, in addition, write to the patient confirming that this has been done. Each step of this process advised by the GMC should be


documented carefully in the patient’s records, so that there is clear WINTER 2016


evidence of the measures that have been taken to persuade the patient to stop driving, and to protect the patient and the public interest.


Cognitive decline Te situation is somewhat different when a patient who may be unfit to drive presents with a condition such as dementia which is associated with cognitive decline. In this case, an additional assessment must be made as to whether the patient understands fully the advice they are being given in relation to driving, and has the mental capacity to remember to self-report to the DVLA and follow the advice given. Te GMC advises that if the patient is incapable of


understanding the advice, for example because of dementia, then the doctor should inform the DVLA immediately. Again the reasons for deciding to disclose in this way should be recorded. Te GMC last produced guidance on confidentiality and DVLA


disclosures in 2009, and revised guidance is due to be released in 2017, a consultation process having been completed through 2015 and 2016. It is likely, however, that the new guidance will simply build on the current guidance, emphasising the key ethical duties and obligations of doctors in relation to fitness to drive issues. Should members have any specific queries in regard to fitness to


drive and making disclosures to the DVLA, please phone an adviser at MDDUS.


n Barry Parker is a medical adviser at MDDUS and editor of Summons


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