A risk on the road - medical case study

...The patient was diagnosed with macular degeneration but continued to drive...

BACKGROUND: MRS D is an 81-year-old woman who suffered a stroke five years ago. She has recently been consulting her GP, Dr F, complaining of problems with her eyesight. Dr F referred her to a consultant ophthalmologist who diagnosed Mrs D with macular degeneration.

Both Dr F and the hospital consultant agree that Mrs D is no longer fit to drive and have explained to her the dangers of getting behind the wheel. They also explained she has a duty to notify the DVLA of the impairment.

However, Dr F is concerned when Mrs D arrives for her latest appointment in her own car. He is worried that she will continue to ignore medical advice but is unsure if it is appropriate to inform the DVLA at this stage.

ANALYSIS/OUTCOME: Dr F discusses the issue with an MDDUS adviser who advises that in these circumstances patients should be given a chance to stop driving voluntarily.

In general, where a patient continues to drive when they may not be fit to do so, the General Medical Council advises doctors to “make every reasonable effort to persuade them to stop.” A doctor could, if the patient agrees, discuss concerns with friends, relatives or carers.

In this case, as a first step, the MDDUS adviser recommends Dr F raise his concerns with the patient in writing and assists with the drafting of a letter. The letter addresses her poor eyesight and the risks this poses when driving, and advises Mrs D that she must stop driving or he will inform the DVLA.

Should Mrs D continue to drive, the GMC makes it clear that in these circumstances doctors “should contact the DVLA or DVA immediately and disclose any relevant medical information”. The disclosure can be made in the public interest as the patient poses a risk to fellow road users. If a disclosure is made, the patient should be informed in writing.

KEY POINTS

• Doctors can breach patient confidentiality without consent if it is in the public interest to do so. First, advise the patient of their responsibility to stop driving if they are unfit.

• If the patient continues to drive try to inform them of your intentions to disclose. If they continue to drive against medical advice, alert the DVLA promptly and inform the patient of this action.

• Seek advice from an experienced colleague, the DVLA’s medical officer or an MDDUS adviser if you are unsure about appropriate action regarding a patient’s fitness to drive.