MDDUS is reminding doctors of their obligation to tell the Driver and Vehicle Licensing Agency (DVLA) when patients are deemed no longer fit to drive yet continue to do so against medical advice.
Revised GMC guidance on confidentiality has come into effect as of April 25 and includes the key ethical duties and obligations of doctors in relation to fitness to drive issues.
The strengthened guidance clarifies the need for doctors to disclose information to the appropriate authorities in situations where a patient ignores their advice to stop driving and is potentially putting others at risk.
The guidance states that the DVLA are legally responsible for deciding if a person is medically unfit to drive. It is the driver’s responsibility to tell the DVLA about any condition or treatment that affects their ability to drive. However, doctors should alert patients to conditions and treatments that might affect their driving and remind them of their duty to tell the DVLA.
MDDUS medical adviser Dr Barry Parker says: “We have encountered cases where patients disagree with the advice of their doctor 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.
“No doctor wants to find themselves in the position of having to act against their patient’s wishes and breach their confidentiality. After all, doctors are accustomed to acting as patient advocates and confidentiality lies at the heart of the trusted doctor-patient relationship. However, confidentiality cannot be absolute and there are situations where a doctor may have to disclose confidential information in order to protect the public interest, even when consent has been refused by the patient.
The decision on whether or not a patient may drive with a temporary or permanent medical condition or treatment is a matter of clinical and professional 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 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.
Said Dr Parker: “In cases where the patient disagrees with advice that they are unfit to drive, a second opinion can be offered, but the patient must agree not to drive until that opinion has been obtained.
“Should all attempts fail to persuade the patient to stop driving, or the doctor discovers that the patient is continuing to drive against advice and poses a safety risk to the public then this should be disclosed to a medical adviser at the DVLA. This 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.
“If the patient objects to disclosure, then the reasons for this should be sought and considered. Where disclosure is still deemed appropriate, the doctor should do so promptly, and then, write to the patient confirming that this has been done. A note should also be made of this in the patient’s records.”
Doctors should contact their medical defence organisation if they have any specific queries in regard to fitness to drive and making disclosures to the DVLA.