I was cycling to work last week when a car swerved out from a parking bay and nearly finished me off. I was too shaken to abuse the driver, and it was lucky I didn’t. She wound down the window to apologise and I recognised the tremulous, apologetic lady as one of my patients.
Tricky situation.
She wasn’t looking when she pulled out, but she says it’s never happened before. She’s never been in an accident and is in reasonable health. Should she be driving? Is she dangerous? Should she tell the DVLA? Should I, if she doesn’t?
The General Medical Council is consulting on draft guidance over the thorny question of confidentiality. Should a doctor inform the DVLA if they know a patient is driving when they shouldn’t be? The answer, at the moment, is that a doctor must inform the DVLA if a person continues to drive against medical advice. Every effort is made to encourage a person to stop driving and inform the DVLA themselves. But if they don’t, doctors have a duty to do so.
Confidentiality is sacrosanct only unless and until a person is a danger to themselves or others. The new guidelines will seek to reinforce the doctors’ duty to inform the DVLA even if their patients don’t want them to.
The problem is that it isn’t always possible to known what “medical advice” to give. Some situations are very clear-cut, and are covered by DVLA guidance. DVLA guidelines distinguish between car and motorbike drivers (group 1) and lorry and bus drivers (group 2), where conditions are stricter for group 2.
Group 1 drivers don’t need to stop driving or inform DVLA if they have high blood pressure, so long as treatment isn’t causing side-effects. So if you have heart valve surgery, you need to stop driving for four weeks but you don’t need to notify DVLA. If you have epileptic attacks, seizures, fits or blackouts, you do have to inform DVLA, and stop driving until told it’s safe to do so. Most often, whether someone is safe to drive or not is a borderline call; just because someone nearly kills me doesn’t necessarily mean they’re unfit to drive.
Our roads are getting safer, even though it doesn’t always feel that way. In 2014 1,775 people died in car accidents in the UK. That was 45% fewer than a decade earlier. In 2013, 35% of road fatalities were caused by loss of driver control, 26% were because “driver/rider failed to look properly” and 20% were attributed to careless or reckless driving or being in a hurry.
Drink-driving fatalities were seven times lower than in 1979 but still contributed to 230 of the 1,754 deaths in 2013. Every road fatality is a tragedy, and most are preventable. The question is: what role do GPs have in helping to make our roads even safer?
Taking away someone’s right to drive is a big deal. Driving is a lifeline for many people who have mobility problems and can’t stand at bus stops, clamber on and off buses or navigate the tube. Many older people find public transport difficult to manage. Stopping them driving can lead to social isolation, effectively imprisoning them at home.
British drivers have to reapply for a licence at 70 and every three years after that. There’s a declaration to sign that you “meet the minimum eyesight requirement” and you “aren’t prevented from driving for any reason”. The RAC has published an interesting report into using self-assessment tools to allow elderly drivers to make their own decision. It urges the government to take a lead in adopting these tools.
According to the report: “Ultimately, the problem remains that there is no consistent support system in place to assist members of the public with decisions about driving in older age. Although the majority of motorists cease driving at the right time, up to a third may be stopping driving earlier than necessary, with a further 10% continuing to take to the roads with poor levels of driving fitness.”
Above all, drivers have to take responsibility for their own actions – and that includes fessing up when you no longer feel safe.
To patients who canvass my view on whether or not they are fit to drive, I pose this question: “If a small child ran in front of your car, could you do an emergency stop?” Some say yes even as members of their family clamour for them to stop driving. I have no objective test to offer.
There’s work to be done to make our roads safer but it’s not reasonable to expect GPs to police the system. We haven’t got the time, the will or the expertise to make a detailed assessment of who is and isn’t fit to drive.
