I’ve had a busy old day in the media, and it’s all to do with driving. The General Medical Council (GMC) has just announced beefed-up guidance for GPs about informing the Driver and Vehicle Licencing Agency (DVLA) if their patients shouldn’t be on the roads. There are 37 million drivers in the UK, and nearly 160,000 notifications to the DVLA last year of drivers being unfit to drive – but the GMC believes doctors should be doing more.
Doctors take confidentiality extremely seriously – if we didn’t, our patients couldn’t trust us. The importance of protecting your patient’s privacy is drummed into us from the first day at medical school. That’s almost certainly why so many doctors have reported feeling anxious about reporting their patients to the DVLA, even if they feel the DVLA needs to know and the patient has refused to do it themselves.
But we also have a duty to the public – and we’re in a unique position to know if someone if likely to be putting themselves and others at risk if they keep driving against medical advice. I’ve been a GP trainer for over 20 years, and for years I ran mock ‘viva’ exams for my registrars going through their final exams. One of our favourite questions related to a patient with early dementia and failing eyesight, who swears blind they’ve stopped driving. Just after seeing them one day in surgery, you get called to the practice car park by the receptionist – to find the patient has backed straight into your car and is now panicking and making matters worse by shunting backwards and forwards, unable to work out how to get out. What do you do? It’s a tricky ethical dilemma and I think you can imagine the range of answers I’ve had over the years.
The DVLA has very comprehensive guidelines on which conditions could affect your ability to drive safely and when it’s illegal to drive or when you have to inform the DVLA so they can carry out further tests. These include angina, heart attack, stroke, abnormal heart rhythms, epilepsy other nervous system disorders, dementia, diabetes (type 1 and type 2), mental health problems, drug and alcohol misuse, eyesight issues and many others.
As things stand, doctors have a duty to tell the patient if they feel they should stop driving or inform the DVLA. The onus is on the patient to pass the information on. But if the patient doesn’t accept this, you offer them a second opinion. If this still doesn’t do the trick, you make ‘every reasonable effort’ to persuade them, including (with their permission) enlisting their carers or relatives. It’s only as a last resort – if the doctor can’t persuade them or discovers the patient is still driving despite all this – that you tell the patient you’re going to inform the DVLA yourself, and confirm this in writing to them afterwards.
The new guidance isn’t exactly new – GPs should still be doing everything they can to persuade their patients to inform the DVLA themselves. But it does spell out the duty of every doctor to put public safety above patient confidentiality if there is a clear conflict. It also reminds GPs to have patients’ fitness to drive at the forefront of their minds when they’re seeing them for any long term condition. Many of the listeners I heard when I was interviewed on this subject today were worried about old people being discriminated against, or losing their independence. This guidance really isn’t about that – nor is it about instructing doctors to throw confidentiality to the winds and pass out information about all and sundry.
It may even help some patients. If it opens up a discussion about staying safe on the roads, we may be able to educate more people about simple tests which could keep them driving. This week is Road Safety Week, and the road safety charity Brake has just produced a new survey showing that 5 million drivers admit to driving with less than perfect vision; while one in five has avoided visiting an optician even if they’ve noticed a problem with their vision; and 4% of drivers has never had a proper eye test from an optometrist. 2,900 casualties a year in the UK are down to poor eyesight, and many of these could be prevented by regular visits to the optician.
Will this change your relationship with your GP? No. Will they stop taking confidentiality seriously? Categorically not. But if you ever drive or travel by bus or car, it could make the roads just that little bit safer.
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