Doctors must inform the DVLA if a patient continues to drive against medical advice, according to new guidance from the General Medical Council (GMC).
The new guidance, which emphasises a doctor’s duty to disclose information where the patient has failed to act, is part of a public consultation on the GMC’s core guidance on confidentiality.
The GMC has moved to clarify its stance that confidentiality is not absolute after feedback from doctors revealed that they often feel anxious about being criticised if they disclose information.
It advises that doctors should disclose information if it is necessary to protect individuals or the wider public from risks of death or serious harm – whether that is from violent crime, serious communicable diseases, or the risks posed by patients who are not fit to drive.
However, the GMC adds that these steps should only be taken as a last resort, if efforts to encourage the patient to act responsibly fail.
The guidance also emphasises that when they diagnose a patient’s condition, or provide treatment, doctors should keep the patient’s ability to drive safely at the forefront of their minds.
Niall Dickson, chief executive of the GMC, said: “Doctors often find themselves in challenging situations. This is difficult territory – most patients will do the sensible thing but the truth is that a few will not and may not have the insight to realise that they are a risk to others behind the wheel of a car.
“A confidential medical service is a public good and trust is an essential part of the doctor-patient relationship. But confidentiality is not absolute and doctors can play an important part in keeping the wider public safe if a patient is not safe to drive.
“We are clear that doctors carrying out their duty will not face any sanction – and this new guidance makes clear that we will support those who are faced with these difficult decisions.’
Steve Gooding, director of the RAC Foundation, said: “37 million drivers depend on the car for getting about and for those with serious medical conditions there is a real fear around losing their license. But with the right treatment many illnesses will not lead to people having to hang up the keys.
"The worst thing motorists can do is ignore medical advice. If they don’t tell the DVLA about something that impacts on their ability to drive safely then their GP will.
“Depriving someone of their ability to drive can create its own set of social and health issues and doctors will take reasonable steps to help keep people mobile, though not at the cost of endangering the wider public. Ultimately the way forward must be for doctor and patient to work together rather than in isolation.”
The road safety charity Brake has also welcomed the strengthening of guidelines.
Gary Rae, Brake’s director of communications and campaigns, said: “This is a positive move by the GMC, which will clarify the responsibilities and duties of both doctor and patient. We do recognise that, previously, doctors have been in a difficult position regarding confidentiality of their patients but the guidance makes it clear that this confidentiality is not absolute.”
The final GMC guidance is expected to be published in late 2016.
A Doctor’s job is not to weigh up the chances of his patient killing another road user against the ‘certainty’ of his patient dying as a consequence of having a licence taken away. The Doctor needs to judge whether the patient is mentally and physically fit to drive, and no more. If they are to assess whether the life a patient in their twilight is worth more than a child spending their existence in a wheelchair after a collision, then we are getting into the area of asking how many angels can dance on the head of a pin.
If they cannot make such relatively simple judgements, then we must call into question their ability to practise medicine.
David, Suffolk
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I agree with Duncan.
Whilst driving can extend the independent mobility of the elderly at some point then that mobility will end. And if that has been at the expense of other physical activity such as walking, using public transport, taxis or cycling then the transition to a “car” free life will not be “care” free and for some will not be possible due to poor physical condition or dementia.
Hence it is so important to give the elderly alternatives to “only driving” and also encourage them to maintain their use of those alternatives. Free bus passes are so important to this continued physical mobility for the elderly. They extend the range of walking and can provide variety in new places to see and explore.
And, of course let’s not forget cycling as well. Even without cars, the elderly can enjoy a rich mix of travel through walking, public transport and cycling. And in doing so they have just as much right to enjoy and use our road network as anyone else.
Rod King, 20’s Plenty for Us
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According to my late Father’s Doctor, removing an older person’s driving licence is essentially condemming them to death because once the licence has gone their rate of cognitive and physical decline accelerates rapidly. His take on it was that he would be gambling on the remote possibility of my Dad killing somebody against the fact that it would definitely kill my Dad.
His recommendation was to ensure that Dad had an alternative way of getting about and for him to get used to that whilst still retaining the car. Once he had become content that the alternative was just as good then it would be possible to have his car mysteriously fail to start one day and so I could take it away for ‘repairs’. This is what we did and although my dad would occasionally enquire whether his car had been fixed or not I would tell him they were waiting for parts which usually satisfied him for a week or two.
Perhaps a leaflet detailing all these various methods of stopping someone driving without condemning them to death might be of greater value than placing our friends in the medical profession in an unenviable situation?
Duncan MacKillop. No surprise – No accident.
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We do not have the resources for “annual or bi annual assessments” nor, on a benefit/cost basis, should they be found, inevitably at the expense of more worthwhile measures.
Idris Francis Fight Back With Facts Petersfield
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Bob
When I referred to “safe system” I was meaning within the road safety and transport context rather than a “safe system” for medical tests.
ie: Safe System is the term used internationally for an approach which:
recognises that, despite preventive efforts, road users are fallible and collisions continue to happen on the roads;
places responsibility upon providers of the transport system for the safety of the system and responsibility upon users of the system for complying with its rules and constraints;
aligns safety management goals with wider sustainability goals including social, economic, environmental and health goals;
and seeks out and shapes actions to reduce death and serious injury with the vision in mind.
Rod King, 20’s Plenty for Us
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David.
They were extremely unfortunate circumstances and it begs the question as to why such an old person was driving a dust cart. That said there are no doubt circumstances of illnesses that have never been identified and which have caused a driver to crash. What if a driver doesn’t go to see a doctor. Under what circumstance could they be deemed to be dangerous? Not all old people present with problems to a doctor that might inhibit their ability to drive. It would beg the question in circumstances where an elderly driver has an accident and where there may be a subsequent loss of life and in the event of that driver having seen the doctor, would questions be asked of the doctor? As I see it regular assessments would be more in order.
Rod
I believe that the system does its best to accommodate all who may wish to drive. A newly qualified driver is understandably not the best or indeed the safest driver in the world as he lacks experience and so as he gains that experience we anticipate that he will become that better driver. Without checks its an assumption that that will in fact take place. In order the verify a driver’s competence should we therefore have a retest every year. Or as we are now doing with young drivers, monitoring them electronically. I believe that there would be a system in place if annual or bi annual assessments were required.
Bob Craven lancs…Space is Safer Campaigner
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If you think that Doctors ought not to report patients whom they think are unfit to drive to the DVLA, then may I refer you to the case of the Glasgow dustcart driver and the six people whose lives were lost?
David, Suffolk
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This is an interesting article. What interests me is the idea that our road system should be designed and managed in a manner which allows people to use it safely even if they do not have the perfect spatial acuity and driving skills that we may well aspire to but are beyond the practical and physical attainment of many.
There is a curve of cognitive skills and experience which improve with age from teens and then a set of acuity skills which gradually reduce with age. And age brings ailments which may effect our ability to cope with the challenges of driving or walking and cycling in such a busy and crowded road network.
So what levels should our “safe system” approach to road safety plan for? Should it be around the skills of the fittest, the most able to be focused and alert, those with the greatest spacial acuity? Or should we have a more tolerant system and set of laws and management practices which take account of the negligent* and imperfect driver? Once we can decide that as a society, we will be better placed to understand when and how doctors should intervene.
*Note that the judgement in the Yetkin v Newham civil case was that “Highway authorities owe a duty to all road users (whether careful or negligent) to use reasonable care in the manner in which they exercise their powers when creating or maintaining roads and highways”
Rod King, 20’s Plenty for Us
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Why? Doctors don’t inform the police every time they have a mentally ill person who might, just might, commit a murder. So why should they be required to notify of a person who may not be as quick as a younger person would be? Let’s have the elderly like me undertake a safety assessment and see whether we are dangerous on the road or maybe just slowing down a bit. This could then end up with elderly people not worrying about a full blown test but one that would indicate if they have a problem, help to put it right or in bad cases advise them to give up driving. This assessment would be done by qualified driving examiners as if the candidate had been ill and had previously surrendered his licence and was returning to driving later.
Bob Craven Lancs…Space is Safer Campaigner
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