Driving is a central part of most adults' lives. It may not always be a pleasure but the sheer convenience of being able to go where you want when you want means that few of us would give up driving voluntarily.
However, some medical conditions prevent or impose restrictions on patients' driving. The Driver and Vehicle Licensing Agency (DVLA) website directs the following unequivocal statement to drivers:
'If you have a medical condition which has become worse since your licence was issued, or you develop a new medical condition, you must write and inform the Drivers Medical Unit of the nature of your condition, as it may affect your fitness to drive. Failure to do so is a criminal offence punishable by a fine of up to £1000.'
Conditions that must be notified to the DVLA are shown in Figure 1 (below).
|Figure 1: Medical conditions the DVLA must be told about|
Once notified of a patient's condition, the DVLA sends a medical questionnaire to the patient and asks permission to obtain a medical report from his or her GP or specialist.
Who decides who is fit to drive?
In most cases, GPs are not asked to give an opinion on a patient's fitness to drive. The DVLA may ask a GP to do a medical examination and complete a standard form; however, the decision on the individual's fitness to drive then rests with the DVLA.
A GP who is concerned about a patient can telephone the Drivers Medical Unit of the DVLA (see Useful information sources, bottom) and speak to a medical adviser.
One of the most common questions raised concerns eyesight. The DVLA website states:
'It is a criminal offence to drive a motor vehicle if you cannot read a standard number plate in good daylight from 20.5 m (67 feet), using glasses if necessary. If you need glasses or contact lenses to do this, you must wear them every time you drive.'
More stringent criteria apply to drivers of vehicles over 3.5 tonnes and minibuses or buses, whose eyesight must be:
- 6/9 on the Snellen scale in the better eye and 6/12 in the other eye, wearing glasses or contact lenses if necessary
- 3/60 in each eye without glasses or contact lenses.
However, drivers who have held a licence since before 1 January 1997 do not need to meet these standards. The Drivers Medical Unit can give further clarification on this if needed.
Another common query concerns patients with insulin-dependent diabetes. In April last year, the DVLA brought in new regulations governing the eligibility of patients with insulin-dependent diabetes to drive large vans or small lorries between 3.5 and 7 tonnes. These patients can now drive these vehicles subject to an initial medical assessment and a satisfactory annual check-up showing evidence of good diabetic control.
A common area of concern relates to the requirements for a licence to drive a taxi. However, responsibility for taxi licensing rests entirely with the Public Carriage Office in London, and with local authorities throughout the rest of the country. The requirements vary among authorities but do include medical standards.
GPs may be asked for advice and to confirm fitness to drive for patients who present more difficult problems, such as a young person with a history of fainting or a patient who has suffered a cerebrovascular accident „ and here lies the potential vulnerability of GPs.
Giving advice to patients
Before attempting to advise patients, GPs must familiarise themselves with the criteria to be assessed, by checking the DVLA's written guidance or speaking to one of the Agency's medical advisers. The GP must carry out an objective examination, having first made sure that the patient understands the nature and purpose of it.
If, at the end of the examination, the GP provides written confirmation of the patient's fitness to drive, he or she should bear in mind the GMC's guidance on signing certificates and other documents.1 The GMC states:
'Registered medical practitioners have the authority to sign a variety of documents, such as death certificates, on the assumption that they will only sign statements they believe to be true. This means that you must take reasonable steps to verify any statement before you sign a document. You must not sign documents which you believe to be false or misleading.'
If the GP feels unable to confirm a patient's fitness to drive, the DVLA clearly needs to become involved in the assessment and it is the patient's responsibility to contact the agency.
If the patient, now fearful of losing his or her licence, fails to take further action, what should the GP do? He or she should follow the advice set out by the GMC in its booklet on confidentiality (see Figure 2, below).2
|Figure 2: Disclosing informatin about patients to the DVLA|
1. The DVLA is legally responsible for deciding if a person is medically unfit to drive. The Agency needs to know when driving licence holders have a condition that may now, or in the future, affect their safety as a driver.
2. Therefore, where patients have such conditions you should:
3. If patients refuse to accept the diagnosis or the effect of the condition on their ability to drive, you can suggest that the patients seek a second opinion and make appropriate arrangements for the patients to do so. You should advise patients not to drive until the second opinion has been obtained.
4. If patients continue to drive when they are not fit to do so, you should make every reasonable effort to persuade them to stop. This may include telling their next of kin.
5. If you do not manage to persuade patients to stop driving, or you are given or find evidence that a patient is continuing to drive contrary to advice, you should disclose relevant medical information immediately, in confidence, to the medical adviser at the DVLA.
6. Before giving information to the DVLA you should try to inform the patient of your decision to do so. Once the DVLA has been informed, you should also write to the patient, to confirm that a disclosure has been made.
The problem for doctors is that once they know of concerns about a patient's fitness to drive, they cannot let the matter drop. In that well-worn phrase of Sir Donald Irvine, "you cannot unknow what you know".
Before 1995, insurance companies sometimes required patients with certain conditions to undergo medical assessment. However, this no longer happens. The Disability Discrimination Act makes it unlawful for providers of services (including all forms of insurance) to discriminate against a disabled person, either in refusing to provide a service, providing a different standard of service or attaching special terms to, in this case, an insurance policy.
As in every other area of medical practice, the secret to steering clear of trouble is to stay within the limits of your expertise, communicate effectively and keep contemporaneous medical records of each patient contact.
|Useful information sources|
DVLA website http://www.dvla.gov.uk
DVLA Drivers Medical Unit Tel: 0870 600 0301
- Good Medical Practice. 2nd edn. London: GMC, July 1998.
- Confidentiality: Protecting and Providing Patient Information. London: GMC, 2000.