Should healthcare professionals breach confidentiality when a patient is unfit to drive?

Should healthcare professionals breach confidentiality when a patient is unfit to drive?

Should healthcare professionals breach confidentiality when a patient is unfit to drive, asks Daniel Sokol, Medical Ethicist and Barrister in The BMJ.

He describes the case of a three-year-old girl who was killed as she crossed a road with her mother by a 72-year-old driver with poor eyesight.

Three weeks earlier, two optometrists had told the man to stop driving. He pleaded guilty to causing death by dangerous driving and was sentenced to four years in prison.

This case raises the familiar question about medical secrecy, says Sokol.

According to General Medical Council (GMC) guidance, doctors should explain to patients deemed unfit to drive that their condition may affect their ability to drive and that they - the patients - have a legal obligation to inform the Driver and Vehicle Licensing Agency (DVLA) about their condition, he writes.

If the patient continues to drive, the GMC advises that “you should make every reasonable effort to persuade them to stop.” If persuasion fails or the doctor discovers that the patient is continuing to drive, the doctor should contact the DVLA to disclose the medical information.

The trouble with this approach is that it relies on patients’ honesty, says Sokol.

Many patients will lie to avoid the loss of their driving licence. They will falsely promise to inform the DVLA and to stop driving. And the chances of the doctor discovering that the patient is continuing to drive are slim, he argues.

Logic calls for the law of compulsory disclosure to extend to patients deemed unfit to drive or fly, he writes: “The GMC, whose new guidance on confidentiality comes into effect on 25 April 2017, should consider making disclosure to the DVLA mandatory, even the patient confirms that this has been or will be done. To rely on the assurances of patients, in the knowledge that they - like most of us - lie to please others and to get out of trouble, is naive and irresponsible. It can also cost lives.”

This new law would not erode doctor-patient confidentiality, he concludes: “It offers a solution to the reluctance of impaired drivers to appreciate the danger they pose to others, as well as the recognition that some patients will deceive to continue driving.”