As a GP, you are used to looking into the wider issues around a patient’s presenting complaint, such as safeguarding matters or a patient’s social circumstances and living conditions. However, one issue that could be over looked is a patient’s fitness to drive, and we are all familiar with the news stories of drivers suffering medical emergencies behind the wheel, often with fatal consequences.
In this blog, we look at what to do if you’re not sure about a patient’s fitness to drive and the steps you should take if you suspect that a patient will continue to drive after you have advised them not to.
Understanding your obligations around a patient’s fitness to drive
Often assessing fitness to drive will be explicit – you may be specifically asked by the patient, or the DVLA to consider this and all HGV Group 2 licence holders require a regular medical assessment.
GPs also have an obligation to consider fitness to drive matters even if the patient has not consulted specifically in relation to that, and when a patient has made you aware of a medical condition that could impact their fitness to drive.
Individuals driving when they should not can, and sometimes does, have fatal consequences. Many may recall the Glasgow bin lorry crash of December 2014 in which 6 people died and 15 were seriously injured. The driver of the lorry had fainted at the wheel and there was evidence in his medical records that he had previous episodes of unexplained fainting. Unfortunately, that information was not prominent in the records so the GPs that the driver presented to didn’t consider it a significant problem and took no action to stop him driving.
James Stewart of DR Solicitors acted for the GPs in the subsequent Fatal Accident Inquiry, and at that Inquiry criticisms were made that GPs did not appreciate the significance of a history of vasovagal syncope (ie fainting) that did not appear to have obvious triggers. Although the driver’s condition was not prominent in the records and the driver himself hid or minimised the problem, the Inquiry found that some of the GPs involved were not clear on their responsibilities as they relate to fitness to drive matters.
Carrying out your obligations
As the GMC guidance on fitness to drive states in its preamble:
“If a patient has a condition that could affect their fitness to drive, it’s their duty to report it. But as their doctor you have responsibilities as well”
The GMC guidance was updated in March 2023 and should be a GP’s first port of call if they have any concerns that a patient may be unfit to drive for whatever reason.
If a patient is assessed as unfit to drive, the first step is to advise the patient that they are not fit to drive and that they should report themselves to the DVLA.
Whilst many patients will accept that they are no longer safe to drive, others will be very resistant to any suggestion that they should no longer drive as it can significantly curtail their freedom and in some cases their livelihood.
Here it should be remembered that whilst doctors have a duty of care to their patients they also have duties to the public at large, as the guidance states:
“Doctors owe a duty of confidentiality to their patients, but they also have a wider duty to protect and promote the health of patients and the public”
The consequence of this wider duty is that if certain criteria are fulfilled, then a doctor can breach patient confidentiality and report a patient to the DVLA without their consent. Clearly this is going against one of the fundamental principles of the medical profession and should be a last resort.
As per the guidance:
“If it is not practicable or appropriate to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential”
Such a fundamental breach of patient confidentiality should not be taken lightly and we would recommend taking professional advice before doing so.
Doctors should only report a patient to the DVLA without their consent when all the other options have been exhausted. Make sure you consult with the relevant GMC guidance very carefully before taking any action, as it lays out the various steps that must be undertaken before confidentiality can be breached.
As you might imagine, the patient involved may raise a complaint for breach of confidentiality, but you cannot allow the threat of a complaint deter you from your obligation to report.
If in doubt, doctors would also be well advised to take advice from senior colleagues or discuss with their defence organisation or discuss with DR Solicitors.
For further information about this or any other regulatory matter, please contact us on 01483 511555 or by email firstname.lastname@example.org