Most states have implemented graduated driver license laws for teen drivers over the past 10+ years. Typically, these laws place age limits, approved times of day for driving, and passenger restrictions on young drivers. There is a growing body evidence that these laws have decreased the number of crashes and injuries/fatalities involving new drivers.
A group at the University of Rochester looked at changes in injuries and deaths in new driver related crashes over an extended period in New York state. During this time, the state first implemented graduated licenses, then added further restrictions on passengers under age 21 six years later. Some interesting patterns emerged.
Here are the factoids:
Before graduated licenses were implemented in New York, young drivers made up 4.2% of all fatal crashes and 3.3% of all personal injury crashes
After implementation of graduated licenses (time of day restrictions), the numbers dropped to 2.9% of fatal crashes and 2.7% of personal injury crashes
When the number of youthful passengers was further limited, the fatality rate for those young riders decreased from 43% to 37%. Injury rate also decreased from 41 to 37%.
Driver fatalities and injuries also decreased further after the number of young passengers was limited (numbers not listed in abstract). [Fewer distractions?]
Bottom line: Graduated driver license laws have been passed in nearly every state (with the exception of Vermont [no night-time driving restrictions], and Florida, South Dakota, Virginia [no young passenger restrictions]). It appears that these laws have reduced the number of deaths and injuries in young drivers. But the unintended consequence is that it has also reduced those numbers in the few young passengers they are allowed to carry as well.
So what should you do if you encounter a patient that really shouldn’t be driving? First, encourage them and/or their family to self-report. If that fails, familiarize yourself with the laws of your state (or province).
In the US, 11 states have mandatory reporting laws for certain conditions that would impair driving. Forty have some type of reporting system for phsyicians and other health professionals. Many allow anyone to report. However, a few stipulate that they may release your name to the driver or that you must have their permission to report. This is essentially the same as not allowing you to report.
Unfortunately, only 29 states hold you harmless from civil or criminal suit if you choose to report. I suspect it would be a tough sell convincing a jury that a patient’s inconvenience is more important than protecting them from an unsafe driver, though. I doubt such a suit would go anywhere.
So brush up on the laws and procedures in your state and decide what is in your patient’s (and the public’s) best interest. Then do the right thing.
We’ve all taken care of patients that either have a baseline condition or have sustained an injury that renders them unfit to drive. What issues need to be considered with regard to keeping them off the road?
There are a number of ethical and legal considerations. As a physician or other healthcare provider, you have three priorities. In order, they are:
Duty to protect your patient
Duty to protect the public
Duty to maintain patient confidentiality
Note that the duty to protect the public supersedes the need to maintain confidentiality. However, if the patient knows that their confidentiality may be violated, they may be less likely to seek treatment, disclose key information, or trust you.
The ideal method of dealing with a driver whom you believe is unsafe is to have a frank discussion with them (and their family, if permitted) regarding why you think they should stop driving and the consequences of failing to do so. They should be encouraged to stop driving voluntarily, or self-report to the license bureau so they can be re-evaluated. It is also very important to encourage the family to support the decision and provide alternative transportation to meet your patient’s needs. Social services should be involved so that transportation alternatives and resources can be provided.
If your patient refuses to surrender their license or self-report for retesting, then you need to consider reporting them to the license bureau yourself. Before doing this you should exhaust all possibility that the patient will stop driving voluntarily. You must also be knowledgeable of your state laws so you know what kind of protections (if any) are given to you after reporting.
Will Our Phones Help Save Us From Being Distracted By Our Phones?
I’ve written many posts on the perils of texting and driving. Everybody knows it’s bad, but they still do it. It’s tough for police to detect, let alone enforce.
How to deal with this problem? Well now, there’s an app for that!
AdelaVoice has released a free app for Android phones that allows the user to interact with their phone without touching or even looking at it. It’s called StartTalking and lets the user send and listen to texts, post to Twitter or Facebook, as well as other tasks. To visit their website, click here.
I think that this app could dramatically improve road safety if it works as advertised. However, I also don’t think it’s the final answer, because research has also shown that just talking on the phone is a distraction and leads to accidents, too.
It will be very interesting to see where this type of solution leads us.
Disclosure: I have no financial interest in AdelaSoft or StartTalking. I don’t even own an Android phone!
During a single week in April, there were 18 driving deaths in Minnesota, most of them involving teens. In at least one crash, the driver was in violation of several of the state’s graduated driver license provisions. Graduated licensing is increasingly popular across the country, and incidents like this are prompting our legislators to tighten them.
One big problem is that each state sets its own licensing standards. And since most states insist on reinventing their own wheel, a patchwork of state standards has been enacted. Some have higher age minimums for obtaining a license. Others limit night driving or number of underage passengers. Most states have addressed phoning and texting while driving.
There is now a push in the US Senate to standardize graduated licensing rules in all states so there is a more even playing field.The proposed legislation would:
Make getting a driver’s license a 3 step process, including a learner’s permit, a restricted license, and finally an unrestricted license.
Prohibit nighttime driving without an unrestricted license.
Prohibit cell phone use without an unrestricted license.
The proposed law makes sense. Accident research has shown that states that adopt a more restrictive licensing policy see a significant reduction in crashes, and a reduction in injury crashes of nearly 40%. Fatal crashes in young drivers was reduced by a whopping 75% in these states!
The major problem with the proposed legislation is that the penalties for states not complying are rather heavy-handed. Such states would face losing some of their federal highway construction funding. Many states would face this issue soon if the law was enacted as it is now written.
Concerned parents should communicate with their legislators and support these efforts to protect their children. More immediately, though, parents need to be involved in the driving decisions of their children. Don’t allow them to drive after dark. Limit the number of passengers they can carry. Require them to use their seatbelts. And make sure they understand the consequences if they choose to break these rules: immediate and non-negotiable loss of driving privileges for a set period of time.
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