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.
A sample of my compiled report of US state reporting laws is shown below. Click it or this link to download it.
To read Part 1 of this article, click here.
- Physician’s Guide to Assessing and Counseling Older Drivers 2e. NHTSA / AMA, 2010.
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.
Tomorrow, I’ll give a state by state description of the applicable reporting laws and a sample letter to send to the license bureau. Click here to view.
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.