One of the toughest aspects of a physician's job is delivering bad news to their patients. Having to tell an older patient that he or she is no longer fit to drive a car translates to a life-changing and frightening prospect.
To an older person, losing the privilege of driving signifies the loss of their life-long freedom and independence. But it's an important conversation for the patient's healthcare team to have: It can be a matter of life and death, not to mention one with legal implications. Following are guidelines for administrators to encourage physicians who must advise their older patients not to drive.
A physician's role in determining driving safety
Physicians have a unique role, because they know things about their patients' well-being they may not have shared with their families. Older patients, especially, can be secretive about matters concerning their health, even with their loved ones. Physicians have access to health information these patients may have a tough time accepting. It's essential that their healthcare team use this insight to protect their wellness.
Age itself is not a decisive factor when it comes to driving ability, but certain health conditions that tend to be more common in older people can make a driver dangerous on the road. The link between unsafe driving and certain health conditions is fairly obvious. Dementia and failing eyesight, for example, present clear hazards when you're behind the wheel. With other conditions, the risks may not be immediately obvious to patients. In certain cases, conditions such as angina, severe arthritis, abnormal heart rhythms, epilepsy and advanced diabetes could impact driving safety.
If a patient who drives regularly suffers from conditions that make driving unsafe, it can put healthcare providers in a difficult position. Some states—namely, California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania— require physicians to file a report with motor vehicle authorities if they have a patient suffering from conditions that could impair driving ability. While doctors are sworn to protect a patient's confidentiality, they also have a responsibility to protect the public at large from the danger posed by an unsafe driver. Meanwhile, in other states, doctors who report patients may be at risk for being sued by the patient for violating confidentiality privileges.
Most patients and their families would prefer that a doctor speak with them directly instead of contacting the authorities. In states that don't call for mandatory reporting, this is typically an ideal path to take, as it is a more compassionate approach and less risky from a legal perspective.
The importance of a frank discussion with patients and family members
For physicians who have a patient who is currently driving but whose health dictates it's time to hang up the keys, it's important to have a candid talk with the patient. Patients may not be fully aware of just how much of a threat certain illnesses can pose if they continue driving.
Patients who should no longer be driving may face certain common issues. They're likely to bump into things when pulling into and out of parking spaces, and they may experience a rash of fender-benders on the road. Some patients do a remarkably effective job of blinding themselves to this problem, but their cars will bear the scars of their plight. Advise patients to inspect their vehicles for damage. Seeing dents and dings on a vehicle can sometimes force a patient to admit there's a problem.
Physicians should let their patients know that driving after they have been advised not to do so by a medical professional carries financial risks. If they face expenses after an accident, their insurance carrier may not cover the loss after learning they shouldn't have been behind the wheel in the first place.
Physicians may also speak with a patient's family, which can be especially useful if he or she is ignoring the advice. A patient may be more likely to stop driving if loved ones are applying pressure. Also, family members are in a better position than doctors when it comes to discerning whether a patient is still driving.
Let family members know they have options if their requests that their loved one stop driving fall on deaf ears. One is to get the family lawyer involved. If a driver who's been advised to stop driving has an accident, the whole family could be targeted in a lawsuit. Being spoken to by a lawyer may be enough to get a patient to hand over the keys.
If none of this works, family members can take steps such as hiding the keys or disabling the patient's car battery. This approach may be deceptive, but it can be incredibly effective at protecting the patient's safety.
The outlook and alternatives
It's important for physicians to let patients know that not being able to drive doesn't mean becoming a recluse. Many cities have public transportation systems geared toward serving those with health difficulties, and it is frequently far less expensive to take advantage of these services than it is to maintain a car. In addition, many senior centers and community centers offer ride-sharing and transportation programs that can take older drivers where they need to go and help them maintain their freedom.
Encourage physicians to communicate the severity of the situation and how alternatives can help older people maintain their independence. Most people would rather not put themselves in a position where they are a danger to themselves or others. A patient who fully understands the risks and available options is more likely to willingly surrender the keys.
Counseling patients about giving up their driving privileges requires a delicate approach. Be firm in communicating the dangers of the situation. At the same time, proceed with empathy. If we're lucky, we all get older, and we could someday find ourselves in the same position as these patients.
Warren Clarke is a consumer advice writer for CARFAX where he shares tips about car buying and maintenance. He is also passionate about driver safety and knowing the right time to hang up the keys.
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