Driving post seizure Flashcards
You are the medical SHO in the Ambulatory Care Unit. You are reviewing a patient who was seen in AMU last week. He is 26 years old and presented initially following a seizure. No cause was found and he was discharged. No medication was started and follow-up was arranged in the first seizure clinic in two months time. He has come in today to have a repeat blood test and general review. You note in the discharge summary that the patient was advised to stop driving. However, when the patient sits down he puts his car keys on the table.
How would you approach this issue?
This scenario raises the issue of patient safety and safety of others.
I would start by introducing myself to the patient and asking about his wellbeing since discharge – has he had any more seizures? I would then ask him what information he was given or remembers being told following his seizure. It may be that he was never told any of this information.
Then, I would need to establish if the pt is still driving - I would ask outright. If he tells me he is still driving I would impress upon him the need to stop driving and explain how he must inform the DVLA that he had a seizure.
I would explain that he is potentially a** danger to himself and others** if he continues to drive, since he could have another seizure at the wheel. I would also explain to him that he would not be covered by his insurance him if he drives following his recent seizure.
Throughout the consultation I would remain non-judgemental and empathise with the patient, acknowledging the impact this will have on his life.
Following this the patient informs you that he understands the risks but that he needs to drive and is not going to stop. What would you do next?
Seek info - I would try and understand the reasons behind the pt’s decisions.
* He may rely on his car for work / family reasons.
* Exploring these concerns may be enough to help us achieve a resolution without the need for breaching confidentiality
If the patient continues to refuse to inform the DVLA and stop driving then I would explain that I have a duty to inform the DVLA and breach confidentiality, as I feel he poses a significant risk to the public.
At this point the patient gets angry and shouts that he will sue you if you tell the DVLA. Who could you ask for help in this situation?
Since I tried to explain but they have not listened, I would ask my reg or consultant for help - they may have more success in getting him understand the reasons behind why he should inform the DVLA of his seizure and stop driving
This will also reitrate to the pt that we have a responsibility to tell the DVLA if we think that he will continue to drive. It is preferable that the pt speaks to the DVLA himself rather than us breaking confidentiality. But this may be unavoidable if he refuses to do so.
Why is confidentiality important?
Confidentiality is integral to the doctor patient relationship. Without it there would be no trust and patients may not divulge information essential for their care. Confidentiality is part of patient autonomy and patients have a right to choose who their information is shared with.
When can confidentiality be breached?
In all circumstances steps should be taken to avoid breaching confidentiality. However, in principal confidentiality can be breached in one of three justified situations:
- The patient consents
- Disclosure is in the patient’s best interest, and it is neither appropriate nor practical to seek consent
- Disclosure is in the public interest.
If a patient has refused to stop driving, despite advice, would you inform their employer?
No, as this would be a confidentiality breach – telling their employer without their consent would mean informing them of a patient’s health information without permission, which risks significant damage to the patient-doctor relationship.
If confidentiality does need to be breached in a case like this, it should be as a very last resort, and only if in the patient or public’s best interests. The correct course of action would be informing the DVLA, and not the patient’s employer, if so.
In what other conditions should patients be informed to contact the DVLA and refrain from driving for a determined period of time?
There is a specialised unit within the DVLA called the Driver’s Medical Group, which has the task of deciding whether individuals are fit to drive. Within this group are different panels specific to a range of disorders where patients must inform the DVLA of their condition. The different panels include:
- Alcohol Drugs and Substance Misuse and Driving
- Cardiovascular System and Driving
- Diabetes Mellitus and Driving
- Disorders for the Nervous System and Driving
- Psychiatric Disorders and Driving
- Visual Disorders and Driving
