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mixed signals
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The surgeon’s role in advising patients of their fitness to drive can be ambiguous. Gareth Evans
and Chris Oliver point you in the right direction
What should you tell a patient who asks if they can
drive after injury? The situation is especially difficult
when they have been given a plaster cast. Patient
education and understanding has increased in recent
years. This has led, unfortunately, to an exponential
increase in complaints and claims of malpractice. So,
not only does today’s surgeon need to have a thorough
understanding of the pathophysiology of disease and
injury and an up-to-date knowledge of the evidence-
based treatment options, they must also be armed
with an appreciation of other aspects of a patient’s
needs, including claims related to injury at work, and
fitness to drive.
Recently in the medical press there have been a
number of articles addressing the medical community’s
level of understanding on how knowledge regarding a
patient’s potential fitness to drive should be handled.
There are two main facets to this: firstly, to define the
need to contact the Driving Vehicle Licensing Authority
(DVLA), and, secondly, the need to contact the
patient’s insurer. In both cases it is essential to clarify
who should be responsible for this.
Clearly, common sense must be employed to deal
with this issue appropriately, but it is clear that the
surgeon has some part to play. The Driver and Vehicle
Licensing Agency’s website insists they be informed if
‘you have ever had, or currently suffer from … impaired
limb function’. Within orthopaedics, for example, the
implication of this instruction means that huge numbers
of patients should be advising the DVLA of their injury
to ascertain whether they are fit to continue driving.
The website does not instruct doctors that they
have an obligation to inform the DVLA of any aspect
of a patient’s fitness to drive. They may be asked, with surgeonsnews
the relevant consent, to provide a report for them. month year
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The online form that the patient is offered to a satisfactory emergency stop, then it is reasonable to
head
complete asks whether they have ‘misused alcohol’ advise them against driving.
The patient might, however, rely on driving for their
in the past three years. With an increasing number of
livelihood. If they follow their doctor’s advice to stop
alcohol-related injuries, the DVLA should see a steady
driving and later learn that it is their responsibility to
rise in the number of such cases. Interestingly, the
determine fitness to drive, rather than the doctor’s,
DVLA does not cover Northern Ireland, and their
could the practitioner find themselves answering a
licensing authority is Driver and Vehicle Licensing
complaint with regards to a loss of earnings?
Northern Ireland (DVLNI). The DVLNI website insists
Nowhere in the recent literature does it state that
on being informed of ‘continuing/permanent difficulty
the doctor is in any way responsible for ascertaining
in the use of arms or legs which affects your ability to
a patient’s fitness to drive, with respect to injury or
control a vehicle’, but again it is the responsibility of
recent operation. It would therefore be reasonable
the patient, rather than the doctor to inform them.
simply to refer the patient to both the appropriate
While there are only two licensing authorities in
licensing authority and their insurer. If any dispute
the UK, there are numerous companies offering car
arises, then by quoting Section 94 of the Road Traffic
insurance, many of which use the same insurance
Act 1991 (1988), you should firmly re-iterate that it
underwriters. It is, therefore, more difficult to provide
is the patient’s responsibility to inform the relevant
advice for a patient with regards to informing their
licensing authority of ‘any health condition likely to
insurer of any recent medical ailment or injury.
affect their driving’.
In a recent publication on the safety of driving while
If a dispute arises over insurance, then either
wearing plaster-immobilisation, a questionnaire was
patient or insurer should be advised that their doctor
sent to 27 car insurance companies. A poor response
could make a recommendation, formally, in writing,
was received to requests for a stated position on what
with patient consent, after appropriate training and for
should be reported to them. Only three companies
a standard fee. Clearly, this would not necessarily be in
chose to respond, and only one response was adequate.
the patient’s best interest but would avoid the risk of
It stated that the patient should seek advice from their
litigation resulting from an informal assessment, made
doctor with regards to fitness to drive.
without adequate training and in the absence of proper
It would appear from this, that there is a reluctance
guidance.
by insurers to define clearly what should be reported to
The surgeon has a role to play in the assessment
them; many simply choosing to place the onus on the
of a patient’s fitness to drive, but the patient must
doctor to confirm fitness to drive.
maintain ownership of the primary responsibility of
Quoting directly from the Highway Code, a informing both DVLA/DVLNI and their insurer.
representative of the Association of Chief Police
Officers states that it is the driver’s responsibility to Gareth Evans, SHO Orthopaedic Trauma
ensure fitness to drive; somewhat contradicting the Gareth.Evans@luht.scot.nhs.uk
view of the insurers. Chris Oliver, Consultant Trauma Orthopaedic Surgeon
Common sense should always prevail; it might be Edinburgh Orthopaedic Trauma Unit, Royal Infirmary
reasonable to make an educated guess as to whether of Edinburgh
a patient can safely drive and advise them as such. cwoliver@rcsed.ac.uk
If a patient is unable to control a vehicle adequately,,
then clearly this poses a danger to the driver and other References are available on the website:
surgeonsnews
people. If a patient, for instance, is unable to perform www.surgeonsnews.info
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