Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Fitness to Drive in a Plaster

226 views

Published on

  • Be the first to comment

  • Be the first to like this

Fitness to Drive in a Plaster

  1. 1. s e c t i o n h e a d 1 surgeonsnews month year volno.-issue no. 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 the relevant consent, to provide a report for them. mixed signals 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
  2. 2. 2 s e c t i o n h e a d surgeonsnews month year volno.-issue no. The online form that the patient is offered to complete asks whether they have ‘misused alcohol’ in the past three years. With an increasing number of alcohol-related injuries, the DVLA should see a steady rise in the number of such cases. Interestingly, the DVLA does not cover Northern Ireland, and their licensing authority is Driver and Vehicle Licensing Northern Ireland (DVLNI). The DVLNI website insists on being informed of ‘continuing/permanent difficulty in the use of arms or legs which affects your ability to control a vehicle’, but again it is the responsibility of the patient, rather than the doctor to inform them. While there are only two licensing authorities in the UK, there are numerous companies offering car insurance, many of which use the same insurance underwriters. It is, therefore, more difficult to provide advice for a patient with regards to informing their insurer of any recent medical ailment or injury. In a recent publication on the safety of driving while wearing plaster-immobilisation, a questionnaire was sent to 27 car insurance companies. A poor response was received to requests for a stated position on what should be reported to them. Only three companies chose to respond, and only one response was adequate. It stated that the patient should seek advice from their doctor with regards to fitness to drive. It would appear from this, that there is a reluctance by insurers to define clearly what should be reported to them; many simply choosing to place the onus on the doctor to confirm fitness to drive. Quoting directly from the Highway Code, a representative of the Association of Chief Police Officers states that it is the driver’s responsibility to ensure fitness to drive; somewhat contradicting the view of the insurers. Common sense should always prevail; it might be reasonable to make an educated guess as to whether a patient can safely drive and advise them as such. If a patient is unable to control a vehicle adequately,, then clearly this poses a danger to the driver and other people. If a patient, for instance, is unable to perform a satisfactory emergency stop, then it is reasonable to advise them against driving. The patient might, however, rely on driving for their livelihood. If they follow their doctor’s advice to stop driving and later learn that it is their responsibility to determine fitness to drive, rather than the doctor’s, could the practitioner find themselves answering a complaint with regards to a loss of earnings? Nowhere in the recent literature does it state that the doctor is in any way responsible for ascertaining a patient’s fitness to drive, with respect to injury or recent operation. It would therefore be reasonable simply to refer the patient to both the appropriate licensing authority and their insurer. If any dispute arises, then by quoting Section 94 of the Road Traffic Act 1991 (1988), you should firmly re-iterate that it is the patient’s responsibility to inform the relevant licensing authority of ‘any health condition likely to affect their driving’. If a dispute arises over insurance, then either patient or insurer should be advised that their doctor could make a recommendation, formally, in writing, with patient consent, after appropriate training and for a standard fee. Clearly, this would not necessarily be in the patient’s best interest but would avoid the risk of litigation resulting from an informal assessment, made without adequate training and in the absence of proper guidance. The surgeon has a role to play in the assessment of a patient’s fitness to drive, but the patient must maintain ownership of the primary responsibility of informing both DVLA/DVLNI and their insurer. Gareth Evans, SHO Orthopaedic Trauma Gareth.Evans@luht.scot.nhs.uk Chris Oliver, Consultant Trauma Orthopaedic Surgeon Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh cwoliver@rcsed.ac.uk References are available on the website: www.surgeonsnews.info

×