Central  South  Dakota  Medical News
The Clinical View
  by P.E. Hoffsten, M.D.
22 October 2003

TO DRIVE OR NOT TO DRIVE

     I never cease to be amazed at the problems presented to healthcare providers.  I thought we went to school to learn how to take care of pneumonia and heart disease and then comes a problem like below.

     A patient recently came to the clinic for her annual review of health status and had no real medical issues. As the interview and examination was closing, she said that she needed help with a problem.  She said her 83-year-old father was continuing to drive and she didn’t feel that he was safe as a driver.  She indicated that she had talked to her father about giving up his driver’s license but he had refused to consider it and became very insulted that she brought it up.  She wanted me to contact the department of transportation stating that he was an unsafe driver and should have his license revoked!!

     After I gulped very hard, I explained to her that South Dakota has no provision for such.  Some states have a law stating that physicians are required to report unsafe drivers.  South Dakota is not one of those states.  Imagine the dilemma of a health care provider in a state that does require filing a report regarding a patient who is felt to be an unsafe driver.  While there is a morale consideration regarding public health and safety, a health care providers first responsibility and allegiance is to the individual patient.  In states that have an unsafe driver reporting provision, this allegiance is intrinsically violated with a conflict of interest.

     A driver’s license is like a rite of passage when a young person first receives their license.  It is the major form of identification in our society.  It provides a form of freedom giving the person the ability to leave their premises at ease for everything from shopping to entertainment.  Losing a driver’s license involuntarily is a massive upheaval for the elderly individual.  It is very common that I hear a patient relate some unpleasant event that begin with, “Since I lost my driver’s license…..”, thus, giving up a drivers license or having it taken away is no small consideration.

     I explained to this lady, that while I understood her plight, I really could play no formal role in restricting her father’s drivers license even though I was also her father’s physician.  Of some small comfort are the statistics regarding accident rates per thousand drivers versus the driver’s age.  These statistics show our teenagers and twenty-year olds have the highest accident rates.  The accident rate decreases with age, even through and including drivers over age eighty!!  Thus, there is no basis to say that individuals over a certain age should have to undergo increased testing or have their drivers privileges curtailed.

     I suggested at this point, that she continue to try to reason with her father.  As his physician I would bring the point up with him as gently as possible at the time of routine visits.  I do take the time to counsel with elderly individuals whose driving capability may be compromised.  I encourage elderly drivers to avoid dangerous situations such as driving in a foreign environment such as big cities that they are not used to, or to avoid driving at night, or with large numbers of people and children in a car.  A person who has a seizure disorder, brittle diabetes, cataracts, or marginally compensated heart disease needs to be encouraged to carefully consider their driving activity.

     But to reiterate the situation in South Dakota, there are no regulations requiring or encouraging physicians to report unsafe drivers.  In this state, a physicians first allegiance is to the individual patient.  The physician may encourage a person to change their driving habits or to discontinue same but it is never a physician’s place to interfere with an individuals driving rights and privileges.