Bill would allow physicians to report unsafe drivers
President of the medical society frowns on strictures
The Massachusetts Legislature's Joint Transportation Committee has drafted and recommended a bill that would allow physicians and law enforcement officers "to make a report to the registrar if there is cause to believe that an operator is unable to safely operate a motor vehicle," according to a summary of the legislative bill.
That bill, as of mid-October, had been sent to the state's House Ways and Means Committee for further consideration, according to House Transportation Committee Research Analyst, Andrew J. Keegan. It had not — at that time — been funded or approved.
The proposed legislation also "would allow for the immunity from civil liability for any physician or law enforcement officer making a report," according to the bill summary.
The American Medical Association in Chicago considers the safety of older drivers to be a public health issue. But the matter of suggesting to a patient who may be mentally or cognitively impaired — such as those with impaired vision, motor skills, or impaired cognition, is a delicate, thorny issue for physicians, based on a review of the AMA's policies and suggestions addressing how physicians should approach this topic with a patient.
According to information on the legal and ethical responsibilities of the physician, "Protecting the patient's physical and mental health is considered the patient's primary responsibility," although the information does not constitute legal advice, the AMA documents indicate.
However, this chapter acknowledges that "Driving is a difficult topic to address, particularly when there is the risk of damaging the patient-physician relationship, violating patients confidentiality, and potentially losing patients."
Needless to say, common sense suggests that if not handled correctly or sensitively, this conversation — where a physician suggests that a patient no longer drive — can have a negative impact on even long-standing doctor-patient relationships.
There is some question as to whether a physician should be able to report to a government body that his or her patient should not drive, however.
In a comment to the Boston Globe on the proposed bill and the powers it entails for physicians, Mario Motta, MD, a cardiologist and president of the Massachusetts Medical Society, was quoted as saying, "Physicians shouldn't be in a position of being a policeman. Physicians are supposed to be in a position to advocate for their patients, and this is not that at all."
Dementia and driving
The Alzheimer's Association receives 275,000 calls annually to its Contact Center, which offers resources and advice on topics of concern to these patients and their families, from driving to advance directives.
Beth A. Kallmyer, MSW, director of Family & Information Services for the Chicago-based organization, does not break out statistics on the number of calls per topic, but she tells Medical Ethics Advisor that if the organization tracked the calls related to driving, the numbers would be "compelling."
Kallmyer notes that in American society, "driving represents independence for seniors, for everybody."
"The most important message, I think, about driving is that if somebody has Alzheimer's, or they get diagnosed, it doesn't mean they have to stop driving right then. But there will come a time when they have to stop driving — there's a time when it is no longer safe."
She says the association's approach is individualized, as needs vary from person to person.
"We believe that people need consultation and assistance and support in how to raise the issue with their family member, and also how to provide them with options, so they can continue to get around and still maintain a level of independence," Kallmyer says.
She also notes that families "walk a fine line with Alzheimer's in terms of wanting to respect the person's autonomy and independence but also needing to make sure they are safe."
Among the behaviors indicating that it may be time for a patient with the disease to stop driving, according to the association's web site, are: forgetting how to locate familiar sites; failing to follow traffic signs; driving at speeds that are not appropriate; or becoming angry and confused while driving.
Involving the patient's physician
One approach the association suggests for families in addressing the topic specifically calls for the involvement of the patient's physician.
"We suggest families sometimes work with patients in telling them that they can't drive [and] to raise that issue of the doctor suggesting they don't," Kallmyer says. "And again, it's about safety. Some people with the disease will listen to what the doctor says, so we think of it in terms of a prescription, where the doctor says, 'It's not OK for you to drive, because the disease is impacting your brain."
For some people, the news from the doctor is all they need to determine that they will no longer drive — that is, for those patients who trust their physician. The contact center staff will often ask a family member what his or her parent's relationship is with his or her physician.
"[We ask questions like] 'Does he trust his doctor? Does he listen to his doctor? Because if that's the case, and they trust the doctor, then this is sometimes a good route to suggest," Kallmyer explains. "If the person doesn't trust doctors and doesn't have a good relationship with his doctor, it's not a good way to go."
When the patient's relationship with his or her physician is not a strong, trusting relationship, and if the family members, particularly if they are adult children of the patient, don't feel comfortable with making that decision for their parent, another person must be selected.
"Sometimes this kind of news comes better from a peer, or someone the person with the disease really respects or relates to, like a sibling, long-term family friend, a minister, or somebody in their life that they would respect," Kallmyer says. "So, it's not always that doctor — it might be somebody else."
Sources
- Alzheimer's Association, Chicago. Web site: www.alz.org
- Andrew J. Keegan, Research Analyst, Joint Committee on Transportation, Office of State Rep. Joseph F. Wagner, State of Massachusetts, Boston. Tel. (617) 722-2400.
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