The scene
During a GP placement, a foundation doctor received a report from the ambulance team about a 30-year old male patient who required help with a severe hypoglycaemic episode. The paramedics needed to give him glucose.
A few weeks later the doctor received a discharge summary from the emergency department saying that the patient had required glucagon for treatment of another severe hypo.
The patient's wife had contacted the surgery to say she was worried about him driving. The patient came to see the doctor – having driven in.
The doctor discussed the situation with his trainer, who said the patient should not be driving and suggested the doctor call the MDU helpline for further advice.
The guidance
The DVLA’s ‘Assessing fitness to drive – a guide for medical professionals’ outlines a number of medical conditions and their impact on driving.
The driver is legally responsible for informing the Driver and Vehicle Licensing Agency (DVLA) about a condition that makes them possibly unfit to drive.
The doctor should nevertheless explain to the patient that their condition may affect their ability to drive, and that they have a legal duty to inform the DVLA.
The GMC’s guide to confidentiality advises that if a patient refuses to accept the diagnosis or dismisses the effect of the condition on their ability to drive, you can suggest that they seek a second opinion, and help arrange for them to do so. You should also advise the patient not to drive in the meantime.
If a patient continues to drive while at risk, you should make every reasonable effort to persuade them to stop. With the patient’s consent, you may discuss their concerns with the patient’s relatives, friends or carers.
If you discover that a patient has been driving against your advice, you should contact the DVLA immediately and disclose any relevant medical information, in confidence, to the medical adviser.
Before contacting the DVLA you should try to inform the patient of your decision to disclose personal information. You should then also inform the patient in writing.
If a patient continues to drive while at risk, you should make every reasonable effort to persuade them to stop.
MDU advice
The MDU adviser explained the GMC guidance to the doctor. He reassured him that if, after speaking with his trainer, the doctor decided to disclose patient information to the DVLA in order to protect the public – having taken the above advice into account – it was unlikely he would be criticised.
The doctor had a long discussion with the patient, after which the patient said that he would tell the DVLA about his hypoglycaemic episodes. The doctor told the patient that he would call to check with the DVLA the following day, to ensure that they had been informed. The patient accepted this.
To help him deal with his hypos, the doctor gave the patient advice and support, and referred him to the diabetes specialist team.