Medical Protection advice line often receives queries from doctors concerned about patients that are driving whilst under the influence of alcohol or drugs. Kate Cowan, advisory case manager, shares our advice.

Member dilemma

I am treating a patient for alcohol and drug abuse. He has attended the surgery on a number of occasions under the influence of alcohol. The surgery is in a fairly rural location and the patient has almost certainly driven himself to the surgery when over the legal limit for safe driving. I am concerned for the safety of the patient and others on the road, but I also do not want to betray the trust I have built up with the patient. Do I have an obligation to report the patient?

Advice

This is a common query received by the Medical Protection advice line, but one which has clear guidance from the GMC and Driver and Vehicle and Licensing Agency (DVLA).The DVLA in Britain, or Driver and Vehicle Agency (DVA) in Northern Ireland, is legally responsible for deciding if someone is medically unfit to drive. This means they will need to know if a driving licence holder has a condition that affects their safety as a driver.

GMC guidance

The GMC has produced guidance on this issue entitled Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA. It confirms that it is the driver’s responsibility to inform the DVLA: 

The driver is legally responsible for telling the DVLA or DVA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency.

Therefore, if you have informed a patient of their legal obligation to inform the DVLA/DVA you do not have an absolute obligation to inform the DVLA/DVA yourself. However, the guidance goes on to state the following:

If you become aware that a patient is continuing to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop. If you do not manage to persuade the patient to stop driving, or you discover that they are continuing to drive against your advice, you should consider whether the patient’s refusal to stop driving leaves others exposed to a risk of death or serious harm. If you believe that it does, you should contact the DVLA or DVA promptly and disclose any relevant medical information, in confidence, to the medical adviser.

Communication

In the circumstances, the preferable option would be to persuade the patient not to drive under the influence of alcohol and to encourage them to inform the DVLA/DVA of their circumstances. 

If the patient will not inform the DVLA/DVA themselves, then you could inform the DVLA/DVA with the patient’s consent. If the patient withholds their consent, then you would need to decide whether or not your duty of confidentiality is outweighed by a public interest justification for disclosure.  

Before contacting the DVLA/DVA, you should try and inform the patient of your intention to disclose personal information. If the patient objects to the disclosure, you should consider any reasons they give for objecting. If you decide to contact the DVLA/DVA, you should tell the patient in writing once you have done so, and make a note on the patient’s record.  

If you decide not to inform the DVLA then you must be able to justify the non-disclosure if called upon to do so. You should fully document your reasons as to why you are satisfied that the patient understands their obligations, and make a comprehensive note of your discussions.

Irrespective of the outcome of the discussion, it is imperative to make comprehensive notes in the medical records to ensure you can justify the decisions made at a later date if required. 

Confidentiality

As you are aware, you do have a duty of confidentiality towards your patients. However, there are instances where your duty of confidentiality can be overridden in the public interest. The GMC’s guidance in Confidentiality: good practice in handling patient information states:

If it is not practicable to seek consent, and in exceptional cases where a patient has refused consent, disclosing personal information may be justified in the public interest if failure to do so may expose others to a risk of death or serious harm. The benefits to an individual or to society of the disclosure must outweigh both the patient’s and the public interest in keeping the information confidential. 

If you decide to inform the DVLA in circumstances when the patient withholds their consent then you should inform the patient of your intended course of action, copy them in to any correspondence to the DVLA and provide a minimal, relevant disclosure.

Further guidance

In Britain Gov.uk also provides guidance in Assessing fitness to drive: guide for medical professionals, which includes Drug or alcohol misuse or dependence: assessing fitness to drive. You can contact the DVLA’s medical advisers on 01792 782 337 or at [email protected]. 

In Northern Ireland NI Direct provides Medical conditions and driving and the DVA can be contacted on 0300 200 7861.