Psychiatrists' responsibilities with regards to patients' fitness to drive.

Abstract

Byline: Mehboob. Yaqub, Shajahan. Ismail, Sally. Babiker, T. Sathyanarayana Rao Driving has become a near universal and essential part of human life. Many of those who are no longer able to drive have a significant impact on their lives in the form of loss of independence, compromise with work, personal interests, and activities.[sup][1] Driving is a complex skill. It is dependent on several cognitive aspects and executive functioning of a human brain (i.e., information processing, attention, concentration, memory, impulse control, judgment, anticipation, problem-solving, and hazard perception).[sup][2] Many psychiatric disorders lead to impairment in the level of cognitive and executive functioning required for safe driving.[sup][3] Moreover, psychotropic medications can also cause disruption in perception, information processing, and overall psychomotor activity.[sup][4],[5] Driving is impaired not only as a direct effect of mental illnesses but also medications have a significant role. Cost of traffic accidents attributable to impairment by medication in Europe is estimated to be about 6.3 billion euros every year.[sup][6] De Las Cuevas and Sanz studied 208 patients in Spain seen in psychiatric outpatient clinics with stable psychiatric conditions and reported that nearly 80% of the patients had cognitive scores which would not allow obtaining or renewal of a driving license. None of the driving patients notified to the relevant authorities about their psychiatric conditions and only 10% recognized that their ability to drive was somehow damaged.[sup][7] Driving, Risk to Public Safety, and Mental Health Services Risk to public safety from road traffic accidents (RTAs) cannot be denied. RTAs do involve patients with mental illnesses but are usually reported in a sensational way, with potential to swing public opinion against those mentally ill and the mental health services caring for them [Figure 1].{Figure 1} In England and Wales, legislation to govern the general issues related to driving licenses exists in the form of Road Traffic Act 1988.[sup][8] The Driver and Vehicle Licensing Agency (DVLA) has provided a detailed guidance for medical practitioners, and mental disorders are addressed under the same set of guidelines. General Medical Council (GMC), UK has published the following advice for medical practitioners in this regard,[sup][9] which is as follows: *DVLA is legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a driving license holder has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver *Doctors should seek the advice of an experienced colleague or the DVLA's medical adviser if they are not sure whether a patient may be unfit to drive. Doctors should keep under review any decision that they are fit, particularly if the patient's condition or treatments change. The DVLA's publication for medical practitioners, at a glance guide to the current medical standards of fitness to drive,[sup][10] includes information about a variety of disorders and conditions that can impair a patient's fitness to drive *The driver is legally responsible for informing the DVLA about such a condition or treatment *If a patient has such a condition, doctors should explain to the patient that the condition may affect their ability to drive and they have a legal duty to inform the DVLA about their condition *If the patient is incapable of understanding this advice, for example, because of dementia, doctors should inform the DVLA immediately *GMC further advises that the confidentiality should be breached if patients continue to drive. The Clinical Audit and Clinical Setting Considering the current guidelines for the medical practitioners, a complete clinical audit cycle was carried out to see whether the mental health practitioners were assessing their patients' fitness to drive and addressing the issue as guided by the relevant agencies and legislation. …