GP Stage 3 Simulated Consultation - Patient 7
You are an SHO working in a GP Surgery. Your next patient is Mr Thomas Bayleigh who is a newly diagnosed epileptic. You met with Mr Bayleigh two weeks ago to discuss the need for him to inform the DVLA, and had arranged a routine follow up appointment.
You are Mr Thomas Bayleigh, a newly diagnosed epileptic who has attended a follow-up appointment. In your last appointment two weeks ago, the doctor advised you to inform the DVLA of your new diagnosis. Despite this, you have not informed the DVLA and have continued to drive.
You are concerned that if you do inform the DVLA, they will suspend your license and that you will no longer be able to drive. This is particularly problematic given your wife’s regular medical appointments (palliative management for terminal ovarian cancer), and the fact that she is no longer able to drive.
If pressed by the doctor, you report that you intend to continue driving for your ‘independence’ and ‘wife’s health’ and under no circumstances do you intend to inform the DVLA.
Aside from your newly diagnosed ‘epilepsy’ you are otherwise well, although after having done some reading on the ‘World Wide Web’, you fear that your recent seizures may be a sign of ‘brain cancer’ and are very anxious about your MRI scan next week.
This consultation requires an awareness of important GMC guidelines (Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA) as well as a degree of sensitive probing to explore Mr Bayleigh’s deeper concerns.
The relevant GMC guidelines advise as follows:
Reporting concerns to the DVLA or DVA
“6. If a patient has a condition or is undergoing treatment that could impair their fitness to drive, you should:
A. Explain this to the patient and tell them that they have a legal duty to inform the DVLA or DVA.
B. Tell the patient that you may be obliged to disclose relevant medical information about them, in confidence, to the DVLA or DVA if they continue to drive when they are not fit to do so.
C. Make a note of any advice you have given to a patient about their fitness to drive in their medical record.
7. If a patient is incapable of understanding this advice – for example, because of dementia – you should inform the DVLA or DVA as soon as practicable.
8. If a patient refuses to accept the diagnosis, or the effect of the condition or treatment on their ability to drive, you can suggest that they seek a second opinion, and help arrange for them to do so. You should advise the patient not to drive in the meantime. As long as the patient agrees, you may discuss your concerns with their relatives, friends or carers.
9. 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.
10. Before contacting the DVLA or DVA, you should try to 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 or DVA, you should tell your patient in writing once you have done so, and make a note on the patient’s record.”
Thus, it is imperative for the doctor to explain the need for Mr Bayleigh to inform the DVLA himself. Persistent refusal would result in the doctor advising Mr Bayleigh that they will be informing the DVLA of Mr Bayleigh’s change in medical circumstances as well as further advising Mr Bayleigh to stop driving in the intermediary period.
Good candidates will explore Mr Bayleigh’s insistence to continue driving, as well as offer solutions which address his concerns as well as GMC Guidance (eg. Hospital Transport Arrangement).