The scene

An ST doctor rang the advisory helpline at the weekend, as he wanted advice about a patient he was about to discharge from the ward.

The patient had been admitted several days before with the first episode of a black out, the cause of which was unknown. Various tests had been performed and the patient was to be discharged home with an out-patient appointment once more results were available.

At the time of being admitted, the patient had been certain there had been no symptoms before the black out, and as a result had been told by the consultant in charge of his care that he would need to refrain from driving and report the incident to the DVLA. The patient had reiterated this account to several different doctors during his admission.

When the ST spoke with the patient on the morning of discharge, the patient explained that before the blackout he had tripped and banged his head, and therefore believed there was a clear cause for his loss of consciousness.

Speaking with the medico-legal adviser, the ST was clear that if the original version of events was correct, the patient should be advised not to drive and to report the incident to the DVLA, in accordance with the guidance included in their document, Assessing fitness to drive: a guide for medical professionals. Given the patient had now changed their account of events, the ST was unclear if he should still give the same advice about driving, in particular as the patient might be unhappy that the advice remained the same.

MDU advice

The medico-legal adviser suggested that as the patient had given a consistent account of events up until now, it would be difficult to disregard that version of events. The original account had been documented by several clinicians and investigations had been performed because of the history provided.

The adviser recommended the doctor to the GMC's guidance; Confidentiality: patients' fitness to drive and reporting concerns to the DVLA or DVA. The adviser reassured the doctor that it was not their role to determine if the patient was fit to drive, but that he did have a duty to explain to the patient if they have a condition that could impair their fitness to drive. The ST would also need to explain that it was the patient's legal duty to tell the DVLA about the incident. If the patient was unhappy with the advice, the doctor could suggest he seek a second opinion, but should still not drive in the meantime.

The adviser suggested that the ST could discuss the case with his consultant, and anonymously with a DVLA adviser if it would be helpful to do so. The adviser recommended that the GP discharge summary should include details of the advice given to the patient and its justification. This information should also be clearly documented in the patient's notes.

The adviser acknowledged that matters related to driving could be emotive, but reassured the doctor that if there was a future dispute, keeping detailed notes of the discussions with the patient would help the doctor explain his approach later on. If any patient complaint resulted, the MDU would also be able to help the doctor respond.

Disclosure to the DVLA

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