The 70-year-old patient was found by an ambulance crew in a confused state, standing beside her car, with the engine running. She was taken to hospital, where an examination showed a bite on the left side of her tongue and a mildly raised creatinine kinase, suggesting she had probably had an epileptic fit.
She was advised not to drive home and not to drive for another year. But she said she intended to keep driving and the A&E registrar phoned the patient's GP and asked him to contact the DVLA. The GP did so and the patient's driving licence was revoked.
The patient alleged the GP had breached his duty of care to her in not speaking to her before contacting the DVLA. She denied having a fit and claimed to have briefly lost consciousness because of a gas leak from the car's air conditioning system. She also accused the GP of breaching her confidentiality.
Previous medical history
An examination of the patient's records showed she had a 20 year history of epileptic seizures associated with a large calcified lesion in the brain. After a fit seven years previously, her driving licence had been revoked for 12 months. Two years later, she had another fit and ignored a letter from her then GP telling her she was unfit to drive until she was free of fits for at least a year. She had contravened section 94 of the Road Traffic Act 1988 by failing to inform the DVLA.
Recently, a deputising GP had visited the patient, diagnosing a further fit and noting that she had not been taking her anticonvulsant medication for two years.
A GP expert argued that the GP's overriding duty in this case was to protect the public. He had been right to immediately contact the DVLA, without first speaking to the patient, even though this appeared to contravene the GMC's guidance on confidentiality 1:
"The advice ... assumes that the patient is a reasonable person with insight into her condition. The patient's past history leaves no doubt that her behaviour was unreasonable in that she has knowingly flouted the law... Compliance with (the GMC guidelines) would, in all probability, have led to acrimonious discussions with the patient who would have tried to delay the action..."
"If the plaintiff had been involved in a further RTA causing injury to a member or members of the public, (the GP) would have laid himself open to a charge of negligence in respect of his failure to take immediate steps to stop (the plaintiff) driving a car on a public highway in the full knowledge that she was unfit to do so."
Outcome of claim
The patient agreed to discontinue the case and to meet the GP's costs in full.
Dr Matt Lee medico-legal adviser, gives the MDU's advice:
Usually GPs are expected to adhere to GMC guidelines and to inform the patient before contacting the DVLA. GMC guidance was revised in 2000 and acknowledges that if it is not practicable to contact the patient first a doctor may consider there is no option but to contact the DVLA straightaway. According to the GMC's guidance such circumstances may arise:
"Where a patient continues to drive, against medical advice, when unfit to do so. In such circumstances you should disclose relevant information to the medical adviser of the Driver and Vehicle Licensing Agency without delay.."2
The onus is always on the doctor to justify such a breach of patient confidentiality.
- Duties of a doctor: Confidentiality, appendix 1, para 6. General Medical Council 1998
- Duties of a doctor: Confidentiality, para 18. General Medical Council September 2000
This page was correct at publication on 12/01/2003. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.