Statistics from Altmetric.com
Editor—Kelly et al's study of knowledge of medical restrictions on driving reveals worrying deficits in doctors' knowledge.1 This accords with results of previous studies2 concerning knowledge of psychiatrists, but contrasts with a comparable study of knowledge3 after dissemination of the Driving Vehicle Licence Authority's (DVLA) “at a glance guidelines”.4For example, 93% of the sample of 89 psychiatrists were aware of DVLA regulations on late dementia, suggesting that ignorance can be countered by educational campaigns. However, even this study revealed inadequate knowledge of General Medical Council (GMC) guidelines on confidentiality, in which the trend was to under-estimate the need for doctors to break confidentiality and to inform the medical adviser at the DVLA. For example, only 32% of respondents were aware that the DVLA should be informed when a patient continues to drive against medical advice. Information concerning the breaking of confidentiality is not explicit in the “at a glance guidelines”, but is described with clarity by the GMC in Duties of a doctor. 5
It seems likely that legal precedent will establish medical negligence when doctors fail to provide appropriate advice on driving regulations. The study of Morgan showed that junior trainees have least knowledge of guidelines,3 and it would seem appropriate to make driving regulations a clearly defined topic for examination in Membership curricula. However, other doctors may require the threat of litigation to focus their minds.
The authors respond:
The paper of J F Morgan1-1 shows some improvement in psychiatrists' knowledge of driving restrictions after dissemination of the DVLA's “at a glance guidelines”1-2compared with the findings of Thompson and Nelson.1-3 Even with these improvements the majority of respondents were incorrect for some of the clinical situations questioned (for example heroin, methadone, and cannabis use/dependence). Both studies used postal questionnaires and it may be that there was an increased awareness of where information could be obtained from, rather than an increase in working knowledge. Not knowing where to obtain the necessary information was apparent in our own study.1-4 Our experience has been that attempts to increase the ability of doctors to consider fitness to drive has been difficult. We recently used an educational programme incorporating slide presentations and the display of relevant posters on the wards to try and increase awareness of driving restrictions. This produced only small improvements in the ability of doctors to record in the medical notes that they had considered a patient's driving status and had advised them appropriately.1-5
We would agree with Dr Morgan that making driving regulations a specific topic for examination in Membership curricula may increase doctors' awareness. However, undergraduate education should be the main priority. That way all doctors will learn to ask about driving as part of the routine social history and will hopefully, as a result, consider whether any of the patient's medical conditions impact on their fitness to drive.