Driving Question

We appreciated the article “When Should Dementia Patients Be Ordered to Park the Car?” in the December 18, 2005, issue. This very sensitive issue will undoubtedly become one of our greatest medicolegal challenges as our population grays, quite similar to the challenge neurologists face with seizures. As our dementia rates rise, it is possible that injuries and fatalities from patient accidents will also rise. Increased appropriate intervention by physicians is warranted. The legal expectation of the physician's making specific recommendations regarding a patient's ability to drive will become essential.

Aside from the medicolegal issues, we have a moral responsibility to make recommendations that protect the patient, family, and society as a whole. Nonetheless, we are not driving experts (as our spouses would gladly tell you). While we appreciate the opportunity to reflect a patient's condition to the state, our ability to “certify” a patient's safe driving is at best questionable.

Clinically, difficulty with clock drawings and brief mental status exams as part of a regular assessment within this population can be suggestive of possible driving problems. Other more definitive options such as neuropsychological or driver-testing programs are often inaccessible. Thus, we may recommend to the family that other events or changes in status such as accidents or becoming lost should warrant an even quicker evaluation.

Patients are more often than not reluctant to give up driving. Family members are loath to be identified as “the bad guy.” Recommendations to abstain from driving are often ignored despite detailed explanations of the possible consequences and dangers to the patient, family members, and others. Documentation of these discussions in progress notes is essential. Referral to the local Department of Transportation for driver evaluation is sometimes unavoidable.