Late in 2011, I wrote an FAQ about patients continuing to drive without wearing spectacles, when they had been told by a doctor or eyecare practitioner that they should not. Since that time there has been a change in the advice given by ABDO, the College of Optometrists and the Association of Optometrists.
This was brought to my attention recently by a member, a low vision practitioner, who had serious concerns with a patient she had seen during her work in a charity low vision service.
The patient was registered as seriously sight impaired (SSI) and at 88 years of age was still driving. He had been advised by several people to cease driving and often agreed to do so but continued driving anyway – whether this was dementia, he simply forgot her shouldn’t drive, or delusion, the commonly held belief of patients that their eyes aren’t that bad or they only drive to the shops once a week.
Whatever the circumstances, our member had grave concerns that it was only a matter of time before a serious accident would occur. Short of impounding the car keys, what could be done?
The advice given on the ABDO website (ABDO Advice and Guidelines 1.8.5) suggests that there should be discussion with the optometrist and that no action should be taken unilaterally but rather it should be a joint approach from the whole practice. This is good advice indeed but this situation was more complicated; our member was the only professionally qualified person on the team.
Having discussed the options, we decided on a plan: the service would write (in large font) to the gentleman stating unequivocally that under no circumstances should he drive and that a copy of the letter would be sent to his GP.
It is such a delicate issue and great care must be taken over how it is handled. There is, of course, the concern over confidentiality. The patient has a right to expect that their information be kept confidential but the latest regulations do advise that, in such circumstances, where repeated efforts to stop a poorly sighted person continuing to drive and thus causing an accident, the right to confidentiality may be waived.
Our member had legitimate concerns herself that such action might discourage other people from consulting the charity if they believed their licence would be at risk. The need to maintain their independence is essential to patients with failing sight and taking their driving licence may be seen as a catastrophe; tact and understanding is needed.
By notifying the patient’s GP, it was hoped that they might be aware of the facts and refuse to sign an application for a renewal of the licence. Of course, that in itself would not preclude the patient driving without a valid licence and motor insurance. Many people choose to do so and chance being caught, so there is only so much a practitioner can do – but documenting fully the actions and advice given to patients will at least protect them from the accusation that the patient didn’t know they shouldn’t drive.