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
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.