I have a question-- I am unclear how far to take this situation. We have a patient who we do not believe is physically or mentally competent to drive. His daughter agrees with this assessment. We have talked to the patient and have documented our concerns. He is not driving to treatment but occassionally takes his car out on the weekends. His family has taken away his keys but somehow he manages to get another set. We are in the state of maryland. Our Motor Vehicles Admin requires a written explanation of concern and they will then investigate and require a re-test. Are we required to lodge such a complaint? Of course I am concerned about his safety and the safety of others. I would prefer if the family made such a complaint as I am concerned that he will no longer trust the dialysis unit. What is the law? Any thoughts?

Jmel,

I too am in Maryland. I am pretty sure that a Doctor can write to the MVA requesting that the license be revoked for medical reasons

the dr does not always want to do this...I was asking about our obligation as a clinic and mine as a social worker-- Thanks for the input...

We had a patient at one time who was in a very similar situation. One morning he drove to his treatment, not realizing he had been in an accident. When staff asked him he said I wasn't in an accident. The state police found his bumper with front license plate. He then realized he should not be driving. Luckily noone was injured.
For the safety of your patient and all others try and convince him he should stop driving. If he won't then take appropriate actions.

That is the main question. What are appropriate actions? I think you have taken the appropriate actions by informing the family who happen to agree with you. It is in the families hands now. You are not his keeper, his parent, his legal guardian or anything of that sort. You do not control every aspect of his life. I think you should reiterate to the family that you feel that THEY should take further action in order to prevent their father from driving and explain why. Tell them what their options. Ask them not to allow him to drive to or from his treatments. And leave it at that.

I would like to add some food for thought to this situation. If the patient was incompent to drive because of alcohol, would you report it? If the patient had uncontrolled seizures would you report it? I feel you/MD/family need to be proactive in this situation. Taking away this persons license will not prevent him from driving. The family will have to be involved. I have a very strong opinion on this issue because the same situation existed in my home town and ended with tragic results. The man took the car, ran a stop sign and killed the son one of my nurses. How will you feel if you don't do something and you face this situation. What if he/she hits the car with your loved one. We can not afford to close our eyes to such a potentially deadly situation. Remember this is also a life threatening issue for the patient.

Well put!

The confused and disoriented patients I have worked with sometimes do well if the car is disabled. Then you can let them have the keys. If the patient has symptoms as in dementia, some of the same "tricks" and "therapeutic fibs" may work. Taking a license often doesn't work if the patient forgets he doesn't have a license.

Honey,

I too am close to this subject. I am a dialysis patient and have been for 17 years. I know from personal experience that after a treatment and immediately before a treatment, I am at my absolute worst. However, by the next morning I am fine. The techs and nurses at the center are exposed to the patients for a very little time before the treatment while they are putting them on the machine, while they are on the machine and for a few minutes after their treatment. Most of the time that they are exposed to the patients, the patients are sitting down. They talk very little to the patients and do no scientific or medical tests that would prove or disprove the patients ability to drive. The patient may have extremely low blood pressure at the end of their treatment which would indicate that AT THAT TIME, they should not be driving. Does that justify taking their driving priveledes away? Absolutely not! The dialysis tech and nurses are not qualified and do not have enough information or proof to make any such call. And as far as comparing a dialsis patient to a drunk, I find this highly offensive. A dialsis patient is not in their situation by choice, unlike a drunk. THe dialysis patient has a set treatment schedule, after which they may feel horrible and be unfit to drive, yet be perfectly capable to drive the rest of the time. The drunk can go out and get drunk anytime.

Again, given the extent of the dialysis techs and nurses qualifications and proof, simply expressing, even strongly expressing your concerns to the family and/or patient is all that you should do. It is up to the family, who have more exposure to the patient and see him at his best and worst to make these calls.

As dialysis patients, our quality of life is screwed up enough without over zealous nurses or techs getting our driving priveledges taken away, basically leaving us more dependent on others and further diminishing our quality of life.lives are screwed up enough

I am guessing that if the family was able to successfully intervene, they would have done so. To say it's their responsibility alone is taking the easy way out. Not to mention one fraught with potential liability. If you're worried about whether he'll trust you any more, imagine what it must be like for his child/ren?

Driving is one of the most difficult things for patients to give up in my experience, more than just about anything else. I have some experience in my own family. When you tell someone they can't drive anymore, you're essentially making them dependent in a way that significantly changes their lives forever. Accepting the need for it is usually gradual. He needs to hear consistently from everyone around him. Perhaps an intervention with you and the family might work?

It's important for people of all ages to have as much independence as they can handle safely. Someone might want to check to see if the local AARP chapter offers the course 55 Alive. I suggested this to a patient whose family felt he was unsafe to drive. AARP also offers several brochures that might be helpful to the patient, family and staff of the clinic in determining driving safety. It's possible this person drives because he doesn't want to bother family and isn't aware of other transportation resources to get where he wants/needs to go. Perhaps if he was given a list of transportation providers, contact info, and cost, this might give him (and his family) other options if he truly is unsafe driving.