Should Doctors Stop Patients From Driving?

When is it time for someone with physical or cognitive problems to give up the car keys? Who makes that decision? And how can it safely and compassionately be enforced?

Some answers from a comprehensive and thoughtful handbook, by the American Medical Association, in collaboration with the National Highway Traffic Safety Administration. Recently updated, the “A.M.A. Physician’s Guide to Assessing and Counseling Older Drivers” is an invaluable addition to the literature on this subject, directed to its own members but accessible and informative to the layperson as well.

The guidebook has plenty of information about assessing a patient’s driving ability; medications and medical conditions that impair mobility, vision, hearing, reflexes and judgment; tips on having the conversation with patients and caregivers; advice on how to avoid isolation and dependence when driving is no longer sensible or safe; discussion of a doctor’s ethical responsibilities; and state-by-state guidelines for reporting drivers to the state department of motor vehicles, which has the ultimate say in who remains on the road.

Fourteen states require greater frequency in renewing licenses after a certain age — say, every two years instead of five for those older than 70. Seventeen states make special demands of the elderly — that they renew in person rather than by mail, for instance, or take a vision test.

Some states offer legal immunity to doctors who report patients, and others don’t. Some allow family members or other concerned parties to report drivers to the state motor vehicles department. Some have stringent privacy restrictions. Others permit anonymous reports. All consider such reporting permissible under the Health Insurance Portability and Accountability Act, the federal law that is supposed to guarantee medical confidentiality.

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