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Licensure Responsibilities for Drivers and Doctors
Most ideas for my blog entries jump out of my head. There's a lot going on inside my head (as well as ample space for ideas to 'bounce around') so I always find useful topics. This time the topic came to me in the form of an inquiry on our WebMD Eye & Vision Disorder Message Board.
Here is an excerpted version of Iceman's message:
Do you think an eye doctor has a moral obligation to intervene when a patient has vision impairments that make driving a vehicle dangerous? I know this is a deep question - but it is one that should be discussed more often. I finally quit driving after pulling in front of a tractor trailer I didn't see and almost hitting two city workers along the road .
I was told that I shouldn't be driving by about 4 doctors, but was actually legal to drive with 20-50 20-60 vision at the time. I also had blind spots. One doctor did write a note that I should not be operating a vehicle but then told the nurse that he wasn't going to fill out a form because they would take my license. Having driven with reduced vision I can honestly say that it is dangerous and I was dangerous to both myself and others . It has been hard not driving and I have had to walk 12 blocks to drug store, bank, etc., but I just wouldn't want to be responsible for someone getting killed by driving with poor vision.
I even know a man with macular degeneration to the point that he has to turn sideways to see me - yet still drives to the store 2-3 times a week. What do you think? What would YOU do?
Licensure is a public trust and it automatically imparts important responsibilities that protect the community as a whole. When the state grants you a driver's license it expects you to operate the vehicle safely, observe the traffic laws, and maintain adequate insurance. Failure to honor that license makes the community less safe.
Since you mentioned it, the minimum corrected vision standard for driving is 20/40 in the better eye with full visual fields. Any person with poorer eyesight (20/60, 20/80, 20/400!) has a personal responsibility to cease driving until the vision improves. If the vision deterioration is permanent the driver's license should be surrendered. This behavior is totally dependent on individual responsibility. People with poor eyesight who continue to drive are irresponsible, plain and simple. They may have 1,000 perfect excuses to justify their irresponsibility but it remains their choice, and it is an unwise choice.
Have you noticed, up until now, the doctor has not gotten involved?
Medical licensure also carries enormous responsibilities: to put patient care first, to render emergency assistance, to practice ethically. Many of these responsibilities are assumed; as an example, do not recommend unnecessary surgery. Other responsibilities are enacted as legal requirements; another example, patients diagnosed with Extreme Drug Resistant TB must be reported to the Public Health department. Additionally, a physician must report any suspected neglect or abuse involving children or senior citizens. Simply stated, the doctor has the responsibility to observe the law on behalf of society.
One of a physician's legal responsibilities involves identifying impaired drivers. Whether it is because of poor eyesight, seizure activity or other disabilities, physicians are required to inform impaired drivers of their situation and to take action. The specifics vary from state-to-state but if the impaired driver does not voluntarily discontinue driving, the physician is required to notify the authorities and retrieve the driver's license.
Is failure to identify an impaired driver any more acceptable than a doctor's failure to report suspected child abuse? The law is the law. If you don't like the laws run for public office!
You probably know where I'm going with this. In 27 years of medical practice I have never had to play 'bad cop'. A quiet, unemotional conversation (often rescheduled away from the busy clinic) usually delivers the desired results. Success often requires the commitment of a friend or family member so that the patient does not feel abandoned. Having knowledge of available transportation resources (low cost community van service, etc.) relieves anxiety and makes this difficult situation a bit more tolerable.
Given this information, impaired drivers who insist on breaking the law deserve the same kind of justice meted out to repeat drunk drivers. Alternatives to driving are always available. The resistance to conform signals a deeper issue regarding the individual's unwillingness to accept change in their life and to adapt.
Tough love? Sure.
A year from now, with the impaired driver still alive, I'm happy to listen to their complaints.
Related Topics: Technorati Tags: vision, driving, eye health
