Taking Away the Car Keys: Is It the Doctor’s Duty?

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To the Editor:

Re “Doctors Should Report Medically Impaired Motorists,” by Sandeep Jauhar (Opinion guest essay, Nov. 8):

I applaud the role that Dr. Jauhar, his family and his father’s internist played in restricting his father’s driving when advancing Alzheimer’s disease made driving unsafe. Doctors should take an active role in assessing patients’ driving safety and counseling patients when medical conditions render them unsafe to drive.

Doctors should be legally protected when they make an individualized clinical decision to report a patient who continues unsafe driving against medical recommendations. At the same time, doctors should also be legally protected when they make an individualized clinical decision not to report a patient who continues to drive against medical advice. Doctors should not be mandated to report patients for unsafe driving.

Mandated reporting has been studied and is not effective in reducing motor vehicle accidents, hospitalizations or deaths. Instead, mandated reporting undermines the therapeutic alliance between patients and doctors, leading patients to withhold medical information or “doctor-shop” to avoid being reported.

In my own practice, I have cared for patients who acknowledge having concealed medical information from doctors in states with mandated reporting. For these reasons, the American Academy of Neurology, the American College of Emergency Physicians and other professional organizations rightly oppose mandated reporting.

Benjamin Tolchin
New Haven, Conn.
The writer is associate professor of neurology at the Yale School of Medicine and director of the Yale New Haven Health Center for Clinical Ethics.

To the Editor:

Dr. Sandeep Jauhar suggests that medical providers should take on the responsibility of reporting medically impaired drivers. As an I.C.U. nurse I have seen, many more times than I would like, the result of medically impaired persons driving motor vehicles. I also have dealt with the scenario he describes — convincing a parent they are no longer physically and/or mentally competent behind the wheel.