“My 85-year-old father isn’t safe to drive any longer, but he absolutely refuses to stop.” It’s a common theme round the dinner table. And in the consulting room too, where exasperated families come hoping the GP can ‘do something’. But there isn’t much we can do. We can be firm with patients, we may be asked by the DVLA to perform a simple health check, and we can contact the DVLA if we feel that the public good justifies it, but we rarely have experience of our patients’ driving skills. “I would be happy to sit beside you driving” a GP told an elderly driver I know well. I have been her passenger. Clearly he never has. And discussing driving ability can be the end of the doctor-patient relationship. Tell a patient that they have a terminal illness and they will probably be distressed and frightened; tell them they shouldn’t be driving and the response is denial and anger.
The DVLA requires elderly drivers to fill in a long form before it will renew their licences, and may require an independent eye check. Unlike many public examinations which require an acceptable average mark over every element, your driving licence will be renewed if you scrape a pass on the visual test. No one checks that you can compensate for only-just-adequate vision through good reflexes, concentration, mental processing, and judgement. And what about hearing? And stiff necks? You need to be able to turn your head easily to look around you. And how many 85-year-olds have the physical strength to manage a powerful BMW in an emergency? Plus, you need road sense. Elderly drivers often choose inappropriate speeds, shooting onto roundabouts and crawling along motorways. Some interpret street signs and rights of way creatively, claiming that because the instructions are ‘misleading’ they are absolved from responsibility. Yet there is no assessment of road sense.
Ophthalmologists can be over-generous, for instance giving a 90-year-old permission to drive on condition that he stays at home after dark. The driver had to take his wife to hospital. It wasn’t till 10pm that she was settled and he felt free to start the familiar 20 minute drive home. Three hours later two police cars had to escort him to his front door.