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Driving

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Symbol of freedom, keys to the open road, imagery ranging from Mr Toad to Thelma and Louise, driving is a massive part of our lives. Therefore giving it up, or having to relinquish one’s licence is a big issue. Discussing driving with people who have memory problems requires respect and careful handling.

I’m aware of how my own practice in this area has changed over the years. As a brash young Consultant, it seemed to me that driving was more of a privilege than a right and that as a doctor I had an important part to play in road safety. "Get ‘em off the roads" would have been overstating it but I certainly expected to be advising patients to stop driving quite frequently. I was well armed with guidance about how one could override patient confidentiality and inform the DVLA directly if the patient showed no signs of stopping. I was even prepared for confrontations where I might come away wielding the patient’s ignition keys in cases of extreme concern.

However, a couple of memorable cases and reading the relevant research brought about some mellowing of this view.

1. I had several unproductive discussions with a man with vascular dementia. They went as follows:-

TD:                   I really think you shouldn’t be driving.

Patient:             Listen, young man, I was a tank commander during the War!! Don’t tell me that I don’t know how to drive!

TD (faintly):       Well, that was a few years ago and I do think that things have changed…

After about my third visit, I realised that I had parked my car next to an ancient vehicle with last year’s tax disc, covered in leaves and pigeon guano. Debris had blown up against the wheels. This car hadn’t gone anywhere for a long time. The penny dropped as to who the owner was… Lesson #1 was therefore to make sure that you check how much driving is actually going on before you get into a confrontation.

2. I advised another man with Alzheimer’s disease to stop driving. He and his wife clearly didn’t think much of this advice and he went to the local test centre, passed an assessment and got his licence back. Lesson #2 was that the diagnosis of AD in itself did not render drivers immediately incompetent. Indeed, he may have been a better driver than his wife, whom I once saw come out of a side road into traffic with the velocity and unpredictability of a champagne cork.

3. Research shows that older drivers may have more crashes per mile driven than younger drivers but (a) they drive much shorter distances, (b) they drive mainly familiar routes (usually ending up with just a supermarket trip), (c) they restrict night time and rush hour driving, and (d) such collisions are usually low impact. Screening tests for older drivers are probably a waste of time and sometimes have adverse effects. Most road carnage is still due to impulsive young men, so why is it that that pensioners who take the wrong slip road onto a motorway always get such a lot of press coverage?

Therefore, these days, I prefer to have a conversation about a patient’s mobility and transport needs in general. It is useful to point out that everyone stops driving in the end so it is really a question of considering when to retire gracefully from this activity. They must inform the DVLA, otherwise they risk not being covered by insurance, but where possible people with early dementia should be given some choice about when they stop. And most people are, fortunately, sensible about it.

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