Question of the Week # 168

168) A 70 year old woman with history of Hypertension, Diabetes mellitus, severe osteoarthritis and Macular degeneration is seen during a follow-up visit. He was seen a month ago in your office for evaluation of his driving capacity. At that time, he was noted to have significant impairment of vision and motor skills. His visual impairment persisted despite corrective glasses. He also uses cane to walk and has persistent deficits of left sided weakness and hemi spatial inattention secondary to a stroke 8 months ago. He was subsequently referred to driving rehabilitation specialist and was deemed unsafe to drive. During his visit 2 weeks ago, he has been counseled and was instructed to stop driving. While talking him about his transportation, he tells you that he drove himself to the clinic today.

Your most appropriate response at this time:

a) “When do you think it’s an appropriate time for a person to stop driving?”

b)  Let’s talk about some of your concerns regarding retiring from driving

c) I am wondering, is there someone whom you trust, and who would tell you when they thought it was unsafe for you to continue driving?

d) “You are a threat to others while driving on the road”

e) “I have a duty to protect you and so, I will have to report you to DMV”

f) “Let me refer you to Driving Rehabilitation so that they can help you with adaptive devices”

 

12 Responses

  1. e) “I have a duty to protect you and so, I will have to report you to DMV”

  2. b) Let’s talk about some of your concerns regarding retiring from driving

  3. e

  4. b

  5. b

  6. He has to report this guy to the DMV! He has been told multiple times not to drive but is still driving and even if we tell him that he’s a threat to others, he won’t listen! Report the MFR!

  7. b. He may have reasonable concerns, so if you know what those concerns are, you can help him address them, and perhaps he himself will stop driving. Always give your pts alternatives, to make their lives easier. How else is he gonna get to your follow up visits?? Help him set up alternatives to driving!!

    • I agree

  8. Iisnt it A…

  9. B

  10. B,

  11. The 5 major steps to intervention using the 5 A’s could be applied. Ask the patient first to get an insight to what the patient is thinking. The patient is clearly adamant about still wanting to drive and is probably not even in the right mindset that he should “retire from driving”. If he sees no problem with what he is currently doing, no intervention to stop him from driving will work. Option B assumes that the patient is contemplating to stop driving but if he has poor insight/ is stubborn, you can’t get him to even talk about a problem which he doesn’t see as a problem.

    I’ll go with Option A.

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