Using DVLA guidelines

In this age of litigation, we are increasingly concerned to fulfil our duties and follow guidelines when they are available. An example of such a duty is to advise drivers about driving in accordance with Driver and Vehicle Licensing Agency (DVLA) Guidelines (2001).

Humphreys & Roy (1995) found that 25% of psychiatrists never gave any advice about driving to patients with psychiatric illness and Elwood (1998) found that 13% of psychiatric patients who continued to drive did not fulfil DVLA standards of fitness to drive.

We carried out a survey of all inpatients on the acute wards of a 200-bedded psychiatric hospital to determine what they recalled about information given about driving. Of the 88 patients surveyed, 56 (64%) completed the questionnaire and 39 (70%) were drivers. Twenty-six drivers (67%) remembered discussing driving with a professional. We found documentation about driving in medical records in only three case-notes.

Possible reasons for these results were that patients were unable to remember conversations about driving due to the severity of their symptoms. They might not have wanted to admit their knowledge because they were suspicious about the aims of the survey. However, with the lack of documentation in the notes, it seems likely that many patients had not discussed driving with a professional. Failure to discuss driving might have been an oversight, or even deliberate. Either would not be too surprising, as we ourselves find the Guidelines (2001) confusing. Diagnoses do not correspond to ICD–10 or DSM–IV. It is not always clear what professionals should be advising; for example, whether a patient should cease driving immediately or not. Some professionals may even decide that it is not in a particular patient's best interests to discuss driving, as it may interfere with the therapeutic relationship and/or compliance with treatment.

However, many professionals are worried about the possible legal consequences of giving incorrect or inadequate advice about driving. The medical adviser at the DVLA has reassured us that there have been no successful legal challenges in the UK to date. However, this is not the case in the USA (Hollister, 1992). Increased clarity in the guidelines would enable us to be sure we can fulfil our duties. We have decided to give written information about driving to all in-patients and will audit the results of this intervention.