How do I…
Discussing driving standards with patients
The AOP’s head of clinical and regulatory, Henry Leonard, discusses speaking to patients about driving and vision standards
Optometrists have a duty to maintain confidentiality and respect patients’ privacy, but there are situations where it may be necessary to disclose information about a patient without their consent. A patient’s visual fitness to drive can be one of these situations.
At the AOP we can provide members with advice on individual cases and we encourage members to get in touch to talk through any concerns that they have.
When it comes to vision and driving, practitioners need to ensure that they are asking the right types of questions during the sight test so that they are aware of what driving and vision standards a patient needs to meet. Questions can include: ‘Do you drive?,’ ‘What type of licence do you hold?’ and ‘Do you wear a visual correction when driving?’.
Knowing the answers to these questions means that, at the end of the test, the practitioner can discuss whether the patient needs to notify the relevant authorities about a problem with their vision. In England, Scotland and Wales, drivers should be directed to the Driver and Vehicle Licensing Agency (DVLA), and in Northern Ireland, drivers would need to contact the Driver and Vehicle Agency (DVA).
It is a matter of the practitioner weighing up their duty of confidentiality against their wider duty to the public interest. AOP members should always seek advice from the AOP’s in-house regulatory team before disclosing information without permission
Having the conversation
How the practitioner communicates their findings and concerns to a patient is important. They must ensure the patient understands the reasons for their concerns and provide clear advice on the patient’s obligation to inform the DVLA or the DVA, whilst communicating this information sensitively.
The practitioner should provide this advice to the patient at the time of the sight test, while also recording any advice given clearly in their clinical notes. In many cases it’s sensible to reinforce this verbal advice with written information, and the AOP has published a helpful driving and vision leaflet for members to download, complete and give to Group 1 drivers.
The first page of the leaflet sets out what the vision standards are for different licences as well as what someone should do if they feel their vision is getting worse for driving. The second page contains a form the practitioner can fill out for the patient detailing their findings and advice. Completing the form, giving a copy to the patient and keeping a copy on file means that the practitioner has a record of exactly what information was given to the patient and when.
When a practitioner has informed a patient they do not meet the required vision standards and should inform the DVLA or the DVA, they may find themselves in a situation where the patient says they cannot or will not stop driving because, for example, they drive for a job or are a carer to a relative and need to drive.
At this point we recommend members contact the AOP’s regulatory team for advice, to talk things through on a case by case basis. Often, we will advise members to send a letter to the patient by recorded delivery, explaining they didn’t meet the required standard at the time of their examination and they must notify the DVLA themselves.
For these situations, the AOP has created a template letter, which is available to download from its website, that practitioners can print out and fill in. Sending the letter by recorded delivery proves that the right advice has been given by the practitioner, and received by the patient.
Where patients have ignored previous advice against driving, and practitioners believe continuing to drive poses a serious risk to the patient and other road users, we often recommend including an additional paragraph in the letter asking the patient to confirm in writing they have notified the DVLA or the DVA within a particular timeframe. This gives the patient a final opportunity to self-declare.
Just like medical doctors, practitioners’ duty to main patient confidentiality is high and breaching it feels quite wrong, especially when a patient says that I don’t want you to tell anybody
A notification form for healthcare professionals is available on the Government’s website but, just like medical doctors, practitioners’ duty to main patient confidentiality is high and breaching it feels quite wrong, especially when a patient says, ‘I don’t want you to tell anybody.’ In the rare cases where it is necessary to disclose information to the DVLA or the DVA without the patient’s permission, we recommend members contact us first.
However necessary it may be, disclosing information without permission could lead to a complaint, so employed or locum practitioners should ensure their line manager is aware of the situation. If a practitioner is advised to notify the DVLA or the DVA after contacting us, they can be reassured if they were to ever find themselves the subject of a complaint, they will have been acting on the advice of their professional body.
The General Optical Council is currently working on the establishment on guidance about disclosing information without consent that will be published in due course.
- As told to Emily McCormick.