Doctor shopping and fitness to drive – a dangerous mix
20 Nov 2019
This case is an important reminder to be wary of a patient who requests certification of fitness to drive at their first consultation.
Case history
Ms C was the driver at fault in a fatal motor vehicle accident on 18 July 2013. Her licence had been reinstated only seven days earlier, after being cancelled in February 2012.
A coronial inquest was held into Ms C’s death in August 20161. It was noted that Ms C had attended the same GP practice from November 2005 until April 2012, receiving treatment for multiple issues including insomnia, osteoarthritis, chronic lower back pain, sleep apnoea and multiple falls.
Ms C had a prolonged admission to hospital in November 2011, following a fall, which was the sixth in 12 months. It was during this admission that Ms C was advised not to drive, because of her unsteadiness, and an assessment by her GP of her fitness to drive.
On 9 January 2012, three of Ms C’s friends attended the local Police Station to express concerns about her ability to drive.
Following receipt of this notification, a police officer visited at her home on 13 January 2012. The officer completed a report to the driver licensing authority (DLA), noting that Ms C appeared frail and struggled to walk. Ms C informed the officer that she would continue to drive, notwithstanding the advice she had received from her treating doctors.
On 25 January 2012, the DLA wrote to Ms C proposing to cancel her licence and seeking a medical certificate confirming her fitness to drive. Ms C requested a certificate from her GP on 23 February 2012, but was advised that she would first need to undergo a driving assessment. Ms C’s licence was cancelled on 27 February 2012.
However, at Ms C’s 17th consultation with Dr P on 1 July 2013, he provided her with a medical fitness to drive certificate.
Medico-legal issues
The Coroner noted that Dr P had not requested copies of Ms C’s clinical notes from her previous treating GP, despite not having seen her for seven years. Further, although Dr P knew that Ms C’s licence had been cancelled, he did not ask why.
The Coroner rejected Dr P’s conclusion that Ms C had good mobility at an assessment on 1 July 2013, because this was inconsistent with all other medical evidence. The Coroner also observed that Dr P’s notes were extremely sparse.
The Coroner found that:
- Ms C was not fit to hold a drivers licence
- Dr P had failed to follow and apply the relevant Austroads guidelines2, or to obtain any corroborating information about her medical history
- Dr P had not demonstrated any insight into his conduct and failings.
However, despite this, the Coroner decided not to refer Dr P to a professional or disciplinary body.
Discussion
Beware of the patient who requests certification of fitness to drive at their first consultation – you can and should refuse to provide certification if you feel uncomfortable doing so. At a minimum, having access to copies of the previous GP notes is essential.
Providing an inaccurate medical certificate to a patient can have very serious consequences for your medical registration.
Julie Brooke-Cowden
Medico-legal Adviser, MDA National
References
- Inquest into the death of Ruth Capps, Coroners Court Southport, delivered on 21 December 2016.
- Austroads. Assessing Fitness to Drive for Commercial and Private Vehicle Drivers: Medical Standards for Licensing and Clinical Management Guidelines. 1 October 2016 as amended up to August 2017.
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