Thursday, June 10, 2010

Beep Beep

Hmm... I recently learned that Maryland's Department of Motor Vehicles has a long list of illnesses that must be reported to the DMV ---by the driver, fortunately, not by the shrink. If a driver reports one of these illnesses, his doc needs to fill out paper work about his ability to drive.

Here is the link, and here is the list:

Customer Self-Report of a Medical Condition

Maryland law requires drivers to notify the MVA if they are diagnosed with any of the following conditions:

  1. Cerebral palsy;
  2. Diabetes requiring insulin;
  3. Epilepsy;
  4. Multiple sclerosis;
  5. Muscular dystrophy;
  6. Irregular heart rhythm or heart condition;
  7. Stroke, ministroke, or transient ischemic attack (TIA);
  8. Alcohol dependence or abuse;
  9. Drug or substance dependence or abuse;
  10. Loss of limb or limbs;
  11. Traumatic brain injury;
  12. Bipolar disorder;
  13. Schizophrenic disorders;
  14. Panic attack disorder;
  15. Impaired or loss of consciousness, fainting, blackout, or seizure;
  16. Disorder which prevents a corrected minimum visual acuity of 20/70 in each eye and a field of vision of at least 110 degrees;
  17. Parkinson's disease;
  18. Dementia, for example, Alzheimer's disease or multi-infarct dementia;
  19. Sleep disorders, for example, narcolepsy or sleep apnea; or
  20. Autism.

A driver must report the problem when it is diagnosed, or when he or she is applying for a driver’s license or renewing an existing driver’s license.

I can't imagine that everyone with these disorders reports these illnesses, because I'm never asked to fill out form for DMV. And how would I know if someone can drive? I suppose if I'm being told about 6 crashes and getting lost....but I have patients who don't have any of the above disorders, who drive, who get into lots of accidents. If everyone abided by this law (and I wasn't able to find the actual law(s), but I didn't look that hard), I think we'd see 1) a lot less traffic and 2) many more clerical positions available at DMV.

Psychiatrists aren't trained to assess driving abilities. We do know the meds we give can cause sedation, and we do warn people of this. Apparently the form that is brought to the doctor asks about conditions which "may affect" ability to drive. So there's the issue of guessing about driving ability, and the issue of predicting the future, without a working crystal ball.

Your thoughts? And this post is about driving cars, not airplanes.


The Girl said...

"Autism" is particularly interesting, considering the number of people who have been diagnosed with ASD and who are high-functioning in everyday life, and that it isn't something that you develop - hypothetically you would have had it when you applied and were tested for your license in the first place, so your driving examiner would have tested you for your license as a person with autism. If they have assessed you as being fit, and your condition hasn't changed, why would you have to then report that you have it?


moviedoc said...

NO doctors know how to assess driving ability. I disagreed with Steve Moffic when he wrote about this:

This is simply bureaucrats attempting to shift the responsibility to docs because they won't have to pay us, and they count on the fact that we are reluctant to say no to our patients. Say no anyway. Maybe you can get the state medical associations to support boycott or strike or whatever you call it. Our role is to diagnose and treat illness. I could argue that there are ethical problems, role conflict, etc. Constitutes a forensic role. No. NO. NO!

Anonymous said...

I had a patient at 38/40 weeks gestation, hoping that I would write a medical certificate for her, stating that she would not go in to labour on her domestic flight.

She wished to travel back home to have her baby.......Am I a mind reader.......She thought it totally unreasonable that I could not comply with her wishes......

Same thing here. What am I a fortune teller....Many will be OK some won't. Is the answer to deny all applications if there is a risk factor? Medico legal best practice may dictate this, but I doubt it is in all my patients best interests...

Blue Calm Sea

Anonymous said...

That's a horrible law. I don't need to disclose my mental illness to the DVM and then bring in a piece of paperwork that clears me to drive. So, what, I'm good for 5years? And then I need to start over again? Theoretically, I could deteriorate substantially during those 5 years but I'd be good to go per the DMV. As good as an 88-year-old great grandma who forgot which pedal was the brake.

It takes a village to raise a child. Why shouldn't it take a village to stop dangerous drivers? Let family members take away the bloody car keys. Why should doctors police this stuff? Drunk drivers get layers and layers of appeals in my state and can easily cry hardship and get their driver's licenses back. Why should the regulations make it harder for upstanding citizens who happen to have a mood disorder? Honestly, I believe Maryland's law is unconstitutional as written (what Dinah showed us, anyway).

Anonymous said...

the difference between a siezure and a panic attack is that with the latter, the sufferer never crashes their car

Sarebear said...

This is one reason I don't drive anymore, and haven't for years, is because I was afraid that the medications I was on would disqualify me from driving, by the DMV, and my anxiety disorders didn't even want me to have to deal with them about it. As meds have changed over the years that I've been on, sometimes I've been not on sedating meds or ones they'd mistake for epiliptic conditions (like when I was on Gabapentin), and other times I've been more tired from the meds.

So I just haven't renewed my license. There's been three times I've had to drive or else cause my husband was too tired to drive home from something, but those are what I would consider emergencies, late in the day, and I wasn't tired from my meds at the time.

Yeah, driving without a license, but driving extremely tired is close to or can be like driving drunk I've heard, so I took it those three times over the years. He tries not to let it get into that situation, though. Work forced a couple of them.

I hate being such a burden.

Bippidee said...

This is standard in the UK, except the list of things you are supposed to tell them about is crazily long - here is a link You are even supposed to tell them if you have Depression, although of course nobody does. I do know people who have been deemed unfit to drive, generally when they are on medications that make them particularly drowsy or something, for example some mood stabilisers and anti psychotics. You have the option of surrendering your licence, rather than letting them poke around in your medical records, and you can then apply to get it back as soon as you feel it is appropriate. If it is taken away following a medical enquiry it is more complicated - you have to have been stable for anything between 6 months and 3 years (depending on the condition) before they will consider reinstating it. If you are interested in reading more about how it works, there are full details here

Catherine said...

Bippidee, I think my favorites are "deja vu" (recurring) and "giddiness" (recurring).

blogbehave said...

Sleep apnea? I can understand the potential perils but with so many people diagnosed, it would surely overwhelm the DMV if each of these cases were reported (and several of the others you mentioned ... i.e., panic disorder) the lines at which are ridiculously long already.

With substance abuse dependence, it's dicey since minimization is common. If patients know they are being assessed for driving impairment, I'm thinking minimization will become rampant across the spectrum.

And yes, unreasonable to expect doctors to judge or predict the impact on driving in so many of these conditions. Unless you add a driver's ed to your staff.

Anonymous said...

I HATE having to lie on those apps.

Gina Pera said...

Yes, it's pretty comical to think that the first thought of someone with a substance-use disorder is calling the DMV for a self-report. ;-)

I've heard that Canada had considered making ADHD a mandatory report for driver's licenses but abandoned the idea on the basis of it probably inhibiting diagnosis.

It is amazing to me, though, that such a list would exclude ADHD, especially given the overlap with so many of those listed conditions (TBI, heart conditions, panic attacks, sleep disorders, etc.).

In fact, the research on ADHD-related driving impairments is substantial -- and shocking. ADHD can be as impairing as alcohol, and of course even worse than the driver with undiagnosed/untreated ADHD "self-medicates" with alcohol or marijuana, not to mention texting, etc. The incidence of "Road Rage" is also higher among those with untreated ADHD.

ADHD deficits can be a serious safety hazard to everyone in the car and on the road.

Gina Pera, author
Is It You, Me, or Adult A.D.D.?

moviedoc said...

So Ms. Pera, someone who does not have a diagnosis of ADHD and uses alcohol is just drinking, but someone who has ADHD and uses alcohol is "self medicating"?? Are you suggesting that alcohol is a treatment for ADHD? Please explain.

Anonymous said...

My rationalization....sign the damn form FIRST, then fill it out..........yeah, i know. Stupid and dishonest. But the meds keep me stable.

Unknown said...

New post s'il vous plait.

Yes we know you are chilling after your magnum opus.

The loyal followers are craving a new post.

Hoping that a support duck and goat of greatfull-ness, will appear "in a where's wally" kind of way somewhere on the cover or dust jacket.

Dinah, Clink Roy did you get any goats (


The Shrink said...

In the UK there's robust guidance on this for doctors. As with your corner of the USA, patients are directed to notify the licensing authority of conditions.

However, if the patient doesn't, the doctor has to.

This works well.

In practice, since it's the law that notification has to take place, I simply state this to my patient and helpfully suggest, "Since they need to be informed, I'll pop a letter in the post to them, shall I?" and the job's done.

Notification is mandatory (and it's an area in the UK where doctors have to breach confidentiality to do this, if patients won't). But after notifying the licensing authority of the condition, the treating doctor has no formal role in assessing fitness to drive at all.

We are asked sometimes for clinical information but the decision on fitness to drive rests with the licensing authority, their doctors/occupational therapists, not with the patient's psychiatrist.

I like this.

I raise the diagnosis with them, but the implications of this are progressed by them. With the ultimate decision to issue/revoke a license being theirs. This, for me, works well. Potential risk is identified by the psychiatrist, the collating of information and deliberation and decision isn't.

Anonymous said...

It is frightening to think of how many people on these drug cocktails are driving around under the influence.

Noni Mausa said...

Oy, the factors, the factors!

First, there's the problem of discouraging diagnosis. In the US such a dx follows you around for the rest of your life, making everything from licensing to health insurance much harder -- better to be thought a ditz than to be confirmed with one of these illnesses. Meanwhile in Canada, psych services are not covered under our health plan unless they rise to the level of severe psychiatric conditions -- which ADHD isn't classed as.

And a parting shot -- isn't it untreated ADHD that produces such lousy driving and general accident-proneness? In which case the dx and treatment would penalize the safer ADHD drivers and leave the others running free.