My ‘Duty of Care.’ - Driving Standards

I clearly remember the words of my university lecturer saying to all of us:-
‘When a patient does not meet driving standard requirements, you can only advise them about it. Your duty is to make sure that they are aware of the clinical results. You are not in a position to tell them whether or not they are allowed to drive’.

 

But what should I do if the patient does not update their spectacles to achieve that standard? Should we notify the DVLA with regards to their sub level vision?  Should we do the same for unsatisfactory visual field results?

 

At that point I thought to myself, if the patient is not meeting the standard in their current glasses and as I have informed them that their vision is below the required standard, they will surely update them. After all, the patient will understand that they are not only endangering their life but also the lives of others. Simple, and that will be the end of that.

 

I couldn’t have been more wrong! Twice this month I have been in a position where I have questioned where does my ‘duty of care’ end?

 

I told my patient today, that I recommend he does not drive without any visual correction as his vision is R 6/20 L 6/18, with corrected acuities of R 6/9 and L 6/7.5.  However, he still did not feel that it was necessary to use any spectacles. So what should I say to him? 

  

I did what I thought best, to write his response on the records and ask the patient to sign it. And as he left the practice, I knew that he would continue to drive. The whole evening I have been thinking to myself what else could I have done?

 

Last month I had a similar situation whereby a patient using monovision contact lenses was complaining of a reduction in her distance vision. Over refraction results showed that she would not be safe for driving in them, as she was not meeting the standards. She then spoke to me in very colourful language and insisted she speak to the manager. I explained to the patient that if she was going to drive in her lenses I would not be happy in continuing to supply them to her for that purpose.  

 

Our contact lens department was certainly not happy with me and perhaps I did overstep my boundaries by not wanting to fit her with more lenses. However, if I had continued to supply her lenses in the knowledge that she would continue to use them for driving, despite not meeting the standard, I do not believe that my duty of care had been exercised. 

 

So is optometry now a growing commercial industry rather than a clinical profession?

 

Share This