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‘An unfit driver killed my partner’: Dr Genevieve Yates
Driving is a privilege, not a right, the GP says, and doctors should not feel ‘bullied’ into signing fitness to drive forms.
Patients who fall in the ‘grey zone’ – those who are not clearly fit to drive, nor obviously unfit – pose the biggest problem for clinicians.
As a GP, Dr Genevieve Yates always knew about the importance of assessing a patient’s fitness to drive.
But the former General Manager of RACGP Education Services did not truly understand the impact of such an assessment until an unfit driver killed her partner in 2015.
‘I was pregnant at the time and my partner was overseas visiting friends in the US,’ Dr Yates told newsGP.
‘He went for his usual morning jog and was hit and killed.’
Naturally, Dr Yates was devastated about her partner’s death at age 39.
But when she learned that the man behind the wheel of the car that caused the crash had dementia and was unfit to drive, she was livid.
‘When I found out later that he’d been assessed as “fit to drive” only a couple of weeks before the accident, and that his family had actually expressed concerns to his family doctor about his ability to drive, it made me really angry,’ Dr Yates said.
‘But [it] also lit the fire in my belly to try and increase the awareness of assessing fitness to drive.’
At that point in her life, Dr Yates had been a GP for approximately 15 years and knew assessing fitness to drive was an important task for GPs.
‘But it wasn’t something that I really paid a lot of attention to,’ she said.
‘And I hadn’t really contemplated how serious this was – not just for the patient’s safety, but also for society’s safety.’
However, it was an issue she thought about a lot in the beginning of her career, as she felt significant pressure to sign such forms for patients.
‘The most memorable experience [I had] goes back to when I was a registrar, back in the early 2000’s, and I was pretty much bullied into signing a fitness to drive form for an elderly woman who was clearly unfit to drive,’ she said.
‘It really disturbed me and I felt really bad about it.’
That uncomfortable feeling soon became outright fear when, a few weeks after signing this patient’s fitness to drive form, Dr Yates found out the patient had died behind the wheel.
‘I heard she died behind the wheel, and I was absolutely petrified, thinking, “Oh my goodness, she’s had a crash and she was unfit [to drive]”,’ she said.
‘It turned out she’d parked the car and had assumedly a massive stroke or something while she was parked, so it didn’t come back to bite me, but it [was] a wake-up call for me.’
After that experience, Dr Yates had a realisation.
‘Sometimes, you have to play the bad cop,’ she said. ‘If all of your patients are totally happy with you all of the time, you’re not being a very good doctor.’
Her attitude towards fitness to drive changed after that experience, but she still felt like she was not addressing the issue as well as she could.
‘I don’t think I did a bad job,’ Dr Yates said.
‘But I certainly don’t think I did as good a job as I did after; of course, my awareness was significantly increased after [my partner’s death].
‘Now I have a bit of a campaign and I do talk to doctors, particularly doctors-in-training and other health professionals, about fitness to drive and about the best ways of doing that in a GP setting.’
According to Dr Yates, one of the biggest issues relates to patients who fall in the ‘grey zone’ – those who are not clearly fit to drive, nor those who are obviously unfit.
Dr Genevieve Yates wants clinicians to understand the potentially life-changing ramifications of assessing a patient’s fitness to drive.
If a patient is clearly unfit to drive, she says that should be an open and shut case.
‘The rules are set out in the guidelines and if someone clearly does not meet the rules, then you just cannot sign [the fitness to drive form],’ she said.
‘The GP has to follow the law, so that’s that.’
If a patient falls into the ‘grey zone’, Dr Yates says the patient should be referred for further testing.
‘Depending on what the problem is will depend on where you want to go,’ she said.
‘So you may want to refer them to a particular specialist, whether it be a geriatrician or a neurologist or whatever condition is relevant.
‘Or you might want to send them for a practical on-road test with an occupational therapist or other driving instructors.
‘The take-home message is … you don’t necessarily have to make a call on your own about those intermediate cases.’
While that might seem clear cut, Dr Yates acknowledges how difficult it can be in practice as it may significantly affect the doctor–patient relationship.
‘Having worked in a rural area for some time, I was very much focused on what losing their licence meant to my patients,’ she said.
‘Their inability to drive themselves will often have significant consequences for their lifestyle and that is an important consideration to have.’
Dr Yates says there are two main groups who tend to pressure doctors into signing fitness to drive forms.
‘Firstly, there’s pressure from the elderly,’ she said.
‘They often say, “I’ve never had an accident”. Or, “I’ve been such a good driver for 60 years”.’
The other group is commercial drivers, who need to meet higher levels of standards to obtain a commercial licence.
‘If they have a condition, for example sleep apnoea, or some kind of vision disorder – something that prevents them from getting a commercial licence – that’s basically taking away their income,’ Dr Yates said.
As a result, patients seeking a commercial licence who are deemed unfit to drive can put ‘enormous pressure’ on their GP to not disclose medical conditions that may interfere with their job.
If a GP refuses to sign a fitness to drive form, patients may also ‘shop around’ for a doctor who will sign the form. Despite this, Dr Yates says it is important not to yield to such pressure and to instead remember that public safety must be placed above individual freedoms.
Nowadays, she considers fitness to drive during every consult; if a patient is put on a new medication that may cause drowsiness, for example, she warns them it may impair their driving and advises to avoid driving during the initial adjustment period, if possible.
She also considers fitness to drive when managing conditions including:
- diabetes
- neurological conditions
- cardiac conditions
- sleep disorders
- psychiatric disorders
- vision issues.
Trauma, post-surgery and pregnancy are other factors that can influence a patient’s fitness to drive, while Dr Yates says drivers need to be advised that national guidelines recommend not driving for at least two weeks following a deep vein thrombosis (DVT), and six weeks following a pulmonary embolism (PE).
Aside from talking about fitness to drive with patients at every relevant opportunity, she notes it is also important to document these discussions.
It has now been almost six years since Dr Yates lost her partner.
She finds talking about her loss difficult, but believes it is worth sharing her story.
‘As painful as it is to talk about – and it still is – I’ve found my story has resonated with people,’ Dr Yates said.
‘The reason I share it is … I just want people to know that when you sign that form it can have consequences.
‘It is an important responsibility.’
More information on Dr Genevieve Yates’ story and her advice to clinicians on assessing fitness to drive can be found in her Pecha Kucha video.
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