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‘An unfit driver killed my partner’: Dr Genevieve Yates


Evelyn Lewin


1/04/2021 4:20:20 PM

Driving is a privilege, not a right, the GP says, and doctors should not feel ‘bullied’ into signing fitness to drive forms.

Elderly hand turning the key in a car ignition.
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.

Fitness-to-drive-article.jpg
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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Dr Romika Krishan Prabha Lal   3/04/2021 6:35:07 AM

This article is a good reminder for fittness to drive.
Unfortunately patients see driving as a right.
We had a patient that reported 2 of our GPs to the Ombudsman after they advised him that he needs a driving assessment by OT first.
He had Parkinsons disease.
It was traumatic for them to undergo the process but they taught us a valuable lesson that public and patient safety comes first.


Dr Angela Lam   3/04/2021 7:35:08 AM

Should change the system and have the RMS sign off on fitness to drive. Doctors can give a recommendation (like the disability support pension), but the final say should be with the RMS. These patients are often violent- especially commercial drivers who need their licenses for their livelihood. And yet a lot are not fit (poorly managed diabetes etc)


Dr Fiona Maclean Pringle   3/04/2021 8:27:49 AM

Genevieve, I strongly agree with everything you have written. Our friend's 8 yr old child was a pedestrian, killed by a older man who had a diagnosis of Motor Neurone disease. Of course the family were devastated - so was the man behind the wheel who died 8 mths later.
As GPs we are well placed to walk beside our patients as their health deteriorates. Besides involving others in assessments- RMS OT and special driving tests, I find it helpful to give a powerful reason- telling the bad news stories, like that of my friend's child and your husband. No one wants to be responsible for the deaths of others.
Early discussion and gradual removal of driving rights- and placing restrictions such as no night driving, restricted speed and driving radius allow the person to think about other transport options. Not easy, but necessary.
I agree, occupational driving is the most difficult. Even there, there is scope for discussion about transitioning to another form of work.


Dr Leighton James Merry   3/04/2021 9:25:50 AM

Genevieve, really appreciate your courage and the undoubted emotional stress endured to produce this excellent guiding reflection. Thank you.


Dr Alan Graham MacKenzie   3/04/2021 12:39:22 PM

It really is an antiquated system that involves a GP certifying that a person is fit to drive.
At best we can comment on their medical health
At no stage do we have any idea of their driving ability .
It also intrigues me that young people with Mental Health issues generally do not seem to be subject to scrutiny


Dr Jonathan Tan   3/04/2021 12:41:17 PM

Thank you for posting this article. It is a very relevant and necessary reminder.


Dr Cynthia Filipcic   3/04/2021 1:25:06 PM

Thank you Dr. Yates.
I agree with Dr. MacKenzie: we can assess medical conditions but not driving ability.
The system needs urgent review and consideration of funding OT driving assessments either routinely or for high risk/on specialist recommendation.
It is very hard when the patient is in a ‘grey zone’ - no clear medical contraindication - but the GP has concerns. A lot of these elderly people in rural areas would be isolated if unable to drive and also cannot afford OT driving assessment.


Dr Helena Spencer   3/04/2021 9:21:42 PM

Thank you Dr Yates,
I also feel strongly about this issue - I have no qualms in saying to a patient "if you kill yourself its your own problem, but if you kill someone else, I am responsible."
In the grey cases it is not difficult to tell a patient that due to age or infirmity you will recommend a driving test.
I have had patients say they have spoken to their partners GP about driving concerns , and been told " Oh, I couldn't take his liscence from him ." Very concerning attitude.
Driving is a privilege not a right.


Dr Peter JD Spafford   4/04/2021 8:31:50 PM

The issue is that we are the assessors and also supposed to provide care. Easier when you have no responsibility for ongoing management of a patient. Perhaps, a bit like some employment medicals, make sure they are done by someone that is not the regular doctor or relationships are at risk. It is good to be aware but not as easy in practice as highlighted. As Drivers medical assessments do not attract a Medicare payment, surely it should be contracted out?


A.Prof Christopher David Hogan   10/04/2021 10:11:15 PM

I distinctly remember following all recommendations & giving due consideration to pass an elderly driver as fit to drive. The next morning I got a call from a local policeman. "She drove fine doc, just one problem- she was on the wrong side of the road" Even when properly & rigorously applied, office tests can be inadequate to completely assess safety to drive- when in doubt organise an OT assessment.
Some states have permitted selective licenses. Some have the capacity for doctors to report that they were coerced into issuing a fitness to drive & it can be cancelled.
Some have public hospital clinics that can assess fitness to drive & authorise selective licenses & OT adjustments - they are without extra cost but have waiting lists
What happens when people continue to drive even without a valid licence?


A.Prof Christopher David Hogan   10/04/2021 10:17:26 PM

Another issue is that a major driver (so to speak) in the development of autonomous vehicles is the increasing demand from an increasingly aging population for independent transport even when they become impaired.


Dr Gurjinder Singh Kairon   11/04/2021 8:27:06 AM

Dear Dr yates,
Thanks , for your very important massage . This is issue we struggle everyday with time constraints and pressure from patients . I think there should be some training for fitness to drive for new GPs and GP in training . Just studying ourselves from Fitness To Drive guidelines is not sufficient .

Gurjinder


Dr Rebecca Overton   11/04/2021 4:00:22 PM

Genevieve I'm so very sorry you lost your partner whilst you were pregnant. It must have been absolutely devastating for you and for your child. Thank you for sharing your story so bravely, to try and benefit us as GP's and our communities. I wish you and your child all the very best for your future.