Wednesday, March 11, 2009

Should Doctors Report Patients with Blackouts?

Today's Chicago Tribune leads its North Chicagoland Extra section with this headline: "Grieving father seeks legislation: Daughter killed in crash caused by driver who ignored doctor's warning on blackouts." The story describes the efforts by Attorney Maurice Grimes to advocate for legislation to require doctors to report all patients with blackouts (syncope) to state officials, who could then revoke their drivers licenses. You see Mr. Grimes lost his lovely 27-year old daughter after she was involved in a head-on collision with a 30-year old man who had experienced blackouts before and was advised not to drive by his doctor. The man was convicted of reckless homicide, sentenced to three years in prison, and released after 5 months and remains on parole.

Both lives, forever changed.

But Mr. Grimes, a Chicago lawyer, remains convinced that "it was murder" and is proposing legislation requiring physicians to report all patients with syncope to state officials.

These cases always tug on emotional heartstrings, and I do not blame Mr. Grimes for pursuing what he feels is the right course of action, but it might be helpful to review our experience with such legislation's effectiveness again. After all, there is a considerable body of research in this area in people with defibrillators and pacemakers, not to mention epilepsy. in fact, I have reviewed these issues before. Even more recently, the TOVA (Triggers of Ventricular Arrhythmias) trial, demonstrated that people with defibrillators had an especially low incidence of arrhythmias resulting in car accidents: 1 episode per 25,116 person-hours spent driving.

While I appreciate the Grimes family's desire to "make something useful" come from their daughter's death, that desire must be balanced with the individual's need for mobility and access to education, employment, health maintenance, and personal enrichment opportunities that, ultimately in our society, are highly dependent on the automobile. Being unable to drive puts limitations on the individual, which results in both emotional stress and loss of economic status.

For this reason, and the other reasons stated in the original Tribune article (especially the difficulty enforcing such legislation), I can only hope that Mr. Grime's proposal never sees the light of day.



Anonymous said...

Required reporting does bring up all the issues you raised, and more. I wish, however, there were better, more uniform guidelines and better support for clinicians who feel the need to report, on a case by case basis.

When I was still working as a psychologist back in the 1990s, I worked with a young woman who had a severe seizure disorder. She had voluntarily stopped driving a couple of years prior to our work but, after her condition improved, she went back to driving again. At the time of our work (and unrelated to our work), her disorder worsened but she continued to drive. She did not share this with her neurologist, but shared it with me. She was putting herself in grave danger, as well as everyone else who shared the roads with her. I wrestled with telling her MD. I urged her to tell him herself. No luck. I then had to consult our practice Legal Beagles to see if this was a duty to warn situation--I wanted to warn, they didn't want me to. They thought we'd be opening ourselves up to all sorts of litigation. We went round and round about it. Finally, with Legal's reluctant approval and the client's knowledge, I spoke to her MD. He had her license pulled. It was the end of our therapy; she never forgave me, but she also never (as long as I lived in that area) killed or maimed herself or anyone else with her driving. I think I did the right thing. She was a college student, living on campus, with no outside job, living in a major urban area with decent public transportation. I hope I would be able to help somebody else in a similar medical condition who really needed to be able to drive, but I don't know what I would do. Case by case.

My father, prior to his fatal heart attack (at age 84) had multiple medical issues and was on buttloads of cascading medications. He would have full body muscle spasms with no warning, which would lock up most of his limb functions. We begged him for 10 years to stop driving. He refused. We begged his doctors to help us--several of them "suggested" to him that he stop driving, but all of them said they had no power or authority to have his license altered or revoked. I am thankful he never hurt anyone behind the wheel.

I don't think it is just up to the doctors to become the drivers' license police, but families often need help from the medical community (and probably law enforcement too). It's not an all or nothing proposition (e.g., either there's a blanket law that covers all situations OR we go hands-off on everybody and hope for the best)--and I'm not saying you implied that. I'm just responding that all of us (families and med professionals) need to help each other sort through the whens and hows, on that case by case basis, and support each other as much as we can.

Lisa said...

I've had my license pulled after a syncopal episode and had to wait six months for my cardiologist to sign off on getting my license back. It upset me in that I felt that I was no more likely to have a second episode while driving than any of his other patients were of having MI's while driving. Should they pull the license's of every post menopausal woman and man over 60 because the risk increases that they could have a heart attack while driving? It is unfortunate that this young woman was killed by someone who fainted at the wheel. But we do know that driving is dangerous and honestly, she was in more danger from someone who just simply fell asleep.