The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Sunday, December 10, 2006

So Much More Than a Driver's License

I've recently been on both sides of a very sticky subject.

First of all, I'm convinced that the city in which I live is home to all of Canada's very worst drivers. People sit in the left hand lane driving 110 kph, oblivious to people trying to pass. No one thinks to actually indicate turns before they make them. Half of the drivers in town seem to be endlessly looking for an address. The worst, I'm sorry to say, seems to be the elderly. They crawl along city streets, braking for no apparent reason at random intervals. They come to a complete stop while merging into faster traffic. They seem to forget that you can turn right on red lights. They'll pull halfway into a lane from a parking lot and then stop when they see oncoming cars-- this subsequently blocks the lane as they don't seem to understand that the fact that half their car is already in the lane means that traffic can't proceed. It's aggravating, sure. And I admit that I am not the world's most patient driver. I've often voiced the opinion that it seems that many of the people on the road probably shouldn't be. Particularly those over 80 years old. In fact, I think that after the age of 75 drivers should have to pass a road test at least every two years to renew their licenses.

Now I know that age doesn't determine driving ability. There are shitty drivers of all ages. There are dangerous drivers of all ages. But when I see a car that appears to be driven by someone who can't see over the steering wheel, has an altered level of consciousness or some combination of the two-- well, more often than not the driver is of very advanced years. Although experience does improve driving ability, age does not. As a person gets older, reflexes slow, perception is decreased and judgment is gradually impaired. Sometimes these alterations are obvious, and sometimes not. Many elderly people have fairly good insight into their declining abilities-- they will stop driving at night, on the highway, in poor weather-- eventually, they give up their license entirely. For others, it's not a voluntary situation.

Last week one of my patients came in with his wife... he is in his early 70's, and although our communication has been a little hit-or-miss in the past I've never really doubted his judgment. The reason for his visit was difficult to tease out from his broken English, but it seemed that a few weeks after a routine visit to his ophthalmologist he had received a letter from the Ministry of Transport (DMV for my American readers) asking him to come in for a 'review'. The patient was, understandably, confused. He attended the 'review' as requested and was required to attend a seminar. After the seminar, he was provided with numerous forms and papers, some of which had to be completed by his family doctor. That's where I came in. As I figured it, the ophthalmologist probably notified the MOT that my patient shouldn't be driving. I think it was awfully unprofessional of him not to have given the patient himself a head's up as to his intentions to contact the Ministry, but knowing the problems I've had communicating with this guy in the past I wouldn't be surprised if he had explained everything and it just hadn't been understood.

It didn't take long for us to determine that there was no WAY this guy should be on the road. When the nurse tested his vision using the Snellen Eye Chart (at left), he was unable to see the chart from 3 meters away with his left eye. Or his right eye. Using both eyes, he was able only to correctly identify the "E" on the top line. And this was his corrected vision-- with his glasses. Scary.

I went into the room to meet a very indignant Mr. E. He had no idea why the Ministry had contacted him in the first place, and didn't think there was any problem with his vision. He read the eye chart fine, he believed. Unfortunately, as in my last appointment with Mr. E., there was no reasoning with him. I explained that it wasn't my job (or the eye doctor's, for that matter) to determine his fitness to drive. All we did was evaluate his health, and report our findings to the MOT-- they did the rest. Which is exactly what I did. I filled out his forms-- I outlined his diabetic control (not good, but no hypoglycemic episodes that we were aware of), his cardiac status (afib, cardiomyopathy and CHF, all controlled with medication) and the results of his eye exam. I noted that although he did not show any overt signs of dementia, we were not able to complete formal testing due to language barriers and he did occasionally show signs of impaired judgment. I carefully documented that the patient has been advised not to drive. Which I did. Mr. E. was crushed.

"What am I gonna do?" he asked, looking at me imploringly, "how am I gonna get around?"

I turned to his wife, who seemed to be taking in the situation with resignation. This was not a surprise to her.

"Do you drive?" I asked her.


I looked back at Mr. E. In one visit, he had lost a good chunk of his independence and his freedom. Suddenly, he looked very old. Although I knew that he was honestly not safe to be on the roads, I felt awful for having to change his life so abruptly. He shuffled out the door, and his wife stayed behind to thank me. She had suspected as much for the past year or so, she said. But he didn't listen. She would take his car keys until the MOT officially revoked his license, she said.

I did what I had to do. But I still feel lousy.



Blogger Medstudentgod said...

It is rather unfortunate that as we age we are relegated to roles we held while in our youth - namely being restricted. I agree that there needs to be increased monitoring of the elderly as I too have come across these exact same scenarios. However, I also understand, just as you, how traumatic losing one's "independence" can be. I commend you on your continued patience with Mr. E and I hope him all the best with his multiple problems.

BTW - what's 110 KPH in the US? I have absolutely no freaking idea. For that matter, what's 3 meters in feet?


10:48 PM

Anonymous Anonymous said...


Med student from Finland here. I experienced something similar only last week - telling this old lady living in the middle of nowhere that her impaired eyesight would prohibit her driving, and she'd thus probably have to move away from her little cottage to live closer to grocery stores, post offices, health care etc... I also felt lousy, but hey, it's our job...

PS I really enjoy your blog!

5:30 AM

Blogger Couz said...

110kph is about 65mph.

3m is about 10 feet.

Hope this helps!

10:38 AM

Anonymous Anonymous said...

thanks - i wish more docs in the states were willing to do this. if family CAN do it, they often will -but many elders don't have family that knows how they drive OR have the ability to negotiate this issue with an elder. now that i work with elders in the community, i am as worried about elder drivers as i am about teenage drivers!

6:54 PM


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