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Last Updated: 1/8/2014  

Proscribing Impaired Driving

Brief description:

  • Injuries and fatalities due to impaired driving represent a potentially preventable source of morbidity and mortality.

  • Alcohol-related deaths accounted for 32% all traffic fatalities in the U.S. in 2008 (1).

  • Quantifying the exact prevalence of other impairments remains difficult because collisions are:

    • Often due to combinations of multiple impairments

    • Highly dependent on the experience of the driver

    • Highly dependent on the number of miles driven

  • Many medical conditions or medications can adversely influence driving and increase the risk for a traffic-related crash.

  • Physicians do not make direct decisions about state licensing, but certain states require physicians to:

    • Report certain medical conditions that may determine driving eligibility

    • Evaluate patients for renewal of a license (e.g., in Georgia and Maine)

  • If risk factors for collision are identified, patients have the opportunity to alter their driving habits, correct the factor, or find safer, alternative forms of transportation.

  • Drivers forced to reduce or discontinue driving may face financial, social, or health consequences due to the loss of mobility (2; 3; 4).

Ethical issues:

  • The ethical obligation of physicians in treating impaired drivers is to provide competent and compassionate care while respecting patient autonomy and confidentiality within the confines of the law (5).

    • Individuals informed of the risks of impaired driving are justified in determining their own driving behaviors unless “their ability to make autonomous choices is so limited that we consider them incompetent” (6).

    • A physician's duty to guard public safety may, in some cases, outweigh patient rights to confidentiality in specific circumstances where there are “overriding social considerations” (7).

Legal considerations:

  • Physicians have a duty to inform patients of medical conditions or substances that may cause impairment and increase patients' risk for a driving-related event.

  • Case law shows that clinicians may be found liable when such risks have not been properly disclosed (8; 9).

  • Physicians have been held liable in cases where, in the interest of patient confidentiality, a known third party was not informed of a significant threat of danger or violence (10).

  • Physicians should determine whether they have a legal obligation to report potentially impaired drivers.

  • In the U.S.:

    • Most states have voluntary reporting laws

    • Be aware that the scope and severity of impairments considered appropriate for reporting may differ substantially from state to state (11; 12)

    • Federal laws strictly outline the physical qualifications and exams required for professional drivers (13)

    • Physicians should review individual state reporting guidelines

DOI: 10.7326/el090
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Disclosures:
James M. Lai, MD, ScM has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard Marottoli, MD, MPH has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Christie A. Joya, DO has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Adam M. Barelski, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Barbara A. Cooper, MD, FACP has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, Editor.
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