We need to talk...a series of tough conversations about health

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Can I Drive? Taking Away the Keys: Legal & Medical Quandaries

Alzheimer’s, Parkinson’s, epilepsy, medical cannabis use, sleep disorders, arrhythmias, or other conditions such as hypoglycemia, can make for deadly road conditions when patients with these health issues insist on continuing to drive.

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Can I Drive? Taking Away the Keys: Legal & Medical Quandaries

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By Dara Farhadi
Twitter: @Dara_Farhadi

In some respects, driving is considered a privilege. In other cases, it’s a necessity. That may be more so in a large state like Arizona. So when patients, after just learning about their newly diagnosed medical condition, are told they are no longer allowed to drive, that can be a tough conversation for doctors, patients and their families to have. As Dr. Joseph Sirven, a practicing neurologist at Mayo Clinic and a faculty member of Arizona State University’s School for the Science of Health Care Delivery, described an anecdote to a crowd gathered Tuesday night at the Downtown Phoenix campus, “one patient told me, ‘driving is life.’ This was the theme of the first of six talks by the school called, “We need to talk: A Series of Tough Conversations about Health.”

The main guest, Dr. Joseph Drazkowski, is a practicing neurologist and Professor of Neurology at the Mayo Clinic in Arizona and an Associate Dean of Mayo Clinic’s Medical School in Arizona. His area of research is centered on the impacts of medical and health issues and driving. He’s also the medical advisor to the Arizona Department of Transportation, the Federal Railroad Commission and the US Department of Transportation. Informed by his background and expertise, Dr. Drazkowski made it clear that although the conversation of taking away someone’s independence can be difficult, it is a necessary measure. A case-controlled study of motor vehicle accidents among Alzheimer patients suggested an odds ratio of 7.9. Drivers with cataracts are 2.5 times more likely to be in an at-fault motor vehicle accident. Patients with sleep apnea are 2 to 6 times as likely to be involved in a motor vehicle accident compared to healthy subjects. People with epilepsy are among the most regulated when it comes to driving restriction laws and medical conditions and patients with diabetes, dementia, or Parkinson’s can also be at a higher risk of getting into an accident.

Such statistics invoke a number of questions: How do we reduce the number of these preventable deaths? How do we speak to our patients and family members about taking away their license? What are the laws associated with driving with a medical condition? Does future technology and ride sharing services eliminate this concern? And even more questions from the audience and from the ensemble of award-winning journalist moderators: Pauline Davies of BBC’s World Today, Preston Phillips of Wake Up Arizona on CBS5, and Carrie Jung of KJZZ News – the valley’s NPR affiliate.

Arizona law, according to Dr. Drazkowski, states that a person who discovers they have any condition that impairs their driving must self-report to the MVD within 5 days. However, the freedom of driving can be difficult to give up for a patient. Audience members expressed concern about how they might have a conversation with a stubborn family member who won’t give up the keys. Dr. Drazkowski suggests the first step is to have a frank conversation. You could also suggest the family member take a non-biased driving test at the MVD or enroll in an adaptive driving program that can determine if the loved one is permitted to drive or not.

The problems, however, don’t stop there. Some physicians aren’t aware of the laws and regulations of patients driving with medical conditions. And many patients aren’t willing to give up that freedom and self-report to the MVD. Dr. Drazkowski conducted a study that looked at patients who saw an emergency physician in Arizona after they had their first on-set seizure or a loss of consciousness.  Technically, such patients are supposed to self-report their condition to the MVD. But Dr. Drazkowski found that patients would do so about 30 percent of the time. If the patient saw a neurologist, it was 50 percent of the time. “Even in the neurology world we alter in awareness,” Dr. Drazkowski said. “We have to do better as practitioners.”

For patients that can afford it, it seems that the best option to get around is using ride-sharing services. There also seemed to be a buzz that evening about potential future devices such as a chip that could be implanted in a patient’s brain to detect upcoming seizures and thus notify the patient when they can or cannot drive. Autonomous vehicles might also be the ultimate solution to this issue, according to Dr. Drazkowski. The technology, however, has not yet reached that point and is not an easily affordable option. For now, awareness and discussion about these tough conversations might be the best strategy to keep Arizona drivers and patients out of harm’s way. 

For more information check out the full video of the talk above.

The next talk, “The Bionic Man and Woman”, took place on Oct. 24th. “I Can’t See a Specialist”, will take place on Nov. 13th. To RSVP for future talks and to be notified about similar events in the future, visit the series webpage.

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