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Friday, August 01, 2003"An increasing number of older Americans are dying in car crashes as an aging population of licensed drivers stays behind the wheel, a study released Thursday says. Nationwide, the number of people 70 and older who died in car crashes increased 27 percent between 1991 and 2001. During that same time, the number of licensed drivers 70 and older increased 32 percent, according to the report by The Road Information Program (TRIP), a nonprofit group that researches information about highways. To be fair to the elderly as a group, however, the absolute numbers aren't all that alarming, except for Florida and Texas. TRIP offers an interesting solution, however - the highway equivalent of large print books: The report calls for more federal funding to increase roadway safety, including clearer signage with larger lettering and pavement markings; brighter lane markings at intersections; and wider lanes and shoulders on streets and highways.” But the AMA has a different idea. Take away the driving privileges of the impaired elderly. There will be those - mostly impaired elderly drivers - who will claim that this is ageism, but there’s no denying that there are those among the very old who should not be driving. People with age-related macular degeneration, cataracts, strokes, senile dementia, heart conditions that place them at risk for sudden death. The list goes on and on. It’s no easy thing to take away a person’s driving privileges. Usually it only buys animosity for the doctor or the family member who has to enforce it. Voices get raised, and sometimes fists. Accusations of condescension and deprivation get hurled. And sometimes, tears are shed. No one likes to face the loss of their liberty. It can be heart breaking. Which is why, sometimes, the practice of medicine requires a hard heart. UPDATE: C. Henry says: This is never a fun topic, but is common in an ophthalmology practice, especially one that deals regularly with neuro-ophthalmology and disease resulting in visual field defects. Usually it is in context of a routine examination of a patient who has an existing diagnosis of glaucoma or retinal disease that also needs a routine certification to renew a driving license. I discover some excluding, irreversible defect and have to tell the patient they cannot meet the visual qualification to drive. It can be heartbreaking. Sometimes the patient is the supporting member of their household, the only one of an elderly couple still driving. Sometimes it is a widow or widower with limited local family and no other practical means of mobility. The loss of driving privileges for them is devastating. But to say nothing is to shirk your public duty (and possibly the requirements of law) and to permit driving by someone who when driving is dangerous to themselves and others. We have a duty to care for our patients, not to lie for them. In these cases I tell them plainly not to drive anymore. I carefully document that I specifically told them not to drive and why. I also note who was present when I told them that. I don't talk around the subject, or give them the impression that I am only making a suggestion. Some actually are relieved to be told not to drive; others obviously are not. Like I said, practicing medicine well requires a hard heart. I don't lie for my patients, either. Which is why some of them accuse me of having no heart. posted by Sydney on 8/01/2003 08:04:00 AM 0 comments 0 Comments: |
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