Should Physicians
Be Responsible for Reporting Their
Patients to the DMV?

By Kamala M. Rodrigues, M.D., Mimi A. Callanan, R.N., Michael W. Risinger, M.D., Robert S. Fisher, M.D., Ph.D.

Of the 180 million Americans licensed to drive, about 700,000 of them have epilepsy. California is one of only six states that require physicians to report a patient's loss of consciousness episodes to the health department and indirectly to the Department of Motor Vehicles (DMV). This requirement stems from the belief that people with a recent loss of consciousness, such as those with complex partial, absence, or tonic-clonic seizures, have a higher-than-baseline risk for crashes.³ While safety on the roads is a valid concern, the assumption that required reporting protects public safety is unproven. We were concerned that required reporting could motivate patients to conceal seizures from their physicians and thereby negate potentially useful changes in therapy and even harm the doctor-patient relationship.

In order to determine the effect of mandatory physician reporting, we surveyed all our adult outpatients at Stanford University Epilepsy Clinic over a four-month period. To ensure anonymity, the health care personnel involved in patient care did not distribute the surveys. Surveys were distributed by front-desk personnel and returned anonymously to a locked box in the clinic waiting area. Patients were specifically told the results were for research purposes only and would not be reported to the doctor or the DMV. Fifty-one percent of the 402 distributed surveys were returned. Ages ranged from 16 to 83 (mean 38). Fifty-seven percent of responders were female.

Of those who responded to the questions on concealment, 8.6 percent admitted that they had already concealed information on their seizures from their physician because they were afraid of having their license revoked. More than double that figure (18.6 percent) had considered withholding such information from their physician. The true numbers are probably much higher, as those who wish to conceal information are less likely to fill out a survey. Some patients may avoid medical care altogether for fear of being reported. Patients surveyed whose license had previously been suspended for medical reasons were more likely to conceal or consider concealing information (Chi-Square = 6.56, p<0.02).

These data suggest that patients are less likely to admit having had a seizure if their physician is required by law to report the seizure to the authorities. Unfortunately, inaccurate information lessens the physician’s ability to appropriately treat, and may therefore defeat the initial purpose of mandatory reporting—to protect public safety.

Additionally, 22 out of 166 responders (13.3 percent) reported that their relationship with their doctor had been adversely affected by mandatory physician reporting. And physicians share this concern. A 1999 study in the Canadian Medical Association Journal found that 59.5 percent of Saskatchewan physicians believed that relationships with their patients had been harmed by mandatory reporting.⁸

The alternative to required reporting is a voluntary system. Approximately 80 percent of our responders said that they would voluntarily refrain from driving if they had a seizure. This high percentage, coupled with a significant admitted percentage of concealment of seizures from physicians and impairment of the patient-physician relationship, suggests that thought should be given to elimination of required reporting of seizures by physicians.

References

1. Krumholz A, Fisher RS, Lesser RP, Hauser WA. Driving and epilepsy. A review and reappraisal. JAMA 1991; 265: 622-626.

2. Fisher RS, Parsonage M, Beaussart M, Bladin P, Masland R, Sonnen AE. Epilepsy and driving: an international perspective. Joint Commission on Drivers' Licensing of the International Bureau for Epilepsy and the International League Against Epilepsy. Epilepsia 1994; 35: 675-684.

3. Lings S. Increased driving accident frequency in Danish patients with epilepsy. Neurology 2001;57:435-439.

4. Dickey W, Morrow JI. Epilepsy and driving: attitudes and practices among patients attending a seizure clinic. J Royal Soc Med 1993;86:566-568.

5. Dalrymple J, Appleby J. Cross sectional study of reporting of epileptic seizures to general practitioners. BMJ 2000;320(7227):94-7.

6. Salinsky MC, Wegener K, Sinnema F. Epilepsy, driving laws, and patient disclosure to physicians. Epilepsia 1992;33:469-472.

7. Berg AT, Vickery BG, Sperling MR, Langfitt JT, Bazil CW, Shinnar S, et al. Driving in adults with refractory localization-related epilepsy. Neurology 2000;54:625-30.

8. Marshall SC, Gilbert N. Saskatchewan physicians’ attitudes and knowledge regarding assessment of medical fitness to drive. Can Med Assoc J 1999;160(12):1701-1704.