Stringent laws requiring doctors to report people whose medical conditions might impair their driving are unfairly penalizing many heart patients who likely pose little danger on the roads, a major cardiac-medicine conference heard Tuesday.
Those medical reports lead to licence suspensions, which in turn can cause people to lose their jobs, stop trusting their doctor or even lie about dangerous symptoms, two cardiologists said after a debate on the issue at the Canadian Cardiovascular Society annual meeting.
Physicians also must deal with the wrath of patients whose lives have been disrupted, they said.
“We all have this sinking feeling that we’re reporting all these patients and causing them all this distress and hardship, and there’s no proof it is doing any good,” said Christopher Simpson of Queen’s University in Ontario.
“Most of the people we’re removing from the road, never would have had a problem…. It’s really very difficult for us to try to predict who is destined to have a medical illness behind the wheel.”
He said it might be preferable if doctors simply urged patients not to drive when the danger seems real, or if at least there was no legal obligation on physicians to report.
Officials with safety organizations and provincial licensing authorities could not be reached for comment on Tuesday.
Seven provinces have laws that force doctors to report patients whose medical problems could lead to an accident while they are behind the wheel; in Alberta, Quebec and Nova Scotia, it is left to the physician’s discretion whether or not to report.
About 20% of those reported are heart patients. Dr. Simpson said he alerts Ontario’s Transport Ministry to as many as 150 of his patients a year.
Carlos Morillo, a cardiologist at McMaster University in Hamilton, Ont., said he has to turn in more than 200 patients annually, though his numbers may be unusual because his practice specializes, in part, in patients who suffer syncopy, or fainting. He admitted the laws probably do prevent some bad collisions, but said he generally shared Dr. Simpson’s concerns.
The Cardiovascular Society publishes guidelines indicating which patients should be reported — often people who are at risk of blackouts or even sudden death because of certain heart arrhythmias and other ailments. On the surface, that would seem to make for a compelling case to pull their licences, said Dr. Simpson.
But there is virtually no scientific evidence indicating such measures prevent crashes, and the chances are very slim that any individual patient, especially when under treatment, would cause an accident, he said.
In fact, some research suggests that 95% of drivers who lose control of a vehicle because of a heart condition did not even know they had a problem.
Licence suspensions can have major impact on patients. Dr. Simpson said many of his patients, especially those in rural areas, lose their jobs because their jobs involve driving, or they have to be able to drive to work.
The response from patients is “universally negative,” he said. “No one thanks us for doing it.”
At the same time, it can leave the medical relationship in tatters, with patients reluctant to tell their cardiologist that, for instance, they are still having fainting spells or seizures, the physicians said.
“I don’t know if they’re fainting or not,” said Dr. Morillo. “The patients learn very rapidly, ‘I better just keep my mouth shut, because otherwise, there goes my licence.’ ”