While many general practitioners (GPs) may feel wary about discussing fitness to drive (FTD) with patients with cognitive impairment, researchers have suggested that discussions around driving should be introduced into routine consultations for all patients with cognitive impairment, even in the absence of apparent functional impairment.
As part of a new study, published in the BMJ Open, researchers interviewed 12 GPs and six patients/carers in Ireland about their experiences of FTD consultations. Discussions around FTD arose either because patients needed a medical report to confirm their FTD or because GPs were proactively preparing patients for future driving cessation.
The authors said in scenarios where cognition had not been previously discussed and this was now impacting on FTD, such situations became ‘acrimonious’. “Being confronted with unanticipated hesitations about FTD while simultaneously learning of the possibility of cognitive impairment represents a double whammy for patients, which understandably leads to consultations becoming heated,” the authors said.
They suggest that where cognitive impairment is known, “GPs can revisit the issue of driving over multiple consultations and use nuanced communication strategies to maintain some sense of patient autonomy and to engage them in planning for driving cessation before a crisis develops."