“You try to compromise,” said Dr. Lent Johnson, a family physician with the Hannibal Clinic, as he explained how doctors work with a patient who may need to give up driving.

“You try to compromise,” said Dr. Lent Johnson, a family physician with the Hannibal Clinic, as he explained how doctors work with a patient who may need to give up driving.
A recent Associated Press article reported doctors may be of help to a family facing this decision, because a patient may be more likely to take the advice from a doctor than from a family member.
When Dr. Johnson agreed to discuss this sensitive subject, he emphasized that finding alternate transportation before asking the driver to give up the keys is important.
“This is terribly disheartening to the patient, so you also need to be prepared to talk about alternate means of transportation,” he said, such as “the OATS bus, and Walden Transportation has different types of vehicles.” Also, Johnson said, “people with state Medicaid can qualify for transportation. In this area we are lucky enough to have lots of very good options, and that’s a key thing - you have to give them some solutions.
“If they shouldn’t be driving, you can convince them you have these other options. We have taxis and paid service for people who have handicaps and the OATS bus, in addition to family and friends.”
In order to become involved, Johnson explained, a physician needs to have a prior discussion with family members. “The physician has to rely on family members to give you some feedback. You can’t always detect it during a visit time. We ask the family to at least broach the issue with the patient, but sometimes you need that support from the physician and that is part of our responsibility.”
When should a family become concerned? “The family becomes concerned about a parent or a spouse when they find damage to the garage” or notice other signs of unsafe driving, he said. Or patients may say they realize they feel unsafe driving.
“Usually families will initially try to mention it in a kind way,” Johnson said. However, “many times it is not well received, and they will send a note in to a physician to draw our attention” to the need for a discussion.
“We may need the assistance of families to draw their attention to how they are driving,” Johnson continued. “We need feedback and it does fall on us many times to try to address this with the patient.”
Once a doctor becomes aware of the situation, he said, “we try to have a conversation about it.” The patient is told “I know driving is important to you,” and asked, “Are you having trouble with vision?” The patient may say “I don’t drive at night any more.”

Vision, hearing
are concerns
“You ask questions to draw out these issues,” Johnson explained, such as “Have you ever been driving and had a near miss or small accidents?”
“You ask nonthreatening questions. ... It is a very delicate discussion. The older people get, the more independent they are, in getting around in a car.
“It is a huge give-away to give up driving,” he said especially “if you don’t live in a community where you have access to public transportation. ... You try to address this issue with the patient.
“A lot of times it is not a matter of driving or not driving,” Johnson said. “Rather than whether they should drive, you ask questions” about what you have observed or “the family has brought to your attention, like problems with vision, problems with hearing, muscle strength and reaction time - and a touchy issue is ‘Are you having problems with memory?’
“You ask these questions, and the patient will answer them honestly,” he noted. “You have to take it in a stepwise fashion, instead of putting them on the spot. It is a little less threatening.”
If the patient says, “I have a little more trouble seeing” or “I’m have trouble hearing,” there are a lot of steps you can take, Johnson added. “Patients are usually already starting to do this. They say ‘I don’t drive after dark’ and I ask, ‘Do you see well enough during the day or when it is raining?’ You can turn off the radio and get rid of distracting sounds.”

Driving affects others, too
Reaction time is another concern in giving up driving, Johnson said. He may ask a patient if he or she has had a small stroke or is getting frail, or “How do you think you can respond to an emergency?”
“People say ‘I have been driving for many years and never have had a problem.”
In this case, he said, “You have to remind them it will involve other people.
“You have to instruct the patient it’s one thing when we are talking about our own safety, but ‘if somebody were to die, you wouldn’t want that to be because you should not have been driving. ... You could kill somebody else.’ ... People will take that much more seriously.”
Another choice is to “refer them to a person like in occupational medicine or a physical therapist, who can test their reaction time,” Johnson said.
Before completely giving up driving, many people “recognize some of their weak spots,” he said, and compromise by not driving in large cities or during heavy traffic times.
However, in some cases the driver should completely stop, Johnson said, such as after having multiple accidents. In this case the physician can “turn a person in and the State Patrol can have the patient go for a drive with them,” he said. “It is my understanding family members can do this, too. And you can talk with insurance people, if they have had multiple accidents.”
If someone is approaching the time to stop driving, Johnson advised the family to become involved, because doctors “need feedback from family members.” With their help, he said, “a physician still can be the person to lead the discussion. A family will ask the physician to bring it up and discuss it. That’s the method I use.”