Do You Really Want Him To Be Your Doctor? by Pat Conrad MD
In the latest edition of Pravda (okay, it was actually “Family Practice News”), I saw this awful gem: “Mass. ED docs reporting impaired drivers to the state.” According to the Massachusetts Safe Driving Law of 2010, providers can report drivers they believe to be impaired to the state without fear of liability. There is some salve about how the law’s intent was to encourage impaired drivers to visit their primary doc’s to get help – sure it is. Think the cops didn’t love this law? Think the politicians and the harpies at MADD didn’t clamor for it?
The article reports that Dr. Eric Mahoney (a fellow Irishman, say it ain’t so!) of the Boston Medical Center helped develop the article, and cites various figures to buttress his good intentions. The discussion also includes those whose traffic mishaps came about through syncope, seizures, dementia, strokes, and the like. But then a moral layer is added by BMC coauthor Lisa Allee, discussing the DUI recidivist problem and observing “the current system [for drunk drivers] really isn’t working.” Is that the purview of medicine?
“When the accident involves substance abuse, reporting is limited to instances of a “violent/high risk” to the public such as driving in the wrong direction, speed exceeding 55 mph, having a child or loaded firearm in the car (I know which would make less noise), or fleeing the police.”
Do we want doctors keeping the demented and seizure-prone from behind the wheel? Sure, but those are conditions, not behaviors. Ah, but the disease theory of addiction! And how many lives could have been saved in the initial AIDS wave if public health officials could have closed down San Francisco bathhouses, and reported those knowingly spreading infection? On the other hand, how do physicians properly determine who was driving how, or whether they were fleeing the police with a loaded baby? What about rules of evidence, chains-of-custody, and the right against self-incrimination? What about the supposed patient-physician privilege? And if a patient is charged with a subsequent incident, cannot the physician be held liable if chart evidence suggests he should have reported the perp the first time around?
Public health is a fine thing to a point. But without greater restraint than that being shown by these Boston moral agents, doctors become further deputized by an arbitrary state. If the cause of “saving lives” can be used as justification for anything, then it can be used to harm. And I’ll bet the hospital won’t even let me keep a bullet in my pocket.
Agree that Docs should not be accountable for patient’s bad choices, but if there is an opportunity to prevent a disaster then we should take it. When there is an obviously intoxicated patient in my clinic (happens rarely) who insists on driving, I direct my front office to call the cops and delay the patient in order to try to head it off before he/she gets behind the wheel. I’ll take the patient confidentiality hit anytime in order to protect my family and all the other potential victims of a drunk driver. The last time it happened the patient fired me (BAL was 4xs legal limit)- I was so happy! I would never be able to sleep again if I did nothing and an innocent life was ruined or lost. I’ve never been sued because of it, rare would be the lawyer, judge or jury that would that be in favor of letting a drunk get behind the wheel.
Way out of line on the MADD comment. I expect that from Pat, not from you. Sick.
I see now, it IS from Pat. That explains the temper.
I agree that Docs should not be held accountable for a patient’s injurious habits. On the other hand, we part ways on your characterization of MADD as harpies. They have drawn long-overdue attention to the serious legal and public health threat of alcohol-impaired drivers. I applaud and support them for that.
I thank you for your comment. Like so many initially worthy causes, MADD took theirs and crossed into zealotry, and no politician dare oppose them. I’m not defending impaired driving, but it’s a helluva lot easier to dodge a drunk than it is an oppressive government, so I’ll jab them them every chance I get. Cheers!