Physician's Guide To The Management of HD
Chapter 6-Other Issues
Driving
All patients with HD eventually lose the ability to drive. This can be a severe blow for some patients, who see driving as a sign of competence and a way of maintaining independence. In many cases, patients, with the help of their families, will realize the time has come and will voluntarily stop driving, often before their physician has come to this conclusion. Other times, however, the issue of driving can become a source of contention between patients, families, and physicians.
People with HD can be divided into groups on the basis of their driving abilities.
- Some mildly affected patients may have no significant problems and simply need to remain alert and not drive when very tired, after drinking, or under hazardous conditions.
- Most moderately to severely affected patients are not safe behind the wheel.
A large number of patients occupy the middle ground; they may have mild symptoms, but the safety of their driving is uncertain.
The physician should ask family members who have driven with the patient for their impressions, and should inquire about recent accidents and traffic citations, including those that were "someone else's fault." Some patients minimize their disability.
A formal driving evaluation, at an occupational therapy or rehabilitation center may be available and can help both physician and patient by providing objective information about the individual's performance.
In a situation in which a patient has become a hazardous driver and is unwilling to stop, or lacks insight into the degree of impairment, the doctor must intervene forcefully for the protection of the patient and others. We have found it useful at such times to give the patient a "doctor's order" rather than a suggestion, and to tell the patient that the instruction to stop driving will be documented in the record.
Some states may require physicians to notify the Department of Motor Vehicles if a patient is no longer safe to drive. In other states, physicians may be held liable if they make such a report without the patient's consent.
Family members, however, are not bound by such constraints and should contact their Department of Motor Vehicles if they feel the patient is dangerous and will not listen to reason. This is a very unpleasant responsibility, but it must be shouldered. Such reports have been made anonymously at times, to preserve harmony.
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Resources:
Evaluating Driving Capacity in HD - Allen J. Rubin, MD,
University of Medicine and Dentistry of New Jersey, 1994, 11 pages.
Practical guidelines to assist physicians and other professionals in making
this difficult determination.
Order online at www.hdsa.org or contact HDSA Publications:
Anita Mark-Paul
(800) 345-4372 Extention 19
email amarkpau@hdsa.org
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Click on subject to be taken to information:
If you are unsure about your loved ones ability to drive, this checklist can help.
Generally, no individual plans for a time when he or she will no longer be able to drive. In fact, your loved one probably assumes that he or she will know when to stop driving. Most individuals, however, never realize that it is time to stop driving.
Making sure that your loved one has reliable transportation to the doctors office and other important appointments can be one of a caregivers most difficult tasks. Transportation can be a tough issue for many caregiving families. The issue is even more difficult if your loved one has mobility problems. Until you have to arrange it, it doesn't seem that something as basic as getting your loved one to a doctors appointment should be so hard. But for most families, it is. Here's how to begin solving this problem.
Enter your zip code to learn about alternative transportation in your area.
