Being asked to sign a form attesting that patient can drive on meds?

[Trismegistus4]

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Up next in the list of things we didn't learn about in residency then are blindsided by being asked to sign our name to and possibly incur liability: statements pertaining to a patient's ability to drive. Now, I am not talking about patients who have a cognitive impairment, but rather about patients whose job involves driving and their employer has certain rules pertaining to being on meds. I've gotten two of these requests from two different employers in the past week, for two different patients. The first patient is on Wellbutrin and just got a job as a truck driver. The company sent me a list of "approved" meds, and said that Wellbutrin is not one of them, and asked if I could change him from Wellbutrin to something else. The second one is for a patient whose job also involves driving a truck, and he is on lamotrigine for bipolar disorder, and they're asking me if it is safe for him to drive while being on lamotrigine.

Of course I have plenty of other patients who drive and are on lamotrigine, and I also don't know any reason why someone couldn't drive while taking Wellbutrin, and don't appreciate being asked to change somebody's meds for this purpose. But, while I personally can't think of any reason why these treatment regimens would interfere with driving, I also don't feel that I'd be offering some kind of expert, informed opinion on the fact that these people could in fact drive. What do the rest of you who have gotten these kinds of requests to do with them?

 

[WisNeuro]

Opening oneself up for potential liability in case of an accident, even if not directly related to the medication, where should people sign up!?

 

[wolfvgang22]

I sign these. Like you said, wellbutrin or lamotrigine are not medications known to impair the ability to drive. Also, patients who are employed and able to afford housing, utilities, and food tend to need less medication in the long run. I'm delighted when I have patients who actually want to work. Lower income patients with mental illness face enough barriers in life. If the patient is taking any meds that do impair driving I decline to fill out the form, of course.
I'm sure someone here may be more risk averse than myself, see only patients that can pay cash, or suggest these patients with few well paying job options just find a different job and pull themselves up by their own boot straps.

 

[TexasPhysician]

I make it clear that there is no medical contra-indication to driving, but I am not attesting to the quality of driving.

 

[Bartelby]

Agree with the two above. These situations sounds okay for signoff as per TexasPhysician's post.

 

[Mass Effect]

I make it clear that there is no medical contra-indication to driving, but I am not attesting to the quality of driving.

This sounds okay, but it would still make me nervous. Truck drivers are notorious for working long hours. This guy falls asleep and crashes, his lawyer will be quick to say Wellbutrin made him dizzy or nauseated or some other side effect that 1% of the population gets from the drug and that's what caused the crashed.

 

[wolfvgang22]

This sounds okay, but it would still make me nervous. Truck drivers are notorious for working long hours. This guy falls asleep and crashes, his lawyer will be quick to say Wellbutrin made him dizzy or nauseated or some other side effect that 1% of the population gets from the drug and that's what caused the crashed.

This why I issue helmets and bubble wrap suits to all my patients.

 

[TexasPhysician]

This sounds okay, but it would still make me nervous. Truck drivers are notorious for working long hours. This guy falls asleep and crashes, his lawyer will be quick to say Wellbutrin made him dizzy or nauseated or some other side effect that 1% of the population gets from the drug and that's what caused the crashed.

Providing or refusing the letter could result in that lawsuit either way. You prescribed the drug.

 

[NickNaylor]

Sounds like a good referral to OT or even a neuropsychologist. There are specific driving assessments that can be performed, and I think those would be much more useful than whatever layman's-equivalent opinion about driving that I can provide.

I wouldn't sign that letter.

 

[Merely]

Sounds like a good referral to OT or even a neuropsychologist. There are specific driving assessments that can be performed, and I think those would be much more useful than whatever layman's-equivalent opinion about driving that I can provide.

I wouldn't sign that letter.

You wouldn’t sign a letter stating Wellbutrin doesn’t cause driving impairment..?

 

[NickNaylor]

You wouldn’t sign a letter stating Wellbutrin doesn’t cause driving impairment..?

I would sign that driving impairment is not a known side effect of either medication, but I'm not going to sign anything that attests to the quality of the patient's driving, as @TexasPhysician mentioned. Those are different statements. I imagine that someone asking for a letter like this is trying to get the latter, which is a much more dangerous proposition from a liability perspective.

 

[FlowRate]

Sounds like a good referral to OT or even a neuropsychologist. There are specific driving assessments that can be performed, and I think those would be much more useful than whatever layman's-equivalent opinion about driving that I can provide.

I wouldn't sign that letter.

Right, if the question is "how's this person's driving?" the gold standard is for a simulated/real driving test (including for old folks when you get worried about their driving.)

So maybe you draft your own letter saying "In my professional opinion, wellbutrin/lamotrigine are not likely to cause driving impairment, although there is always a possibility of an idiosyncratic reaction to any medication. I am not able to attest to the quality of my patient's driving."

Maybe this is the sort of thing worth running by a lawyer in your state to make sure you get the wording right?

 

[thoffen]

Pass the liability buck around. My feeling is that employers are not likely to accept half-statements and are wanting, like us, to deflect the liability elsewhere. Certainly OT or neuropsych might be the experts here, but is it really an appropriate use of resources to involve them in the general case? Given that a patient's livelihood may be at stake and a huge determiner of their health, I'd be willing to take on more than my usual role to help a patient here, but of course I would always try to get away with the narrowest possible statement.

 

[Trismegistus4]

Pass the liability buck around. My feeling is that employers are not likely to accept half-statements and are wanting, like us, to deflect the liability elsewhere. Certainly OT or neuropsych might be the experts here, but is it really an appropriate use of resources to involve them in the general case? Given that a patient's livelihood may be at stake and a huge determiner of their health, I'd be willing to take on more than my usual role to help a patient here, but of course I would always try to get away with the narrowest possible statement.

I was just mulling over this last night and thinking about that exact issue: why are the employers sending us these forms and wanting us to sign them anyway? What do they get out of it? And I figure that it's got to be that they're trying to deflect any liability from themselves. If this guy crashes the truck and injures or kills someone, they now can whip out this letter and say "well, the doctor said it was safe for him to drive, it's his fault."

 

[MacDonaldTriad]

People will always ask us to write all kinds of crazy letters. It is our job to say no unless it makes sense that we can clearly say yes.
"To who it may concern; My evaluation of Mrs. so and so indicates that there is no reason to believe that she wouldn't be an ideal mother".
Pull out the Lamictal insert and see what it says about coordination and refer them to that and say nothing else.

 

[PikminOC]

One of your patients is bipolar and drives a semi truck and they want you to sign off on liability. Do not want.

 

[WisNeuro]

Pass the liability buck around. My feeling is that employers are not likely to accept half-statements and are wanting, like us, to deflect the liability elsewhere. Certainly OT or neuropsych might be the experts here, but is it really an appropriate use of resources to involve them in the general case? Given that a patient's livelihood may be at stake and a huge determiner of their health, I'd be willing to take on more than my usual role to help a patient here, but of course I would always try to get away with the narrowest possible statement.

More OT, they are generally the ones that have the simulated driving stuff set up. They use some cognitive testing, but they don't understand how norms work, so the interpretation is useless. The actual simulated or behind the wheel eval is the most sensitive. We have some tests that are sensitive to impaired driving skills, but we'd still refer out for a formal driving eval if someone is in that grey area. Most of us wouldn't accept an eval for driving ability unless it were couched in the context of a larger clinical question (e.g., dementia plus ability to maintain I/ADLs). In the case of a non-dementia age person with no other indication of neurological issues, insurance would usually balk at allowing the neuropsych exam a lot of the time anyway.

 

[Crayola227]

I was just mulling over this last night and thinking about that exact issue: why are the employers sending us these forms and wanting us to sign them anyway? What do they get out of it? And I figure that it's got to be that they're trying to deflect any liability from themselves. If this guy crashes the truck and injures or kills someone, they now can whip out this letter and say "well, the doctor said it was safe for him to drive, it's his fault."

The company demonstrating that they did due diligence by contacting you, doesn't know mean that you are "wrong" and are going to be able to be held liable in court.

Basically, the fact that something you signed helps someone out in their own court case, doesn't necessarily mean you have now sank yourself in your own.

IMHO physicians are frequently painfully ignorant about the law. I'm not saying I'm an expert. I would rather err on the side of helping the patient. If I'm going to make some legal assumption that is going to screw over a lot of patients (like how these letters get approached) I would just fork out $300 and see an attorney and a get a quick and reasonable answer to this question. Or ask one of my lawyer friends what they think, if they're willing to at least wax poetic on the topic while not giving me legal advice.

 

[675015]

Not signing these forms doesn't eliminate your liability, does it?

I thought, if you are prescribing a truck driver a medication that impairs driving, you need to either strongly advise against driving (or even call DMV in some states) or change medications.

My understanding is in a lawsuit, a lawyer would ask if you took a social history, if you knew he drove for a living, if you knew risks of medication, if you advised against driving etc. etc. If you didn't address these safety issues, good luck, but I don't think saying "Well I never signed the work form" would be a very strong defense?

 

[Armadillos]

Kind of a sad state of affairs when psychiatrists can’t be bothered to support the wellbeing and productivity of a patient by saying that Wellbutrin is not known to pose significant risk to drivers. Your surely incurring more potential liability driving yourself to work every day than you are by saying Wellbutrin is considered safe to take while driving.

 

[Mass Effect]

Not signing these forms doesn't eliminate your liability, does it?

I thought, if you are prescribing a truck driver a medication that impairs driving, you need to either strongly advise against driving (or even call DMV in some states) or change medications.

My understanding is in a lawsuit, a lawyer would ask if you took a social history, if you knew he drove for a living, if you knew risks of medication, if you advised against driving etc. etc. If you didn't address these safety issues, good luck, but I don't think saying "Well I never signed the work form" would be a very strong defense?

Unless there's known affect on driving and you didn't warn the patient, you are not liable. I tell all my patients the most common side effects of medications so I can explain it to them. If say, dizziness, is one, then I warn them of that and tell them not to drive until they know how it affects them. If I prescribe prazosin, I always talk about falls, for example. I don't see how I'd be liable if someone crashed with Wellbutrin.

 

[Mass Effect]

Kind of a sad state of affairs when psychiatrists can’t be bothered to support the wellbeing and productivity of a patient by saying that Wellbutrin is not known to pose significant risk to drivers. Your surely incurring more potential liability driving yourself to work every day than you are by saying Wellbutrin is considered safe to take while driving.

A few years ago, I would have agreed with you. However, I've seen people pass the liability buck and it always comes down to the doctor who has to sign/write/fill out all this unnecessary paperwork. I might write a letter that states "so and so has been warned of the side effects of Wellbutrin. Driving impairment is not one of them" and be done with it, but some of these places require 4 pages of documentation and I'm sorry, but that's just unreasonable.

Yes, I do them because I feel bad for the patient, but I don't look down on docs who don't or suggest that it's a sad state of affairs because they can't be bothered. In my 4th year of residency, I had a patient who needed one of these letters for extra breaks during the day (long story). I wrote the letter. HR then sent her in with a 7-page nonsense document that included exactly what I said in the letter, no more, no less. It's ridiculous and it totally eats up a doctor's time.

 

[Merovinge]

Kind of a sad state of affairs when psychiatrists can’t be bothered to support the wellbeing and productivity of a patient by saying that Wellbutrin is not known to pose significant risk to drivers. Your surely incurring more potential liability driving yourself to work every day than you are by saying Wellbutrin is considered safe to take while driving.

I think it more reflects the painful state of how defensive doctor's are trained to practice in the US than psychiatrists being risk adverse (although statistically we are). Have you seen what happens in ED's lately?

 

[675015]

Unless there's known affect on driving and you didn't warn the patient, you are not liable. I tell all my patients the most common side effects of medications so I can explain it to them. If say, dizziness, is one, then I warn them of that and tell them not to drive until they know how it affects them. If I prescribe prazosin, I always talk about falls, for example. I don't see how I'd be liable if someone crashed with Wellbutrin.

I agree. My point was that your liability doesn’t change wether or not you sign a form for the employer.