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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
1x Speed
2x Speed
25. Impaired Driver
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The physician [medical practitioner] who knows only medicine knows not even medicine.
~ Mark Twain
Deadly Obligation
The Fatal Consequences of Ignoring Medical Obligations for Public Safety
Dr. Elizabeth White was a well-respected neurologist who had been practicing in the small town of Millville for over 20 years. She was known for her compassion, dedication, and her ability to diagnose and treat even the most complex neurological conditions.
One day, Dr. White received a call from the local police department regarding a car accident that had occurred earlier that day. The driver of the car, a middle-aged man named John, had suffered a seizure while driving, causing him to lose control of his vehicle and crash into a tree. John was taken to the hospital with minor injuries, but the police were concerned that his seizure disorder may have played a role in the accident.
Dr. White immediately recognized John as one of her patients. He had been diagnosed with epilepsy several years ago and had been seeing her regularly for treatment. She knew that it was mandatory for John to report his seizure disorder to the DMV, but she wasn’t sure if he had done so.
Dr. White went to the hospital to examine John and was shocked to learn that he had not reported his condition to the DMV. She explained to him that it was his legal obligation to do so and that failing to report could result in serious consequences. She also informed him that she was obligated to report him to the DMV, as it was her duty as a medical practitioner to ensure public safety.
John was visibly upset and begged Dr. White not to report him. He explained that he needed his driver’s license to get to work and take care of his family. Dr. White sympathized with his situation but explained that she had a professional and ethical obligation to report him. She assured him that they could work together to find alternative transportation options and that she would do everything she could to ensure that he received the proper medical care to manage his condition.
A few weeks later, Dr. White received a letter from the DMV thanking her for her report and informing her that John’s license had been suspended until he could provide medical documentation proving that his condition was under control. Dr. White was relieved to know that John was no longer a danger on the road and proud that she had fulfilled her duty as a medical practitioner to ensure public safety.
However, a few weeks after that, Dr. White was found dead in her office. The police launched an investigation, and it was discovered that Dr. White had been receiving threatening phone calls and emails from someone who was angry about her decision to report John to the DMV. The police were able to trace the calls and emails back to John’s wife, who had been furious with Dr. White for causing her husband to lose his license.
John’s wife was arrested and charged with Dr. White’s murder. It was a tragic reminder of the importance of mandatory reporting laws and the need for practitioners to prioritize public safety over personal relationships.
Abstract
Practitioners have a significant role in determining medical conditions that impair a driver’s ability to operate a vehicle safely. It is mandatory for patients to self-report any seizure disorders to the DMV and for most states, reporting by practitioners is still voluntary. Practitioners do not have the authority to revoke driving privileges, but they are responsible for reporting visually impaired drivers. This mandatory reporting can diminish patient autonomy and the liberty of both the patient and the practitioner. The practitioner has a professional obligation to act in the patient’s best interests and report the impaired driver to the proper authorities for both the patient’s well-being and public safety. As a matter of social justice, failure to comply with mandatory reporting laws is a Class A misdemeanor. Practitioners are obligated to comply with mandatory reporting laws for reasons of patient autonomy, professional beneficence and nonmaleficence, and social justice. Noncompliance would be considered a violation of the patient-practitioner relationship and professional misconduct.
**
Think
[25:1] There is a wide range of medical conditions that can impair a driver from safely operating a vehicle. Vehicles range from the gamut of cars, trucks, motorcycles, buses, trains, and planes, to name a few. Commercial vehicles generally have higher governmental medical standards of driver competency than just personal use. The question regarding the impaired driver is what the practitioner’s role is or ought to be in such determinations.
[25:2] In all states, it is mandatory for the patient to self-report any seizure disorders to the Department of Motor Vehicles (DMV), and for most states, practitioner and medical-provider reporting is still voluntary. Practitioners and medical providers do not have the authority to suspend or revoke driving privileges; only the DMV has that authority. However, the practitioner is responsible for reporting a visually impaired driver to the DMV so that the DMV can determine whether or not the patient’s vision is deficient enough to warrant that their license should be removed or limited.
Assess
Patient: 1) Autonomy
[25:3] Mandatory patient reporting diminishes patient autonomy (informed consent) and the liberty of both the patient and the practitioner. If a practitioner is mandated to report an impaired driver, then the practitioner must communicate that to the patient, preferably before the examination and certainly after the examination. A patient-practitioner relationship is a social contract that is grounded on confidentiality and privacy. Patients should be forewarned of any exceptions to those conditions to limit misunderstandings and perceptions of a breach of patient confidentiality and privacy. With mandatory reporting, the practitioner has no liberty but to report. This needs to be made clear to the patient. With mandatory reporting, the patient also has no autonomy (informed consent) except to understand that their medical impairments will be reported regardless of whether they consent to it or not. The ideal is for the practitioner to explain the situation so that the patient understands and consents to the medically at-risk reporting mandate. This approach attempts to keep intact the patient-practitioner relationship and minimize any perception of a breach of confidentiality and privacy.
[25:4] Mandatory reporting is not a breach of the patient-practitioner relationship because the categories of mandatory reporting is part of the patient-practitioner social contract.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[25:5] Professionally, the practitioner must maximize the patient’s best interests, as determined by the patient’s reasonable goals, values, and priorities—beneficence (do good). Patients’ reasonable goals, values, and priorities would include the safety of themselves and others from being harmed by an impaired driver, especially if that impaired driver were to be themselves—nonmaleficence (do no harm).
[25:6] The practitioner as a health care professional has the moral duty to maximize the patient’s best interests, and that means that the practitioner must report the impaired driver to the proper authorities for both the patient’s best interests—beneficence (do good) and the sake of public safety—nonmaleficence (do no harm). As a patient educator, the practitioner should have a tactfully but candid conversation with the patient about how the patient can reduce driving risks and devise alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
Public Policy: 4) Justice
[25:7] Civilly, as a matter of social justice (be fair), it is considered an unfair distribution of benefits and burdens to allow an impaired driver to operate a vehicle that puts themselves and others at risk of harm or death. The government, as a result, has mandated practitioners to report various types of impairments to various authorities and failure to comply with mandatory reporting is a Class A misdemeanor—justice (be fair).
[25:8] Practitioners comply with such laws, as the laws are rational, reasonable and coherent with: patient autonomy (informed consent), professional beneficence (do good), professional nonmaleficence (do no harm), and social justice (be fair). Although the ideal would be for all four principles to be coherent with each other if by chance the autonomous choice of the patient is for the practitioner not to report, then that would be overridden primarily by the interest of justice (be fair) and its focus on public safety, but also on the practitioner’s obligation of nonmaleficence of doing no harm.
[25:9] Mandatory reporting is a legal and professional requirement that is part of the patient-practitioner relationship, and not reporting would be the practitioner’s violation of the patient-practitioner relationship, a form of professional misconduct.
Conclude
[25:10] For any patient with a seizure disorder, the practitioner is required by federal law to encourage the patient to self-report. Regarding driving a vehicle by a visually impaired patient, the practitioner must report the patient to the DMV so that the DMV can determine whether or not to revoke, suspend, or limit the person’s driver’s license as the practitioner does not have that legal authority.
[25:11] In summary, practitioners must abide by mandatory reporting laws, balancing patient autonomy with their professional obligations towards beneficence, nonmaleficence, and social justice. Encouraging patients with seizure disorders to self-report and reporting visually impaired drivers to the DMV is part of the practitioner’s role in ensuring public safety. Failure to comply with these regulations is a breach of the patient-practitioner relationship and professional misconduct. Ultimately, practitioners must prioritize both the well-being of their patients and the safety of the public when addressing impaired drivers.
**
25. Review Questions
1. The practitioner has the mandatory duty to report seizure disorders to the Department of Motor Vehicles (DMV).
2. If the practitioner honestly believes that a patient might be a driving risk, then the practitioner has the authority to suspend or revoke the patient’s driving privileges.
3. The ideal is for the practitioner to explain the situation, so the patient understands and consents to the medically at-risk reporting mandate. This approach attempts to keep intact the patient-practitioner relationship and minimize any perception of a breach of confidentiality and privacy.
4. As a patient educator, the practitioners should have a tactful but candid conversation with the patient about reducing driving risks and devising alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
5. The government has mandated practitioners to report various impairments to various authorities, and failure to comply with mandatory reporting is a Class A misdemeanor.
6. Mandatory reporting is a legal and professional requirement that is part of the patient-practitioner relationship, and not reporting would be the practitioner’s violation of the patient-practitioner relationship, a form of professional misconduct.
**
CORRECT! 🙂
[25:2] In all states, it is mandatory for the patient to self-report any seizure disorders to the Department of Motor Vehicles (DMV), and for most states, practitioner and medical-provider reporting is still voluntary. Practitioners and medical providers do not have the authority to suspend or revoke driving privileges; only the DMV has that authority. However, the practitioner is responsible for reporting a visually impaired driver to the DMV so that the DMV can determine whether or not the patient’s vision is deficient enough to warrant that their license should be removed or limited.
Wrong 😕
[25:2] In all states, it is mandatory for the patient to self-report any seizure disorders to the Department of Motor Vehicles (DMV), and for most states, practitioner and medical-provider reporting is still voluntary. Practitioners and medical providers do not have the authority to suspend or revoke driving privileges; only the DMV has that authority. However, the practitioner is responsible for reporting a visually impaired driver to the DMV so that the DMV can determine whether or not the patient’s vision is deficient enough to warrant that their license should be removed or limited.
CORRECT! 🙂
[25:2] In all states, it is mandatory for the patient to self-report any seizure disorders to the Department of Motor Vehicles (DMV), and for most states, practitioner and medical-provider reporting is still voluntary. Practitioners and medical providers do not have the authority to suspend or revoke driving privileges; only the DMV has that authority. However, the practitioner is responsible for reporting a visually impaired driver to the DMV so that the DMV can determine whether or not the patient’s vision is deficient enough to warrant that their license should be removed or limited.
Wrong 😕
[25:2] In all states, it is mandatory for the patient to self-report any seizure disorders to the Department of Motor Vehicles (DMV), and for most states, practitioner and medical-provider reporting is still voluntary. Practitioners and medical providers do not have the authority to suspend or revoke driving privileges; only the DMV has that authority. However, the practitioner is responsible for reporting a visually impaired driver to the DMV so that the DMV can determine whether or not the patient’s vision is deficient enough to warrant that their license should be removed or limited.
CORRECT! 🙂
[25:3] Mandatory patient reporting diminishes patient autonomy (informed consent) and the liberty of both the patient and the practitioner. If a practitioner is mandated to report an impaired driver, then the practitioner must communicate that to the patient, preferably before the examination and certainly after the examination. A patient-practitioner relationship is a social contract that is grounded on confidentiality and privacy. Patients should be forewarned of any exceptions to those conditions to limit misunderstandings and perceptions of a breach of patient confidentiality and privacy. With mandatory reporting, the practitioner has no liberty but to report. This needs to be made clear to the patient. With mandatory reporting, the patient also has no autonomy (informed consent) except to understand that their medical impairments will be reported regardless of whether they consent to it or not. The ideal is for the practitioner to explain the situation so that the patient understands and consents to the medically at-risk reporting mandate. This approach attempts to keep intact the patient-practitioner relationship and minimize any perception of a breach of confidentiality and privacy.
Wrong 😕
[25:3] Mandatory patient reporting diminishes patient autonomy (informed consent) and the liberty of both the patient and the practitioner. If a practitioner is mandated to report an impaired driver, then the practitioner must communicate that to the patient, preferably before the examination and certainly after the examination. A patient-practitioner relationship is a social contract that is grounded on confidentiality and privacy. Patients should be forewarned of any exceptions to those conditions to limit misunderstandings and perceptions of a breach of patient confidentiality and privacy. With mandatory reporting, the practitioner has no liberty but to report. This needs to be made clear to the patient. With mandatory reporting, the patient also has no autonomy (informed consent) except to understand that their medical impairments will be reported regardless of whether they consent to it or not. The ideal is for the practitioner to explain the situation so that the patient understands and consents to the medically at-risk reporting mandate. This approach attempts to keep intact the patient-practitioner relationship and minimize any perception of a breach of confidentiality and privacy.
CORRECT! 🙂
[25:6] The practitioner as a health care professional has the moral duty to maximize the patient’s best interests, and that means that the practitioner must report the impaired driver to the proper authorities for both the patient’s best interests—beneficence (do good) and the sake of public safety—nonmaleficence (do no harm). As a patient educator, the practitioners should have a tactfully but candid conversation with the patient about how the patient can reduce driving risks and devise alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
Wrong 😕
[25:6] The practitioner as a practitioner has the moral duty to maximize the patient’s best interests, and that means that the practitioner must report the impaired driver to the proper authorities for both the patient’s best interests—beneficence (do good) and the sake of public safety—nonmaleficence (do no harm). As a patient educator, the practitioners should have a tactfully but candid conversation with the patient about how the patient can reduce driving risks and devise alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
CORRECT! 🙂
[25:6] The practitioner as a practitioner has the moral duty to maximize the patient’s best interests, and that means that the practitioner must report the impaired driver to the proper authorities for both the patient’s best interests—beneficence (do good) and the sake of public safety—nonmaleficence (do no harm). As a patient educator, the practitioners should have a tactfully but candid conversation with the patient about how the patient can reduce driving risks and devise alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
Wrong 😕
[25:6] The practitioner as a practitioner has the moral duty to maximize the patient’s best interests, and that means that the practitioner must report the impaired driver to the proper authorities for both the patient’s best interests—beneficence (do good) and the sake of public safety—nonmaleficence (do no harm). As a patient educator, the practitioners should have a tactfully but candid conversation with the patient about how the patient can reduce driving risks and devise alternative forms of transportation, such as public transportation, Uber or Lift, and family members.
CORRECT! 🙂
[25:9] Mandatory reporting is a legal and professional requirement that is part of the patient-practitioner relationship, and not reporting would be the practitioner’s violation of the patient-practitioner relationship, a form of professional misconduct.
Wrong 😕
[25:9] Mandatory reporting is a legal and professional requirement that is part of the patient-practitioner relationship, and not reporting would be the practitioner’s violation of the patient-practitioner relationship, a form of professional misconduct.
25. Clinical Vignettes
1. Mr. Solomon Thompson, a 45-year-old truck driver, was brought to the emergency room after a motor vehicle accident. He was found to have slurred speech, delayed reaction time, and an unsteady gait. Blood alcohol content (BAC) was measured to be 0.14%, above the legal limit for driving. The medical team suspected that Mr. Thompson was under the influence of alcohol, which may have contributed to the accident. The differential diagnosis included alcohol intoxication, brain injury, and stroke.
2. Mr. Augustus Francis, a 55-year-old construction worker, was brought to the emergency department after being involved in a car accident. Upon examination, the medical team noticed that Mr. Francis had slurred speech, difficulty walking, and delayed reaction time. Mr. Francis admitted to taking his prescription pain medication before driving. The differential diagnosis included medication side effects, medication interactions, and substance abuse.
3. Ms. Abigail Rodriguez, a 30-year-old teacher, visited her primary care practitioner complaining of frequent headaches and fainting spells. After further examination, the practitioner diagnosed her with a seizure disorder and informed her that it is mandatory for patients to self-report any seizure disorders to the DMV. The differential diagnosis included epilepsy, medication side effects, and brain injury.
4. Mrs. Helen Kim, a 50-year-old real estate agent, visited her primary care practitioner for a routine check-up. During the examination, the practitioner noticed that Mrs. Kim had uncontrolled blood sugar levels and neuropathy in her legs. After further examination and tests, the practitioner diagnosed Mrs. Kim with poorly controlled diabetes. The differential diagnosis included peripheral artery disease, medication side effects, and hypothyroidism.
5. Mr. Trey Hernandez, a 35-year-old Uber driver, visited his primary care practitioner for a routine check-up. During the examination, the practitioner noticed that Mr. Hernandez had high blood pressure and was taking medication to manage it. After further examination and tests, the practitioner diagnosed Mr. Hernandez with hypertension. The differential diagnosis included kidney disease, medication side effects, and sleep apnea.
CORRECT! 🙂
Explanation: The practitioner has a professional obligation to report Mr. Thompson's BAC to the Department of Motor Vehicles (DMV) for possible license suspension. As explained in paragraph [25:2], practitioners are responsible for reporting visually impaired drivers to the DMV so that the DMV can determine whether or not the patient's driving privileges should be limited or revoked. In this case, Mr. Thompson's BAC is above the legal limit, indicating that he was impaired while driving, which poses a risk to public safety. Reporting Mr. Thompson's BAC to the authorities for a possible DUI charge, or to his employer for potential employment consequences may be appropriate in some cases, but it is not the practitioner's primary responsibility. Discharging Mr. Thompson without reporting his BAC to anyone is not an ethical option as it would fail to ensure public safety and violate the practitioner's professional obligations.
Wrong 😕
Explanation: The practitioner has a professional obligation to report Mr. Thompson's BAC to the Department of Motor Vehicles (DMV) for possible license suspension. As explained in paragraph [25:2], practitioners are responsible for reporting visually impaired drivers to the DMV so that the DMV can determine whether or not the patient's driving privileges should be limited or revoked. In this case, Mr. Thompson's BAC is above the legal limit, indicating that he was impaired while driving, which poses a risk to public safety. Reporting Mr. Thompson's BAC to the authorities for a possible DUI charge, or to his employer for potential employment consequences may be appropriate in some cases, but it is not the practitioner's primary responsibility. Discharging Mr. Thompson without reporting his BAC to anyone is not an ethical option as it would fail to ensure public safety and violate the practitioner's professional obligations.
CORRECT! 🙂
Explanation: The practitioner has a professional obligation to report Mr. Francis to the authorities for a possible DUI charge [25:6]. As explained in paragraph, the practitioner has a moral duty to maximize the patient's best interests, which includes reporting impaired drivers to ensure public safety [25:5]. Mr. Francis admitted to taking prescription medication before driving, which impaired his ability to operate a vehicle safely. Reporting Mr. Francis to the authorities for a possible DUI charge is necessary to ensure public safety and discourage further impaired driving [25:6]. Discharging Mr. Francis without reporting his medication use to anyone is not an ethical option, as it would fail to address the underlying issue of impaired driving and could put others at risk of harm [no source]. Reporting Mr. Francis's medication use to his employer is not necessary and could compromise patient confidentiality [no source]. Reporting Mr. Francis's medication use to the prescribing practitioner may be appropriate in some cases, but it is not the primary responsibility of the practitioner in this case [no source]. Therefore, the correct answer is to report Mr. Francis to the authorities for a possible DUI charge to ensure public safety [25:6].
Wrong 😕
Explanation: The practitioner has a professional obligation to report Mr. Francis to the authorities for a possible DUI charge [25:6]. As explained in paragraph, the practitioner has a moral duty to maximize the patient's best interests, which includes reporting impaired drivers to ensure public safety [25:5]. Mr. Francis admitted to taking prescription medication before driving, which impaired his ability to operate a vehicle safely. Reporting Mr. Francis to the authorities for a possible DUI charge is necessary to ensure public safety and discourage further impaired driving [25:6]. Discharging Mr. Francis without reporting his medication use to anyone is not an ethical option, as it would fail to address the underlying issue of impaired driving and could put others at risk of harm [no source]. Reporting Mr. Francis's medication use to his employer is not necessary and could compromise patient confidentiality [no source]. Reporting Mr. Francis's medication use to the prescribing practitioner may be appropriate in some cases, but it is not the primary responsibility of the practitioner in this case [no source]. Therefore, the correct answer is to report Mr. Francis to the authorities for a possible DUI charge to ensure public safety [25:6].
CORRECT! 🙂
Explanation: The practitioner should advise Ms. Rodriguez to self-report her seizure disorder to the DMV. As explained in paragraph [25:2], it is mandatory for patients to self-report any seizure disorders to the DMV in order to ensure public safety on the roads. Reporting Ms. Rodriguez's seizure disorder to the DMV without her consent is not appropriate in this case, as it violates patient autonomy and confidentiality. Discharging Ms. Rodriguez without discussing DMV reporting requirements is not an ethical option, as it fails to ensure that Ms. Rodriguez receives appropriate care and may put others at risk. Reporting Ms. Rodriguez's seizure disorder to her employer is not necessary and could compromise patient confidentiality. Therefore, the correct answer is to advise Ms. Rodriguez to self-report her seizure disorder to the DMV to ensure public safety. The practitioner should also work with Ms. Rodriguez to develop a treatment plan to manage her seizures and minimize the risk of harm to herself and others.
Wrong 😕
Explanation: The practitioner should advise Ms. Rodriguez to self-report her seizure disorder to the DMV. As explained in paragraph [25:2], it is mandatory for patients to self-report any seizure disorders to the DMV in order to ensure public safety on the roads. Reporting Ms. Rodriguez's seizure disorder to the DMV without her consent is not appropriate in this case, as it violates patient autonomy and confidentiality. Discharging Ms. Rodriguez without discussing DMV reporting requirements is not an ethical option, as it fails to ensure that Ms. Rodriguez receives appropriate care and may put others at risk. Reporting Ms. Rodriguez's seizure disorder to her employer is not necessary and could compromise patient confidentiality. Therefore, the correct answer is to advise Ms. Rodriguez to self-report her seizure disorder to the DMV to ensure public safety. The practitioner should also work with Ms. Rodriguez to develop a treatment plan to manage her seizures and minimize the risk of harm to herself and others.
CORRECT! 🙂
Explanation: The practitioner has a professional obligation to report Mrs. Kim to the DMV for a possible license suspension. Diabetes can cause complications that can impair a driver's ability to operate a vehicle safely, such as neuropathy, visual impairment, and hypoglycemia [25:1]. Reporting Mrs. Kim's condition to the DMV for a possible license suspension is necessary to ensure public safety and prevent harm [25:1]. Discharging Mrs. Kim without discussing the impact of her condition on her ability to drive is not an ethical option, as it fails to ensure that Mrs. Kim receives appropriate care and may put others at risk. Prescribing medication to manage Mrs. Kim's blood sugar levels and allow her to continue driving is not appropriate in this case, as it does not address the underlying issue of impaired driving and may put others at risk. Advise Mrs. Kim to self-report her condition to the DMV may be appropriate in some cases, but it is the practitioner's responsibility to ensure that the patient understands the mandatory reporting requirements [25:2]. Therefore, the correct answer is to report Mrs. Kim to the DMV for a possible license suspension to ensure public safety. The practitioner should also work with Mrs. Kim to develop a treatment plan to manage her diabetes and minimize the risk of harm to herself and others.
Wrong 😕
Explanation: The practitioner has a professional obligation to report Mrs. Kim to the DMV for a possible license suspension. Diabetes can cause complications that can impair a driver's ability to operate a vehicle safely, such as neuropathy, visual impairment, and hypoglycemia [25:1]. Reporting Mrs. Kim's condition to the DMV for a possible license suspension is necessary to ensure public safety and prevent harm [25:1]. Discharging Mrs. Kim without discussing the impact of her condition on her ability to drive is not an ethical option, as it fails to ensure that Mrs. Kim receives appropriate care and may put others at risk. Prescribing medication to manage Mrs. Kim's blood sugar levels and allow her to continue driving is not appropriate in this case, as it does not address the underlying issue of impaired driving and may put others at risk. Advise Mrs. Kim to self-report her condition to the DMV may be appropriate in some cases, but it is the practitioner's responsibility to ensure that the patient understands the mandatory reporting requirements [25:2]. Therefore, the correct answer is to report Mrs. Kim to the DMV for a possible license suspension to ensure public safety. The practitioner should also work with Mrs. Kim to develop a treatment plan to manage her diabetes and minimize the risk of harm to herself and others.
CORRECT! 🙂
Explanation: In this case, the practitioner may discharge Mr. Hernandez without reporting his condition to the DMV or discussing the impact of his condition on his ability to drive, as hypertension alone is not a medical condition that impairs a driver's ability to operate a vehicle safely. As mentioned in paragraph [25:2], there is a wide range of medical conditions that can impair a driver's ability to operate a vehicle safely, but hypertension is not typically one of them. Therefore, reporting Mr. Hernandez's condition to the DMV for a possible license suspension is not necessary in this case. Prescribing medication to manage Mr. Hernandez's hypertension and allow him to continue driving may be appropriate, but it is not necessary in this case, as hypertension alone does not typically impair driving, and practitioners do not have the authority to allow or disallow driving, rather only the DMV has that authority. Advising Mr. Hernandez to self-report his condition to the DMV is also not necessary, as hypertension is not typically a medical condition that requires reporting. Therefore, the correct answer is to discharge Mr. Hernandez without discussing the impact of his condition on his ability to drive, as it is not necessary in this case. The practitioner should still work with Mr. Hernandez to manage his hypertension and minimize the risk of harm to himself and others.
Wrong 😕
Explanation: In this case, the practitioner may discharge Mr. Hernandez without reporting his condition to the DMV or discussing the impact of his condition on his ability to drive, as hypertension alone is not a medical condition that impairs a driver's ability to operate a vehicle safely. As mentioned in paragraph [25:2], there is a wide range of medical conditions that can impair a driver's ability to operate a vehicle safely, but hypertension is not typically one of them. Therefore, reporting Mr. Hernandez's condition to the DMV for a possible license suspension is not necessary in this case. Prescribing medication to manage Mr. Hernandez's hypertension and allow him to continue driving may be appropriate, but it is not necessary in this case, as hypertension alone does not typically impair driving, and practitioners do not have the authority to allow or disallow driving, rather only the DMV has that authority. Advising Mr. Hernandez to self-report his condition to the DMV is also not necessary, as hypertension is not typically a medical condition that requires reporting. Therefore, the correct answer is to discharge Mr. Hernandez without discussing the impact of his condition on his ability to drive, as it is not necessary in this case. The practitioner should still work with Mr. Hernandez to manage his hypertension and minimize the risk of harm to himself and others.
**
25. Reflection Vignettes
1. Ms. Sarah Johnson, a 65-year-old retired accountant, presents for her yearly physical. She reports being in overall good health but has age-related macular degeneration, and her visual acuity has decreased to 20/200 OU. The differential diagnosis includes age-related macular degeneration, cataracts, glaucoma, and diabetic retinopathy. The practitioner performs a comprehensive eye exam and recommends that Ms. Johnson see an ophthalmologist for further evaluation and treatment. The practitioner also emphasizes the importance of regular eye exams, especially for individuals with age-related macular degeneration, and offers to provide information and resources to Ms. Johnson to help manage her condition and maintain her vision. The practitioner reiterates that early detection and treatment can help prevent further vision loss and improve overall quality of life. In addition to the recommendations for further evaluation and treatment, the practitioner also discusses the potential risk of impaired driving with Ms. Johnson due to her decreased visual acuity. The practitioner advises Ms. Johnson to consider limiting her driving or seeking alternative transportation methods to ensure her safety and the safety of others on the road. The practitioner also informs Ms. Johnson that, as a healthcare provider, they are mandated by law to report any patients who may be a danger to themselves or others on the road to the Department of Motor Vehicles (DMV). The practitioner encourages Ms. Johnson to be proactive in managing her vision and driving safety and to communicate any concerns or limitations with the practitioner or ophthalmologist.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Mr. John Doe, a 35-year-old construction worker, is brought into the emergency department handcuffed to a stretcher by police officers. The officers suspect that Mr. Doe was driving under the influence of alcohol, causing a motor vehicle accident that resulted in three deaths. On examination, the practitioner notes that Mr. Doe is slurring words, confused, unable to identify himself, and unaware of what has happened. The differential diagnosis includes alcohol intoxication, head trauma, and underlying medical conditions. The practitioner orders a comprehensive evaluation to determine the cause of Mr. Doe's symptoms and provide appropriate emergency management. While the police officers request a blood alcohol test, the practitioner explains that immediate emergency management takes priority over forensic testing and that the blood alcohol level can be evaluated at a later time if necessary. The practitioner emphasizes the importance of prompt and effective emergency care for all patients, regardless of the circumstances surrounding their admission.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
