The question: My 74-year-old father has reduced mobility due to a healing broken neck, heart problems due to excessive alcohol consumption and cataracts. The doctor reported these issues to the ministry and his driver's license was revoked but only for his eyesight. To my knowledge, my father has never driven while under the influence, nor has he been charged with any alcohol-related offences. I asked the doctor to refer my father for cataract surgery but he refused, saying he will not sign off for six months as he wants to keep my father off the road and stop him from drinking. What are my options so my father can have his cataracts fixed?
The answer: The words "alcohol consumption" and "cataracts" in the same sentence regarding any driver, let alone an elderly one, make me nervous. It's no wonder the doctor reported your dad: It's a safety issue not only for your father but the public at large. I do take issue, however, with the physician refusing to provide a referral to a specialist, which I will get to later.
Cambridge, Ont. family physician John Crosby said reporting patients who are medically unfit to drive is one of the toughest things a doctor deals with and it can take a toll on the relationship.
"I have people who still hate my guts 10 years later and they can't fire me because they can't find a new doctor," said Dr. Crosby, who, in his 38-year career in emergency medicine and family practice, has been involved in about 20 cases. "It really wrecks the relationship. It's hard."
Evaluating fitness to drive includes a physical, a thorough history, laboratory tests and sometimes referring a patient to a specialist such as a neurologist or geriatrician to make the final call. Then there's a referral to a driver assessment centre.
The physician provides a report but it's the motor vehicle licensing authority that suspends or restricts a driver's license. Typically, it's done in cases where patients had trouble with vision, dementia, alcoholism, or seizures – essentially those conditions that cause a driver to lose control of the car.
Families fighting on behalf of their parents need only ask themselves one question: Would I allow the kids to ride in the car with their grandfather?
As for the referral to a specialist for the cataract surgery, I recommend your father go back to the family physician. Go with him.
Thank the physician for taking such good care of your dad. Tell him you are concerned about your dad's cataracts and you would like him to be referred to an ophthalmologist. If the physician refuses, you have a giant-sized problem because he holds the keys to a referral. Your other option is to contact the regulatory body, the college of physicians and surgeons in your province, to help sort it out with you and the doctor.
Given that waits for an ophthalmologist can be weeks to months and there's another wait for surgery, I'm hoping the referral won't be a big barrier.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com