Hello, hello, hello, what’s going on here then...

Do I work for the NHS or the DVLA? This is what I found myself wondering about in my last clinic.

It’s rare in medicine that your duty to act as the patient’s advocate is not the over-riding factor in all clinical decision-making. However, if you are fortunate enough to be a diabetologist, then several times a month you will find yourself in the professionally invidious position of doing the DVLA’s bidding, potentially not putting the patient’s concerns centre stage.

Allow me to furnish you with a hypothetical scenario. A 42-year-old patient with a 20 year history of diabetes consults you for their routine annual review and during the appointment also requests that you complete a medical questionnaire for the DVLA. They have the form with them and plonk it in front of you. You are working your way through the questions fairly well until you get to the one that asks if you have inspected a written record of their recent blood glucose monitoring results.

You are happy that day-to-day glycaemic control is not a major problem for this patient, their HbA1c is 59 mmol/mol, the hospital notes bear witness that they have never been seen in A&E with a major hypo - nor trauma from a road traffic collision caused by hypoglycaemia for that matter. They verbally report no major hypos and good hypoglycaemic awareness and your clinical instincts tell you that you have no reason to disbelieve this account of things.

You have previously scrutinised their glucometer and recorded in the notes “glucometer readings mainly single figures/low teens”. However, they do not have either glucometer or glucose monitoring diary with them today. You would not be making an issue of this minor point were it not for the DVLA form, after all, have you never, not even once, arrived at work without your hospital ID badge? We are all human.

But now the pressure’s on, the patient’s driving license is about to expire, they need it for their livelihood, they have to get the form back to the DVLA in the next three days or the license expires. Do you just tick the box saying you’ve inspected the glucose monitoring diary? No, better not do that, what if that one in a million chance comes to fruition and they have a huge hypo on the way home and plough in to a crocodile of school children on a zebra crossing?

OK, plan B, politely explain to the patient that it will not be possible to complete the form today even though your professional instincts are telling you that to do so would be quite OK? You explain, the remonstration starts, the pleading, the imperative to keep driving with which you so completely empathise. Now, from being kind, sympathetic, benevolent, you are cast as cruel, heartless and callous.

Not only has this consultation gone badly wrong, but the entire therapeutic relationship has been seriously injured, perhaps forever, by a third party who was never invited to this consultation in the first place. Oh dear, how did it ever come to this? Did you ask to be both policeman and doctor at the same time? I suspect not, I know I certainly didn’t.

For advice on driving and diabetes CLICK HERE.

Tags for this article: DVLA

The author - Dr Jeremy Turner

Jeremy Turner A consultant diabetologist and endocrinologist in Norfolk, and author of Diabetes Bible

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My blog expresses my personal views on the rapidly advancing field of diabetes. It is aimed at fellow physicians and is not offering medical advice to readers. I will not respond to requests for clinical advice. If you have health concerns please contact your GP or specialist.

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