Prescription for Danger?

Doctors say a law requiring them to report patients who shouldn't be behind the wheel must be changed, or impaired drivers will end up on the road.

A medical organization representing family doctors is pushing for a change in the state's Traffic Law that it says will improve relationships between doctors and their patients.

Under the law, all physicians, including family practitioners, are required to report every illness liable to impair a person's driving ability to the Health Ministry's Medical Institute for Road Safety. But the Israel Family Physician Society says putting that onus on doctors can put a strain on the doctor-patient relationship, and on the trust between the two. (Since 2006, family physicians have also been required to sign a form attesting to driving competency for anyone who wants to take driving lessons. )

The doctors' society wants to create an automatic reporting system that would remove the reporting obligation from the doctors. The group's chairman, Prof. Shlomo Winker, says that the relevant information can be found in medical files at hospitals and HMOs, and there is no reason that information systems at these medical facilities cannot generate the data and transfer it to the institute via computer, without the involvement of physicians.

This would be good "not only for the doctors but also for the system, because automatic reporting will finally ensure that people who endanger themselves and others by driving will not get behind the wheel," says Winker.

MK Afou Agbaria (Hadash ) introduced an amendment to the law at the start of the year that would rid doctors of their current legal obligation. "There is room for improving the law," says Agbaria. "We want the relationship between doctor and patient to be one of mutual trust, not suspicion. It is inappropriate that physicians providing treatment would act as informers who pass on information about their patients to certain authorities."

Doctors ignoring government orders

An internal review by the institute shows that, in practice, the rate of reporting by family doctors is actually very low. According to recently-assembled Health Ministry data, physicians reported only 2,900 cases of potential driving impairment to the institute between January through July this year. Officials estimate that this is probably less than 10 percent of all new patients diagnosed in Israel with conditions that would require reporting. These conditions include: epilepsy, serious heart disease, neurological problems (such as strokes ), certain sleep disorders (such as sleep apnea ), certain psychiatric conditions, and vision impairments.

At a meeting in January of the Knesset's Health Committee, Prof. Avinoam Reches, chair of the Israel Medical Association's Ethics Committee, said that many patients actually threaten their doctors in an attempt to "persuade" them not to reveal their medical conditions. He also said the obligation to report damages the doctor-patient relationship.

In February, a physician was questioned by the police after a patient of hers, who developed diabetes as the result of a pancreatectomy and was taking insulin, was seriously injured in a car accident. The doctor, who had not reported the patient, as required, received the support of the Israel Medical Association; eventually the police decided not to pursue a case against her.

'The whole system could collapse'

The Health Ministry, however, opposes automatic reporting. It says this method would "result in overreporting, which would cause the whole system to collapse. The current Traffic Law does not require reporting in every situation, and physicians must use their discretion before reporting to the institute."

The ministry says automatic reporting would forward to the institute medical information about millions who suffer from various chronic conditions that do not affect their driving. "They would then be obligated to undergo testing and pay a fee, ultimately resulting in unnecessary aggravation for many citizens."

The ministry's director general published a memo in 2009 reminding doctors of their obligation, because of the low percentage of reporting. And the ministry's Institute for Road Safety met with the Israel Police recently "to urge better investigation of traffic accidents and to take steps against doctors who failed to report to the institute, when accidents occur as the result of a medical condition that required reporting," the ministry said.

The ministry is also taking further efforts to increase reporting. "The importance of the issue is raised at meetings and conferences held in the ministry. We encourage contacting hospitals to generate a computerized report about patients whose conditions represent a direct threat to their driving ability. Furthermore, contact with the Israel Defense Force's medical corps has been intensified on the subject of reporting," says the Health Ministry.