SJT Textbook: Confidentiality — Patients’ Fitness to Drive & Reporting to the DVLA/DVA
GMC fitness to drive & DVLA reporting sets out when doctors must advise patients to stop driving and when disclosure is required to protect public safety.
🎥 Video Lesson (YouTube)
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GMC Fitness to Drive & DVLA Reporting: Core Principles
🎯 THE CORE PRINCIPLE
Fitness to drive is both a safety and legal issue. While confidentiality remains essential, GMC guidance is clear: doctors must protect patients and the public from serious harm caused by unsafe driving. Patients have a legal duty to report relevant conditions to the DVLA/DVA. Doctors must encourage, advise, and document — but if the patient refuses and risk remains, disclosure without consent becomes justified and necessary.
The MSRA SJT tests your ability to:
* Prioritise safety over confidentiality
* Follow proper steps (advise → persuade → assess risk → disclose)
* Document all actions
* Handle objections appropriately
* Communicate clearly and ethically
* Understand your professional obligations
🧩 KEY PRINCIPLES (MSRA SJT Interpretation)
1. DVLA/DVA makes the final decision
Core idea: Doctors advise; DVLA/DVA decides. Exam cues:
* Provide clear medical advice
* Refer to DVLA/DVA medical standards
* Seek specialist advice if uncertain
2. Patients must self-report their medical conditions
Core idea: The duty lies with the patient. Exam cues:
* “Explain the patient’s legal obligation”
* “Encourage immediate cessation of driving” High-yield:
* Inform → document → follow-up
3. Confidentiality applies — but public safety overrides
Core idea: If a patient continues to drive when unfit and risk persists, disclosure is justified. Exam cues:
* Imminent harm
* Repeated refusal
* Incapacity or inability to understand High-yield:
* “Disclose minimally to DVLA/DVA after informing the patient”
4. Follow the correct disclosure sequence
Core steps:
1. Assess condition’s impact on driving
2. Explain risk + legal duty to notify
3. Advise patient to stop driving
4. Encourage self-reporting
5. Offer second opinion if they disagree
6. Document discussions clearly
7. If they refuse + risk remains → disclose to DVLA/DVA
8. Inform patient in writing afterwards
5. Consent is ideal — but not always possible
Core idea: Attempt consent first, but disclosure can proceed without it when justified. Examples:
* Patient lacks capacity
* Serious risk to the public
* Persistent refusal
6. Responding to DVLA/DVA requests
Core idea: Doctors must cooperate promptly and accurately. Exam cues:
* Prepare reports without delay
* Provide factual and relevant information
7. Apply the same principles to other transport roles
Core idea: Similar duties apply to pilots, HGV drivers, bus drivers, etc. Exam cues:
* Contact relevant authority for advice
⚡ HIGH-YIELD ACTIONS (What Scores Points)
1. Explain the medical condition’s impact on driving clearly.
2. Advise the patient to stop driving immediately if unfit.
3. Inform them of their legal duty to notify DVLA/DVA.
4. Encourage self-reporting and provide written information.
5. Offer a second opinion if they dispute your advice.
6. Document all discussions in detail.
7. Assess the level of risk if they refuse to stop driving.
8. Disclose to DVLA/DVA only if serious risk persists.
9. Inform the patient before disclosure, then confirm in writing.
10. Provide prompt, accurate reports when DVLA/DVA requests information.
* Failure to inform DVLA/DVA when serious harm is likely
* Ignoring requests from licensing authorities
* Not documenting safety-critical conversations
* Avoiding disclosure because “it might upset the patient”
* Assuming confidentiality is absolute
* Delaying action in high-risk conditions (e.g. seizures, hypoglycaemia)
These traps prioritise comfort or convenience over safety and legal obligations.
💬 MODEL PHRASES (Use These in SJT Logic)
* “I recommend you stop driving immediately until further assessment.”
* “I will document today’s discussion clearly in your record.”
* “If you choose not to report this and continue driving, I may need to inform the DVLA.”
* “I will only disclose the minimum necessary information.”
* “I will inform you in writing if disclosure is required.”
D – Document advice carefully
R – Recommend stopping driving
I – Inform about legal duty to notify DVLA/DVA
V – Verify patient understanding
E – Encourage self-reporting
S – Serious risk → doctor must disclose
A – Advise second opinion if disagreement
F – Follow DVLA medical guidance
E – Explain disclosure decision and follow up in writing
📋 QUICK FAQ
Who decides fitness to drive?
DVLA/DVA — not the doctor. Does confidentiality prevent reporting?
No — if serious risk persists, disclosure is justified. What if the patient disagrees?
Offer a second opinion; still must stop driving until resolved. Must the patient be informed before disclosure?
Yes, unless it is impractical or unsafe. What if the patient lacks capacity?
Inform DVLA/DVA promptly; capacity is not required for safety disclosure.
📚 GMC ANCHOR POINTS
* Confidentiality (fitness to drive)
* Duty to protect public from serious harm
* Legal requirements and DVLA guidance
* Accurate documentation
* Minimum necessary disclosure
* Patient autonomy vs public safety
💡 MINI PRACTICE SCENARIO
A patient with uncontrolled epilepsy insists on continuing to drive despite repeated seizures. They refuse to notify DVLA. Best action: Advise them again to stop driving, explain your legal and ethical duties, and inform them that you will notify DVLA due to the serious ongoing risk. Why: Public safety overrides confidentiality.
🎯 KEY TAKEAWAYS
✓ Public safety > confidentiality when serious risk exists.
✓ Patients must self-report conditions affecting driving.
✓ Doctors must advise clearly and document thoroughly.
✓ Disclosure without consent is justified when risk persists.
✓ DVLA/DVA decides fitness — not the doctor.
✓ Provide minimal, relevant information when reporting.
✓ Written follow-up is essential after disclosure.
🔗 RELATED TOPICS
* → Communicable disease disclosure
* → Public interest disclosures
* → Duty of candour
* → Safeguarding adults
* → Capacity and decision-making
* → Legal reporting duties
📖 FULL PRACTICE QUESTIONS
Example SJT — Best of 3 (8 options; choose three)
A patient with recent episodes of hypoglycaemia continues to drive and refuses to notify DVLA.
Options:
A. Explain their legal duty to report to DVLA
B. Advise them to stop driving immediately
C. Document the discussion clearly
D. Respect confidentiality and take no action
E. Notify DVLA without telling the patient
F. Disclose to DVLA after explaining your intention
G. Wait for their next endocrinology review
H. Tell their employer instead of DVLA
Correct three: A, B, C
• A: Legal duty must be explained.
• B: Patient safety first — stop driving.
• C: Essential documentation.
Why others are weaker/wrong:
• F: Only appropriate if they continue to drive after A+B fail.
• D/E/G/H: Unsafe or inappropriate.
Example SJT — Rank 5 (best → worst)
A patient with severe visual impairment insists on continuing to drive.
Options:
A. Advise them to stop driving immediately
B. Encourage them to self-report to DVLA
C. Offer a second opinion if they disagree
D. Inform DVLA without warning
E. Suggest they wait to “see if eyesight improves”
Ideal order: A (1) > B (2) > C (3) > D (4) > E (5)
• A: Immediate risk → must stop driving.
• B: Supports autonomy + legal duty.
• C: Appropriate if patient disputes assessment.
• D: Disclosure should be preceded by informing patient.
• E: Unsafe delay.
- GMC — Patients’ Fitness to Drive & Reporting to DVLA/DVA
https://www.gmc-uk.org/ethical-guidance