Lesson 4.6: Fitness to Drive, Medical Errors, and Duty of Candour
Fitness to Drive — DVLA Framework
The responsibility to inform the DVLA lies primarily with the patient. Your role as an FY2 is to advise, document, and, if the patient refuses and continues to drive, consider a public interest breach of confidentiality.
| Condition | Group 1 (Cars) | Notes |
|---|---|---|
| Epilepsy | Must not drive for 12 months after last seizure. | 6 months after a first single seizure. Group 2 (lorries/buses): 5 years seizure-free. |
| Insulin-treated diabetes | May drive if well controlled and no disabling hypoglycaemia. Must monitor BM before driving. | DVLA must be informed of insulin treatment. |
| Syncope (single episode) | 4 weeks off driving (unexplained). 3 months if a cardiac cause is identified. | Any suspected epileptic event requires seizure-free period before driving. |
| Stroke / TIA | 1 month off driving after TIA. 1 month after stroke if no relevant residual deficit. | Group 2: 1 year restriction after TIA or stroke. |
| Dementia | DVLA must be informed. Annual review. Driving cessation when unsafe. | Involves autonomy vs. safety, handle sensitively. |
| Atrial fibrillation | No restriction if rate is well controlled. | Short restriction applies after cardioversion. |
| Visual field defects | Must meet DVLA visual acuity and field standards. | Refer for formal testing if in doubt. |
Fitness to Work — Med3 Certificates
As an FY2, you may be asked to complete a Med3 (fit note). Key points:
- You may certify 'not fit for work' OR 'may be fit for work with support', the latter is strongly encouraged.
- The fit note is not for acute illness lasting under 7 days, patients self-certify for those.
- You do not need to specify a diagnosis if the patient does not consent, but you must give a reason for the incapacity.
- For prolonged illness, consider an occupational health referral.
Medical Errors — The Duty of Candour
The statutory Duty of Candour (Health and Social Care Act 2014) requires NHS organisations and individual practitioners to be open and transparent when things go wrong.
An apology is not an admission of liability in English law (Compensation Act 2006). You must apologise when something has gone wrong. Not apologising because you fear litigation is not justified, and the examiner is watching for this.
When telling a patient about an error, follow this approach:
- Prepare: know the facts before you speak. Involve your senior first if possible.
- Setting: private room, seated, uninterrupted. Offer a chaperone or nurse to be present.
- Open honestly: "I need to speak with you about something important regarding your care. I'm afraid an error was made."
- Explain clearly: what happened, when, and what the potential consequences are, in plain language.
- Apologise sincerely: "I am truly sorry this happened. You deserved better care."
- Explain next steps: what will be done to manage any harm and prevent recurrence.
- Signpost PALS (Patient Advice and Liaison Service) and the formal complaints process.
- Document everything.
Incident Reporting — Datix
- All incidents — errors, near-misses, and adverse events — must be reported through the trust's incident reporting system (Datix in most NHS trusts).
- A near-miss is as important to report as an actual error, near-misses identify systemic risks before harm occurs.
- Reporting does not automatically mean disciplinary action. The NHS safety culture treats reporting as the responsible, professional behaviour.
- If you make an error, inform your senior immediately, then complete the report together.
SBAR for Escalating After an Error
S — Situation: 'Mrs Patel in Bay 3 has received 10mg IV methotrexate instead of the prescribed 2.5mg oral dose.'
B — Background: 'She was prescribed low-dose methotrexate for rheumatoid arthritis. The dose was prepared and administered 30 minutes ago.'
A — Assessment: 'She is currently asymptomatic, but I am very concerned about methotrexate toxicity — GI injury and bone marrow suppression.'
R — Recommendation: 'I believe we need haematology urgently and consideration of folinic acid rescue. I would appreciate your immediate attendance.'