Sirven: Telling Patients To Give Up The Car Keys

By Dr. Joseph Sirven
Published: Monday, February 10, 2014 - 2:51pm
Updated: Wednesday, May 21, 2014 - 5:10pm
(Photo by Julie Levin-KJZZ)
Dr. Sirven does not enjoy the "giving up the car keys" conversation with his patients.

If you have ever had to tell your aging parents that it is time to give up driving, you know just how tough that transition can be. Well, as it happens, doctors struggle with this conversation too.

KJZZ commentator Dr. Joseph Sirven explained. He is a practicing physician and chairman of neurology at the Mayo Clinic in Scottsdale.

I have a confession to make. There is one office visit that I truly hate, telling a patient he can no longer drive.

A 2006 study estimates that 30 percent of older adults diagnosed with dementia continue to get behind the wheel. The fact is, this creates a public health hazard that can lead to injury and death. The problem is that millions of older Americans are diagnosed with dementia, so this dreaded visit has now become routine.

Many states like California compel doctors to report their impaired patients. This is complicated because, we as doctors must protect privacy while looking out for larger public health concerns. This very fine line is often ambiguous and distressing.

Invariably these office visits follow a common arc. They are set up by concerned family members who bring in their loved one looking for an authority figure. 

“Doctor, tell him…give up the keys," they say.  

I get it and I am sympathetic, but it is usually the messenger who is harmed.

What undoubtedly happens next is an outpouring of emotions just like the Kübler Ross stages of grief. denial, anger (so much anger!), bargaining ("I will only drive to the grocery store or avoid highways"), depression (typically seen at the next visit) and if lucky, acceptance.

Truth be told, I am rooting to find a way to keep my patients driving, because taking the keys away leaves me with a sad reminder of my own mortality. So, when I tell someone they are no longer able to drive, it hurts, because I wonder what I will do when that day arrives for me.

You see, I have learned a fundamental truth about the privilege of driving. Driving is connection, driving is freedom, driving is life. It is no wonder they shoot the messenger. 

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