We thank both our correspondents for their constructive contributions.
Dr. Schneider points out that the sentence “If the patient asks the physician to produce a report on his or her fitness to drive, the obligation to maintain confidentiality is of course removed” is misleading. In all likelihood, Dr Schneider refers to the guidelines for expert reports issued by the Federal Highway Research Institute (Bundesanstalt für Straßenwesen, BASt), which says under section 2.3, “Legal position of the expert” that the person to be assessed/reported on is the expert’s client, contractual partner, and party liable for costs. The expert report may be passed to the authorities or third parties only with the explicit agreement of that person—otherwise medical confidentiality will prevent this.
In our article on this subject, we complied with the rules and regulations for the licensing of drivers in Germany (Fahrerlaubnisverordnung, FeV). These regulate the approach of the licensing authorities for assessing the affected person’s fitness to drive in § 11, “Fitness.” If the licensing authorities are in doubt about a person’s fitness to drive, they can commission a report to help them come to a decision. The affected person is obliged to commission at their own expense and within a defined time frame an expert report on their own fitness to drive. They have to inform the licensing authorities about which institution has been commissioned to provide the report. If the requested report is not presented by the deadline, the authorities may conclude that the affected person is unfit to drive. The person is entitled to view the transmitted documents. Since the affected person is the one who commissioned the expert report for the licensing authorities, s/he therefore agrees with this approach. It is not difficult to see that the requirements of the BASt and the FeV regarding expert reports for the licensing authorities diverge substantially. As far as we can find out, this discrepancy has existed for years and can be resolved only by the Ministry of Transport, which is responsible for the guidelines on expert reports of both the FeV and the BASt. From a legal perspective, the FeV as a statutory instrument is superior to the guidelines of the BASt.
Matters are different if a client (a private company or authority) requests an expert report on an employee’s fitness to drive. In this scenario, the expert should be released from their duty of confidentiality by the affected person if the expert report is sent to the client.
In his letter, Dr. Afflerbach points out that in Table 4 in the article, drivers in group 1 are described as fit to drive, 2–4 weeks after sternotomy. He claims that they will be fit to drive after 6 weeks at the earliest.
Unpublished guidelines for expert reports on fitness to drive from the European Union (New Standards for Driving and Cardiovascular Diseases) of 2013 state that no specific European guidelines exist that stipulate when a patients is fit to drive after cardiac surgery. Dr Afflerbach’s correspondence was extremely compelling, and it therefore seems to make sense to assume fitness to drive only 6–8 weeks after successful cardiac surgery. The likelihood with which other participants in road traffic will be harmed if someone returns to driving—appropriate to their condition—as early as 2–4 weeks after sternotomy is impossible to answer. Furthermore, such patients will mostly be in rehabilitation clinics.
On behalf of the authors
Prof. Dr. med. Hermann H. Klein
Conflict of interest statement
Prof Klein has received travel expenses and speaker honoraria from KelCon.
|1.||Klein HH, Sechtem U, Trappe HJ: Fitness to drive in cardiovascular disease. Dtsch Arztebl Int 2017; 114: 692–702 VOLLTEXT|