We thank Specht, Thorbecke, and Coban for their critical comments on our article and wish to add several comments in response.
At the time our article was accepted (20 August 2009) we did not have access to the new guidelines on expert reports and thus had to take recourse to the information available at the time. In a later chapter on the topic of epilepsy and employment we naturally included the new guidelines, in which some time limits were changed or stated with greater precision (1).
A detailed explanation of the recommendations of the employers’ liability insurance associations relating to the occupational health assessment of epilepsy patients (BGI 585) (2), as mentioned by Specht, Thorbecke, and Coban, would have exceeded the scope of this article but were also included in the chapter mentioned above.
We still think that documentation and patients’ signatures are important.
We agree wholeheartedly that an in-depth and informative discussion with the epilepsy patient (and a witness) improves compliance and should thus be sought. A trusting doctor-patient relationship should be the objective in each phase of treatment. However, in aiming for this we must not lose sight of a sound legal foundation; we think that those two issues are not mutually exclusive. It would be a shame if our article was misunderstood in that sense.
We did not ask the question of whether reporting a patient to the vehicle licensing authorities is a measure of last resort, but for us that goes without saying; it was included in the article in that sense.
Early retirement in the described case has to be considered on the basis of the individual case and should under no circumstances be regarded as an ideal or even adequate solution to the problem—it merely reflected what had happened in this case, without any further evaluation on the part of the authors.
Prof. Dr. med. Thomas Kraus
Dr. med. Monika Gube
Institut für Arbeitsmedizin und Sozialmedizin
Universitätsklinikum der RWTH Aachen
Conflict of Interest Statement
The authors of all contributions declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Gemeinsamer Beirat für Verkehrsmedizin beim Bundesministerium für Verkehr, Bau- und Wohnungswesen und dem Bundesministerium für Gesundheit. Begutachtungsleitlinien zur Kraftfahreignung. (6th edition). 2000 (revised chapter „3.9.6 Epileptische Anfälle und Epilepsien“; Stand: 2. 11. 2009).|
|2.||Ausschuss „Arbeitsmedizin“ des Hauptverbandes der gewerblichen Berufsgenossenschaften (HVBG): BG-Information: Empfehlungen zur Beurteilung beruflicher Möglichkeiten von Personen mit Epilepsie (BGI 585) Köln: Carl Heymanns Verlag 2007.|
|3.||Gube M, Ell W, Schiefer J, Kraus T: Medicolegal assessment of the ability to drive a motor vehicle in persons with epilepsy [Beurteilung der Kraftfahreignung bei Epilepsie]. Dtsch Arztebl Int 2010; 107(13): 217–23. VOLLTEXT|