I have patients with serious liver, kidney, heart and lung diseases who regularly drive to my office for an appointment. Other people with certain diseases sometimes associated with sudden loss of consciousness (prior strokes, diabetes, abnormal heart rhythms, and sleep disorders) regularly hop into their cars to drive to work, to run errands, or to car pool.

Now, don’t get me wrong. There are many responsible drivers, juniors and seniors, who know their health limitations, known when to drive and when to be driven. This column is not about them. But I really get nervous when using the ATM at the bank drive-through and see Braille instructions on the machine, it appears, for a sight-impaired driver. Heck, I fear old blind Billy is going to deposit his seeing eye dog’s check and then slam into my car as he exits the bank’s driveway, because he probably can’t see the big red K even when he is standing at the door of K-Mart.

A case in point: I had to renew my driver’s license last week and witnessed an interesting display of family love and kindness coupled with an outrageous lack of judgment. It seemed that granny wanted to renew her license, so her daughter brought her to the license bureau tucked between the No More Tears Shampoo aisle and the Herbal Medical Cure aisle at a Kroger store. Granny stuck her one good eye in the vision test apparatus and succeeded in correctly naming more than half the numbers on the chart. She was then happily steered to the fingerprinting arena. When told to place her index finger in the recording slot, she appeared very confused. Her daughter was there lickety-split to raise the correct finger to the device. Finally, granny was totally lost when told to move to the left and have her photograph taken. Granny smiled at the blank wall with her back to the camera until the daughter said pleasantly but vigorously, “Granny, turn this-a-way so we can get your picture”. A few minutes later granny had her new license. She zipped off in a red Firebird.

I asked the officer of the Department of Public Safety, who served both Granny Firebird and me, if she were concerned. She said it gets even worse, but all one really has to do is pass a vision test to get a non-commercial driver’s license. For a commercial license (to drive big trucks and buses), the health rules are a lot stiffer. If you have a history of high blood pressure, diabetes requiring insulin treatment, a seizure disorder, significant vision or hearing deficits, or loss or impairment of a hand or limb, you cannot get a commercial license. It would seem logical we should assume that the driver of a 30,000 pound truck won’t black out on I-95. The logic does not legally extend to the health status of Granny “Get Out of the Way” Firebird. Doctors everywhere are being faced with public and personal safety issues of an aging society in which most people get around via their personal vehicle.

As patients get older or as chronic diseases progress, the simple fact is that alertness, coordination, and reaction times deteriorate. The older or infirm patient may even recognize the risks but (fearfully) continues to drive to the Mall in a dangerous struggle to remain independent for as long as possible. As a matter of public safety, physicians are becoming stricter in monitoring patients’ capacity for safe driving and in the administering of health examinations for drivers seeking commercial licenses. Because of the rising rate of accidents associated with the adverse health status of the driver, the physician may be legally liable for an accident caused by the ill health of his or her patient. Oh, great. Sue the doctor when granny runs a stop sign and plows into a group of nuns. I can hear the lawyers already! This is the law, folks, so be prepared to drive granny home from my office when I tell her that she cannot cruise the Strand in her Firebird anymore. I am doing it to protect the public, granny, and me.

As family members and as citizens who share the road, we all have a responsibility to each other. If someone has a chronic illness, watch for signs of driving hazards. This may be particularly true for a month or more following any hospitalization. Weakness, confusion, dizziness, fatigue, and other symptoms, if present, should lead you to diplomatically prevent the patient from driving. It is helpful to bring the matter to the attention of the physician who may not be at all aware that the patient is still driving. One of the worst tragedies is the patient who survives a serious illness only to die in an avoidable accident. It happens.

So, the next time you see a driver in a red Firebird using the ATM Braille instructions, call her daughter. I’m sure she will be happy to drive granny anywhere she wishes, and I won’t be so nervous on the road.