How do we counsel on driving for patients presenting with syncope?
Of course we rely on the full history and physical to help us make our differential diagnosis. But, I wondered if there were specific guidelines I could use, and I wondered what my liability is as a physician in Georgia. Here’s what I found:
The 2017 ACC/AHA/HRS Guidelines on Syncope are great, and they have this excellent table with recommendations for monitoring periods:
Table 10. Avoidance of Private Driving After an Episode of Syncope: Suggested Symptom-Free Waiting Times for Various Conditions
They also point out that the considerations are different for private drivers versus commercial drivers.
I also googled Georgia law and found that under Title 40 (Motor Vehicles and Traffic) in our 2024 Code, that here, the Driver License Advisory Board seems to make the decision. There is a section that says:
“ All physicians licensed under Article 2 of Chapter 34 of Title 43 to diagnose and treat disorders and disabilities defined by the commissioner may report to the department the full name, date of birth, and address of any person with a disability which would render such person incapable of operating a motor vehicle safely.”
As well as:
“The reports required by this Code section shall be confidential and shall be used solely for the purpose of determining the qualifications of any person to drive a motor vehicle on the highways of this state. No civil or criminal action may be brought against any person or agency for providing the information required in this Code section. The reports, or any reference to the reports, shall not be included in any abstract prepared pursuant to Code Section 40-5-2.”
All of which I interpret to mean that we can (and maybe should) report, but that we are not liable if we do not. I’m not a lawyer, though. My general practice is to document my recs in the note – I haven’t come across a patient yet who insisted on driving after being told to wait, but if I did, I think I would consider reporting, because public health. But, as the guidelines point out, we let inexperienced 16yos drive alone, so there is always some risk on the road.
Anyways, hope you find this table to be a useful reference like I did.
Shen WK, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136(5). doi:https://doi.org/10.1161/cir.0000000000000499
