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Balancing confidentiality against public safety, knowledge of when disclosure is justified, and compassionate problem-solving.
A structure to build your own answer on — not a script.
Identify
Confidentiality and his livelihood versus risk to himself and other road users.
Principles and guidance
Confidentiality is important but not absolute; GMC guidance allows disclosure in the public interest where there's risk of death or serious harm. The legal duty to inform the DVLA is the patient's.
Explain and explore
Make sure he understands the risk and his legal duty; explore his concerns (job, money, independence); help with alternatives (lift sharing, public transport, speaking to employer, support services).
Escalate proportionately
If he continues to drive, tell him you intend to inform the DVLA, then do so; share only what's necessary; document; seek advice from a senior or defence organisation if unsure.
Maintain the relationship
Continue care and support; explain the rules about regaining a licence when seizure-free for the required period.
A strong but not perfect answer. Read the notes to see why it works — then make your own version with your experiences.
This is a conflict between confidentiality — and his worry about losing his job — and the safety of other people on the road.
Confidentiality is really important, because patients need to trust that they can tell their doctor things honestly; he's only told the GP about driving because he trusts her1. But GMC guidance says confidentiality isn't absolute, and disclosure can be justified where there's a risk of death or serious harm to others. A seizure at the wheel could clearly cause that.
The first step is to talk to him. The GP should make sure he understands that it's his legal responsibility to inform the DVLA2 and stop driving, and why — including that he may not be insured. It's also worth exploring what's driving his decision3: the fear of losing his job, perhaps money worries. The GP could help him think through alternatives, like lifts or public transport, and point out that employers have duties to make reasonable adjustments. Many people regain their licence after being seizure-free for a period set by the DVLA.
If he still keeps driving, the GP should tell him she's going to inform the DVLA, and then do so — sharing only the necessary information — and document everything. She shouldn't tell his employer4, as that isn't necessary to prevent the risk.
I think that sequence is right because it respects him as far as possible and keeps the relationship intact, but it doesn't let his confidentiality put other people's lives at risk.
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