A patient who has just received an appropriate ICD shock tells you he intends to keep driving because he needs his car for work. What is your duty?

Question

A 54-year-old self-employed delivery driver received an appropriate ICD shock for ventricular tachycardia three days ago. He is otherwise well. When you explain the driving restrictions he becomes angry, says he will lose his business, and tells you he has no intention of stopping.

Accepted Answer

My duty here is to inform, to document, and only then, if necessary, to disclose. The legal obligation to notify the DVLA rests with him, not with me, and I would say that clearly. I would explain the restrictions that follow an appropriate ICD shock for Group 1 entitlement, and that an ICD permanently bars Group 2 licensing, giving him the specific timeframes and pointing him to the DVLA guidance. I would then record in the notes that I have given this advice, and I would put it in writing to him and copy his GP, because that documentation is what makes any later action defensible. His anger is really about losing his income, so I would spend most of the consultation on that rather than on restating the rule. I would explore what his employer or his business could accommodate, involve occupational health, refer him for benefits and welfare advice, and give him a realistic timeline so he can plan rather than face an indefinite prohibition. I would also make sure he understands why the restriction exists — that a shock at the wheel risks his life and other people's — because framing it as protection rather than punishment often shifts the conversation. If, despite all of that, he continues to drive and cannot be persuaded to stop, then continuing to say nothing would expose others to a risk of death or serious harm, and disclosure to the DVLA medical adviser would be justified in the public interest. I would tell him before I did so, and I would document my reasoning. Throughout I would keep my consultant informed, since this is not a decision I would make alone.

Driving After an ICD Shock

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