Scenario 3 Discussion:

Scenario 3

Number 3 is another tough one. If you look at your sheet, there's a whole section about confidentiality and when it's OK to breach confidentiality. Whenever there's an issue of public safety, and I did ascribe different allowances to do that. Now, with this gentleman, his neurological exam was fine. His mom is 53 and she had onset around age 40. And I spent a long time talking to this guy and his wife and he felt--as an airline mechanic, they have built in checks and balances, thankfully, where they do get exams at least annually. But he wasn't prepared yet to tell his employer.

So he and I had a deal. He and I had a contract, as it were, that he would continue to come back to our neurologist to monitor his status and the minute there was any suspicion, he was going to tell his employer, and get a desk job where he wasn't going to be responsible. For now, I'm trusting that. He told me that that's how he would proceed. If we suspect that he is not complying with his end of our deal, it will then be our obligation to all of us in this room to tell his employer.

Q: Is that a legal thing? What if he were applying to be a pilot?

Same. In other words, I would counsel that pilot that it is his duty to inform his employer. It is his duty but if he doesn't do it, I will. So I try to work with the families. Because I don't want to blow the whistle if I don't have to. They need to do that. That's part of our testing. It was part of our counseling all along. That was brought up early in the process. If you're coming to me with that level of employment, whenever there's any possible jeopardy to anybody, including yourself, I will raise that early on. Truck drivers, handlers of heavy equipment, school teachers. Anybody who deals with the public is potentially at risk to jeopardize those people.

I have teachers that come to me for testing and they are concerned that they are not able to give their students their best. That's jeopardizing their students. So we talk about how and when to tell an employer, how to make that decision. I always caution people, just like driving a car, you don't want to know how many people are out there driving cars with neurological diseases. You don't want to know. So my caution to my people is, you stop driving before you have an accident, not because you have an accident. And I will get right on it. I will be very directive.

Q: I thought neurologists were obligated to inform the DMV…

The question was why aren't neurologists obliged, obligated to let the DMV know if driving--any physician, any physician, any provider, anyone at all who has that knowledge is obligated to inform if the person will not inform themselves. But yes, physicians are obligated.

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