"Sorry, doc, I forgot all about that"

I have intermittently been reading the conclusions from the Canadian Consensus Conference on Dementia.1 The thoroughgoing effort of Christopher Patterson and colleagues to manufacture concrete from Jello has provided me with considerable amusement during breaks in my current attempt to practise rational medicine with limited resources in rural Africa.

I have a comment related to recommendation 25: "Primary care physicians should notify licensing bodies of concern regarding competence to drive ... unless the patient gives up driving voluntarily." Until the end of 1997, I worked as a primary care physician and advisory physician at 2 long-term care facilities in London, Ont. From my Canadian practice experience, the recommendation should have been that "primary care physicians should notify licensing bodies of concern regarding competence to drive ... even if the patient gives up driving voluntarily."

Promises to give up driving voluntarily are subject to erosion by the genuine or conveniently exaggerated effects of short-term memory deficits: "Sorry, doc, I forgot all about that." My usual policy was to approve of the patient's wise decision to give up driving voluntarily but to tell him or her that I was required to inform the Ministry of Transportation anyway, just to keep everyone honest.

I never received an adverse reaction to this strategy; when I didn't use this approach, however, I sometimes encountered awkward situations involving practical inconvenience (including personally having to disable vehicles and having to confiscate driver's licences) and obvious potential medicolegal problems.

If ever the recommendations are revised, I would appreciate it if the committee would take into account my two cents' worth.