Changing Gears: From Surgeon to Driving Advisor

Plaster casts inconvenience patients, especially when they are applied to the right leg. In addition to complaints about immobilization, having to use crutches, and itchy skin that cannot be scratched, patients often ask their orthopedic surgeons about driving.

Since patients need increased mobility to drive, safety becomes a concern. Several stakeholders are involved in this debate — including surgeons, licensing authorities, and insurance companies — but which one should advise the patient?

A recent issue of The Surgeon attempts to answer this question in an article written by a team of researchers from the Department of Trauma & Orthopaedics at Russell Hall Hospital in the United Kingdom. The authors contacted 188 senior plaster technicians, 16 automobile insurance companies, and 40 police forces to learn about the advice on driving that is given to patients in specific casts.

According to the researchers, patients were more likely to ask for advice on driving from casting technicians than surgeons. But while half of the patients asked for their advice, the casting technicians reported providing it only 10% of the time, although 88% referred patients to their motor vehicle insurers or local Department of Motor Vehicles (DMV). The casting technicians also referred patients to their surgeons and the police, but those referrals were made much less frequently than referrals to insurers and the DMV.

On the insurance company side, all insurers indicated that they would cover patients unless a doctor had explicitly objected to the patient driving. If a patient drove against a surgeon’s medical advice, then the insurers reported that they would invalidate the patient’s policy and even prosecute.

Police departments gave a range of answers, but only one was consistent: referring patients to their surgeons for advice on driving with a plaster cast.

Although surgeons are not specifically trained to assess patients’ ability to drive while wearing a leg cast, the researchers concluded that insurance companies and police forces look to doctors to advise their patients on driving. The researchers further suggested that physicians advise those patients to avoid the roads, since plaster casts impair driving ability.