Background: Determining whether a patient with epilepsy ought to be allowed to drive a motor vehicle is a challenging matter for the physician. This situation is fraught with medicolegal uncertainties, not just for general practitioners, but also for specialists and occupational health physicians.
Methods: A case is reported and discussed in the light of a selective review of the literature and the German medicolegal assessment guidelines for the determination of the ability to drive a motor vehicle.
Results: The risk associated with driving can be estimated as a function of the type of epilepsy from which the patient suffers and of the frequency of seizures. The expert can then express an opinion on the basis of this assessment, within the framework of the German medicolegal assessment guidelines and the German Driver Licensing Act ("Fahrerlaubnisverordnung"). There is no general duty of physicians to report a patient's unsuitability for driving a motor vehicle, but physicians have a right to report to the authorities that a patient should not be allowed to drive when the patient fails to comply with a recommendation not to drive and when a higher legally protected interest is at risk.
Conclusions: The drawbacks of secondary prevention, as illustrated by the case presented here, could be minimized if the treating physician took the patient's occupational history and gave the relevant advice early on in the course of the patient's illness. Likewise, early counseling about driving would lessen the need for physicians to tell the authorities that patients should not drive in cases where the public interest overrides the patient's right to confidentiality.