Dear Editor: Once again, the ever vigilant Dr Jerome raises an important issue omitted from our article “The Clinical Use of Risk Assessment” (1). The issue of risk assessment and dangerous driving was thought to be beyond the scope of our contemporaneous mandate; however, it is an issue that bears deliberation. It would be interesting to consider how frequently driving risk is considered in the general practice of psychiatry. This issue may be addressed in the study currently being conducted at McGill. For instance, in the emergency room, should this be a part of any assessment? It could be argued that patients who are suicidal, homicidal, or suffering from a psychiatric disorder and who take psychiatric medication may have a condition that could interfere with their ability to drive a motor vehicle safely. Bearing in mind that the courts have stated that we have no discretion (1), are these conditions reportable? There are also ethical issues to be considered. If a mildly suicidal patient comes into the emergency room for help, he or she may not be appreciative when he or she has to leave without a driver’s licence. This then raises the issue of informing patients of the limits of confidentiality before they seek advice (2). We have argued previously that, as the limits to psychiatric confidentiality are eroded, our therapeutic efficacy may also be eroded (3). Thank you again, Dr Jerome, for increasing our awareness and anxiety in the practice of our profession in these increasingly difficult times. See also C 35380 fo. References 1. Glancy G, Chaimowitz G. The clinical use of risk assessment. Can J Psychiatry 2005;50:12–7. 2. Glancy G, Regehr C, Bryant A. Confidentiality in crisis: part I–the duty to inform. Can J Psychiatry 1998;43:1001–5. 3. Glancy G, Regehr C, Bryant A, Schneider R. Another nail in the coffin of confidentiality [editorial]. Can J Psychiatry 1999;44:83. Graham D Glancy, MB, ChB, FRCPsych, FRCPC Gary A Chaimowitz, MB, ChB, FRCPC Etobicoke, Ontario
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