Test your knowledge

Try these sample AKT questions provided by Dr Mahibur Rahman from Emedica

1. A 68-year-old patient with a history of moderately severe dementia attends surgery with his wife. His symptoms have been getting worse and he has had two minor driving collisions in the last three weeks. On examination, his MMSE score has deteriorated from 13 to 8 since his last hospital appointment. The patient does not understand that it might be dangerous for him to keep driving, and seems confused as to where he is. Which of the following is the most suitable action?

A – Inform the DVLA about this patient’s condition.
B – Ask the patient to contact the DVLA and inform them of his condition.
C – Report the risk posed by this patient to the police.
D – Ask his wife to contact the DVLA for advice.
E – Request another hospital appointment for assessment of his fitness to drive.

2. A 30-year-old patient with epilepsy attends for repeat anticonvulsant medication. During the consultation he mentions that he drove his car a week ago. He has recently been diagnosed, and when you explain that he should not be driving, he refuses to listen. He tells you he will not inform the DVLA despite your advice. Which of the following does the GMC advise?

A – Inform the DVLA after the patient has left, without letting the patient know.
B – Ask the patient’s permission to inform the DVLA, and inform them if he agrees.
C – Inform the patient that you have a duty to inform the DVLA, and contact them as soon as possible.
D – Inform the patient that you have a duty to inform the DVLA, and contact them as soon as possible. Inform the patient in writing afterwards that a disclosure has been made.
E – Offer the patient a second opinion from one of your colleagues in the practice.

3. A 28-year-old man admits that he has been diagnosed with HIV. He recently attended a sexual health clinic after having an extramarital affair. He asks you not to tell his wife, who is also a patient registered at the practice. He explains that he is not going to tell her, as they are trying for a baby and he feels this may make her leave him. Which of the following is the recommended course of action?

A – Respect his wishes and maintain confidentiality.
B – Explain that you have a duty to report his illness to the “Proper Officer” of the local authority or the consultant in communicable diseases.
C – Report his illness to the “Proper Officer” of the local authority or the consultant in communicable diseases, without discussing this with him.
D – Explain that you have a duty to inform his wife, and inform her only if he agrees.
E – Explain that you have a duty to inform his wife, and inform her whether he agrees or not.

Answer: A – Inform the DVLA about this patient’s condition.

It is clear that this patient is not safe to drive. If he does not understand that his illness impairs his ability to drive, then you have a duty to inform the DVLA. In this case, this is better than option B as the patient does not understand and may not be able to contact the DVLA. The GMC in Confidentiality: Reporting Concerns About Patients to the DVLA or DVA (2009) states: “Make sure that the patients understand that the condition may affect their ability to drive. If a patient is incapable of understanding this advice, for example, because of dementia, you should inform the DVLA immediately.”   

Answer: D – Inform the patient that you have a duty to inform the DVLA, and contact them as soon as possible. Inform the patient in writing afterwards that a disclosure has been made. 

Where a patient has a condition that impairs their ability to drive, they should be encouraged to contact the DVLA themselves. If they refuse to do so, then you have a duty to contact the DVLA yourself. You should inform the patient of your decision to do so, and let them know in writing afterwards that you have made a disclosure. If disclosing without consent, documentation of the reasons why is essential. (GMC, Confidentiality: Reporting Concerns About Patients to the DVLA or DVA (2009)).

Answer: E – Explain that you have a duty to inform his wife, and inform her whether he agrees or not.

HIV is not a notifiable disease, so does not need to be reported to the “Proper Officer”. The GMC states: “You may disclose information to a known sexual contact of a patient with a sexually transmitted serious communicable disease if you have reason to think that they are at risk of infection and that the patient has not informed them and cannot be persuaded to do so.” GMC, Confidentiality: Disclosing Information About Serious Communicable Diseases (2009). In this case, as the couple are trying for a baby, there is a risk of transmission to the wife. It is best practice to let the patient know of the disclosure if it is safe to do so.

Dr Mahibur Rahman is the medical director of Emedica, and works as a portfolio GP in the West Midlands. He is the course director for the Emedica AKT and CSA Preparation courses, and has helped hundreds of GP trainees achieve success in their MRCGP, AKT and CSA examinations each year.