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Drives with both hands on the steering wheel
    Differential Diagnosis[Top] [Nav]
universal sign of the bad driver
    Discussion -- not available online[Top] [Nav]
    Notes[Top] [Nav]
       *This card, more than any other, provoked a strong reaction from readers. My suspicion is that everyone perceives themself as a great driver, and any hint otherwise causes consternation. Nevertheless, I stand by this card, despite my inability to find the reference.
       *If the quantity of publications is any indication, the interaction between medicine and driving has mushroomed in recent years. No doubt a review article somewhere uses the following conceptualization: To avoid problems, a driver's brain must
  1. receive usable sensory data about the state of the world,
  2. be awake and able to process the information,
  3. apply sound judgement to the problem, and
  4. effect some movement in order to avoid the problem.
The sections below categorize diseases in this way.
    Update Comments[Top] [Nav]
  • States with vision testing of elderly drivers have a lower rate of fatal automobile crashes involving the elderly than do other states. [102]
  • In California, physicians are required to report patients with dementia to the state driving board. [116]
  • No specific references here yet, but remember, ???? parkinsonian patients can move normally when there is a sudden emergency. [117]
  • By coincidence, 22 patients with stable cardiac disease drove into a radar trap while wearing a Holter monitor. All reported some cardiac symptoms, such as tachycardia. In the group as a whole, an increase in ventricular ectopy was seen. Two patients had runs of ventricular tachycardia (18 and 25 beats, respectively) and 4 had myocardial ischemia. The authors acknowledge that the risk of dying in an autmobile mishap is probably higher than the cardiac risk imposed by speed traps. [119]
  • For other spy signs, see card TH-006. [121]
  • We have seen that physicians, spies, and journalists observe humans closely. Cervantes would have us add another category: nervous lovers. Don Quixote's flowery speech is too long to type, but it ends with:
    For you must know, Sancho... that between lovers the outward actions and movements they reveal when their loves are under discussion are more certain messengers, bearing news of what is going on in their innermost souls.
    Footnotes in Print Edition[Top] [Nav]
    (1) Goldfinger.
  Fleming I. New York: Signet, 1959: 53 (chapter 7).
I am still very much interested in any pointers readers can offer to a printed reference about driving with two hands on the wheel. I am (sheepishly) beginning to think that it may not have been in a James Bond novel after all.
    (2) US Preventive Services Task Force. Automobile injury--selected risk factors and prevention in the health care setting.
  Polen MR, Friedman GD.   JAMA 1988 Jan 1;259(1):76-80.  Pubmed+Abstract  Similars
    New References[Top] [Nav]

Sensory, especially vision, problems
    101.Night myopia: implications for the young driver.
  Fejer TP, Girgis R.   Can J Ophthalmol 1992 Jun;27(4):172-6.  Pubmed+Abstract  Similars
    102.Required vision testing for older drivers [letter].
  Nelson DE, Sacks JJ, et al.   N Engl J Med 1992 Jun 25;326(26):1784-5.  Pubmed  Similars
    103.New investigations concerning the relationships between congenital colour vision defects and road traffic security.
  Verriest G, et al.   Int Ophthal. 1980;2(2):87-99.
    104.Visual processing impairment and risk of motor vehicle crash among older adults.
  Owsley C, Ball K, et al.   JAMA 1998 Apr 8;279(14):1083-8.  Pubmed+Abstract  Similars

Potential disturbing of consciousness
    105.Automobile accidents in patients with sleep disorders.
  Aldrich MS.   Sleep 1989 Dec;12(6):487-94.  Pubmed+Abstract  Similars
    106.Drivers with untreated sleep apnea. A cause of death and serious injury.
  Findley LJ, Weiss JW, et al.   Arch Intern Med 1991 Jul;151(7):1451-2.  Pubmed+Abstract  Similars
    107.Driving and the implantable cardioverter defibrillator. Study Group on ICD and Driving [letter; comment].
  Jung W, Luderitz B.   Lancet 1996 Sep 7;348(9028):687-8.  Pubmed  Similars
    108.Motor vehicle accidents in patients with an implantable cardioverter- defibrillator.
  Curtis AB, Conti JB, et al.   J Am Coll Cardiol 1995 Jul;26(1):180-4.  Pubmed+Abstract  Similars
    109.Driving safety among patients with automatic implantable cardioverter defibrillators.
  Finch NJ, Leman RB, et al.   JAMA 1993 Oct 6;270(13):1587-8.  Pubmed+Abstract  Similars
    110.When should patients with lethal ventricular arrhythmia resume driving? An analysis of state regulations and physician practices [see comments].
  Strickberger SA, Cantillon CO, et al.   Ann Intern Med 1991 Oct 1;115(7):560-3.  Pubmed+Abstract  Similars
    111.The effect of epilepsy or diabetes mellitus on the risk of automobile accidents [see comments].
  Hansotia P, Broste SK.   N Engl J Med 1991 Jan 3;324(1):22-6.  Pubmed+Abstract  Similars
    112.Benzodiazepine use and the risk of motor vehicle crash in the elderly [see comments].
  Hemmelgarn B, Suissa S, et al.   JAMA 1997 Jul 2;278(1):27-31.  Pubmed+Abstract  Similars

Poor decision-making
    113.Alzheimer and vascular dementias and driving. A prospective road and laboratory study [see comments].
  Fitten LJ, Perryman KM, et al.   JAMA 1995 May 3;273(17):1360-5.  Pubmed+Abstract  Similars
    114.Predictors of automobile crashes and moving violations among elderly drivers [see comments].
  Marottoli RA, Cooney LM Jr, et al.   Ann Intern Med 1994 Dec 1;121(11):842-6.  Pubmed+Abstract  Similars
    115.The older driver. Clinical assessment and injury prevention [see comments].
  Underwood M.   Arch Intern Med 1992 Apr;152(4):735-40.  Pubmed+Abstract  Similars
    116.The elderly driver: what physicians need to know.
  Foley KT, Mitchell SJ.   Cleve Clin J Med 1997 Sep;64(8):423-8.  Pubmed+Abstract  Similars

Movement disorders
    117.No specific references here yet, but remember, ???? parkinsonian patients can move normally when there is a sudden emergency.

    118.Effects of the 65-mph speed limit on rural interstate fatalities in New Mexico [see comments].
  Gallaher MM, Sewell CM, et al.   JAMA 1989 Oct 27;262(16):2243-5.  Pubmed+Abstract  Similars
    119.Cardiac risk of speed traps.
  Cocco G, Iselin HU.   Clin Cardiol 1992 Jun;15(6):441-4.  Pubmed+Abstract  Similars
    120.Effectiveness of air bags [letter; comment].
  O'Neill B.   N Engl J Med 1992 Apr 16;326(16):1091.  Pubmed  Similars
    121.For other spy signs, see card TH-006.
    122.Don Quixote.
  de Cervantes Saavedra M; Cohen JM (trans.). Baltimore: Penguin, 1950 (original: 1604 and 1614): Part 2, chapter 10, page 525.
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    ©1986-2000 John Sotos, MD. All rights reserved.  Last updated 16:34 PDT on July 4, 2000.[Top]

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