title: Who should answer the question: "Can I drive with this plaster cast?".
abstract: BACKGROUND
  The application of a plaster cast is known to affect driving ability, but patients continue to drive. The individuals and authorities involved in assessing driving safely include doctors, the Driver and Vehicle Licensing Agency (DVLA), police, insurance companies, and patients, but it is unclear who should take responsibility for the advice given, especially in the event of an accident.
  
  
  METHODS
  We contacted senior plaster technicians in 348 hospitals in the UK. We recorded their responses regarding advice given to patients on driving in specific casts. Sixteen motor insurance companies and 40 police forces were also contacted in order to canvass their opinions.
  
  
  RESULTS
  188 technician interviews (response rate 54%) were conducted. Only 10% of respondents offered advice unprompted; an average of 48% of patients asked for advice. 88% of respondents referred patients to their motor insurance companies, and also to the DVLA (11.7%), doctor (10.6%), or police (5.9%). Only 20.2% of plaster rooms provided written information. All insurance companies would insure patients provided the doctor had not explicitly objected to driving, but there was no consensus amongst the responses received from police. In the event of an accident after the treating doctor had advised against driving, insurance companies were likely to invalidate the policy, and the police would seek penalty punishment or prosecution.
  
  
  CONCLUSIONS
  Although doctors are not specifically trained to assess the ability of patients to drive, insurance companies and police forces place the responsibility on doctors to advise patients. Since current evidence suggests plaster casts can impair driving ability, we suggest patients should be advised not to drive. Patients accept all responsibility if they continue to drive after receiving this specific advice and understanding its implications.
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK. Electronic address: maulikjgandhi@yahoo.co.uk.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gandhi
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: D
authors.initials: D
authors.lastname: Freitas
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lewis
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: L
authors.initials: L
authors.lastname: Bolton
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bhasin
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: D
authors.initials: D
authors.lastname: Leonard
authors.affiliation: Department of Trauma & Orthopaedics, Russell Hall Hospital, Dudley Group of Hospitals, Pensnett Road, Dudley, West Midlands DY1 2HQ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Marsh
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control*; D001294:Attitude to Health; D001334:Automobile Driving; D002370:Casts, Surgical; D037001:Directive Counseling; D006801:Humans; D007346:Insurance, Accident; D010349:Patient Compliance; D010817:Physician-Patient Relations; D016495:Police; D012449:Safety; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: Advice; Car; DVLA; Driving; Insurance; Plaster cast