DOT Physical Questions

[MSPAC]

I had a patient today who couldn't understand or speak English and I specifically recall from my online training last year (from the state medical association) that the patient should be able to do this. But, I was told by a colleague today that there are exceptions like those driving migrant workers or something about driving a firefighter crew. Another colleague then tells me that it's not the provider's job to determine the patient's command of the language. I suppose this is true because the certificate doesn't ask that but at the same time the certificate and the forms to be filled out by the patient are in English so it probably should be a given that they do anyway. A question to those of you who see patients for DOT physicals:

1. When do you make exceptions with language barriers, if at all?

2. Also, do you guys measure neck circumference too? I just learned that I'm the only one here who does. 

[rev ronin]

1. Never came up when I was doing these.  I would require a translator be present--not that a CDL candidate could be relied upon to answer honestly on anything, of course, but still.

2. I definitely would now as part of sleep apnea screening using STOP BANG criteria (http://stopbang.ca/osa/screening.php) unless they already scored 3+ just based on other criteria (e.g., age, sex, BMI) in which case it wouldn't make me screen them any harder.

Yes, sleep apnea isn't a mandated screen, but if you're going to check hernias and get urine protein screens, I don't see how one can ethically justify NOT screening and referring for sleep apnea testing prior to passing a driver.

[sas5814]

I so don't miss doing DOT physicals. I'm still certified but I'm hiding that fact from my current employer.

[Guest UVAPAC]

If someone can't read or speak any English, they can not pass a DOT PE.  How can they read the road signs?  How can they read traffic signals?  One day they will enter the highway going the opposite direction of traffic, and it will fall squarely on you for not being able to read the road signs.

 

I have begun screening for OSA on exams.  Anyone with a BMI > 40.0 goes.  Anyone with a BMI 35+ with 3+ risk factors (HTN, DM II, hx AFib, age, gender, etc) go for a sleep study.  Don't like it, go somewhere else.

 

I know I have had some disagreements with others on here... but if based on paperwork if I know someone will require additional documentation, or be required to go for a sleep study I talk to them ahead of time.  If they are not agreeable I will refund their money, and submit as an incomplete exam and note the patient left after discussing Sleep Study or additional documentation would be required.  

[Guest UVAPAC]

1 hour ago, sas5814 said:

I so don't miss doing DOT physicals. I'm still certified but I'm hiding that fact from my current employer.

All of the urgent cares and primary care doctors in this area have wisely stopped performing these exams.  In turn our office has had a massive influx of DOT PE's unfortunately.  Good for business... Bad for my mental health!

[sas5814]

Yea one of the brain spawns admin had was for us to do DOTs in our UC system. First I spent a lot of time explaining why that was such a bad bad idea and then told them half the providers would quit...so they were going to have to sell a lot of DOTs to make up for the cost of replacing all those providers. 

[MSPAC]

On 3/28/2018 at 11:03 PM, rev ronin said:

Yes, sleep apnea isn't a mandated screen, but if you're going to check hernias and get urine protein screens, I don't see how one can ethically justify NOT screening and referring for sleep apnea testing prior to passing a driver.

The training program I did specifically mentioned neck circumference >15.5 in women and >17.5 in men automatically get sleep apnea testing. 

I never quite understood the reasoning for doing hernia checks. How am I protecting the public by doing them?

 

On 3/29/2018 at 10:31 AM, sas5814 said:

I so don't miss doing DOT physicals. I'm still certified but I'm hiding that fact from my current employer.

You are a very smart man. I envy you.

On 3/29/2018 at 0:23 PM, UVAPAC said:

If someone can't read or speak any English, they can not pass a DOT PE.  How can they read the road signs?  How can they read traffic signals?  One day they will enter the highway going the opposite direction of traffic, and it will fall squarely on you for not being able to read the road signs.

This was my thought as well. But I was speaking to a friend who lives in Florida and he says their DMV driving tests are available in French Creole and Spanish. I suppose that's what's happening here. How would I be responsible for an accident caused by someone who doesn't speak/understand English when the DMV is the one to give them a driver's license to begin with? 

I wonder if there is someone to ask these questions to from the DOT. Anyone know?

[Cideous]

I would not fail someone for not speaking English.  I read no where that it was a requirement when I took the DOT test.  You are opening up yourself to liability there I believe if the only reason you fail them is their language.  If they pass physically, I give them the card and boot them out the door.

[Mcshald]

I have done these exams for more than 20 years, and have had training from both Natalie Hartenbaum's course in the distant past and more recently a Concentra course.  Although the rule is drivers must be able to read and speak enough English to follow traffic signs, they are permitted a translator for the DOT exam.  It is the responsibility of the DMV who licenses the driver and the motor carrier who hires the driver to ensure they can function in terms of being able to drive a vehicle and understand rules of the road.  Our job is to determine whether they meet the physical standards for the DOT.  

[Guest JMPA]

14 hours ago, MSPAC said:

I never quite understood the reasoning for doing hernia checks. How am I protecting the public by doing them?

commercial drivers must be able to inspect their rigs, this may require climbing/squatting/kneeling/pulling themselves up. If a driver is unable to perform these maneuvers do to a hernia than they are putting others lives in jeopardy. i agree that hernia exams  should be mandatory for all CDL drivers

[Reality Check 2]

I have done DOTs in 2 states for over 25 years.  In Texas where 40% of my patients spoke Spanish for 10 years. 

Although I agree that we are supposed to ascertain their medical capacity - the forms ONLY come in English.

If they arrive unaccompanied to an exam and the form is only in English - that limits my capacity to evaluate their history adequately. I speak 3 languages - I don't offer them during DOT exams. And I don't speak Russian/Ukraine - our main local issue.

If a person is required to speak, read and understand English sufficient to communicate with law enforcement and read road signs = then a DOT form should be no different.  

I am unable to communicate with this person sufficiently to determine their medical fitness or their understanding of the medical requirements. I certainly can't counsel them about an A1c of 9 or explain sleep apnea. 

I usually called the employer and told them that so-and-so doesn't speak English and couldn't fill out the forms - sorry, I can't help you. It never went past that. I would also mention that blood pressure was unacceptable or there was gross glucose in the urine if that was true and that created yet another DOT issue. These items were done by MAs before I ever got to the patient.

Thankfully, I am not going to ever have to do another DOT ever again - the VA doesn't do them and I don't tell anyone I still have certification. 

I agree with everything DOT stands for but got tired of being yelled at, threatened, coerced by a jerk doctor and generally having to explain freaking common sense to folks about why weighing 375 pounds, smoking and being diabetic with a heart stent truly created issues about driving a 45000 pound truck. The scrutiny needs to be real and valid - we need better support to enforce these issues safely.

[Cideous]

I've said it here many times.  The two worst types of patients I have are Drug seekers and DOT's.....Still true to this day.

[Guest UVAPAC]

I had a patient just last week who checked off "no" medications and "no" surgeries.

When I said you don't take any prescription medications he responded "I do, I just didn't write them down on the form."  When I asked why he would do that he stated "HIPPA laws, it's none of your business."  I then read him the statement on the federal form that he was signing, and essentially told him he is lying under oath, and any accident he is involved in would be his liability/responsibility and not mine.  He then asked if he could have a new form.