The U.S. Department of Transportation (DOT) recently began requiring a physical examination of its employees that can be conducted only by a licensed medical examiner who has been trained and certified by the Federal Motor Carrier Safety Administration (FMCSA). Many advanced practice nurses (APNs) and physician assistants (PA) have taken the certification exam and are on the National Registered Certified Medical Examiner list.

During the DOT physical examination process, a medical examiner is required to determine whether the driver has the physical, mental, and emotional ability to operate a commercial vehicle without jeopardizing public safety. I have now seen many young adults come into the clinic for their first scheduled DOT physical examination. A majority have indicated that they smoke. 

Upon exam completion, I share the results with the driver, and immediately see a reaction of relief and happiness. I then make a request: “Share with me how many cigarettes you smoke each day?” A majority of the drivers have indicated that they smoke 1 to 2 packs a day. My usual follow-up conversation and the patient’s typical reactions are as follows:

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I understand that getting this certificate is very important to you and you need this for your job. 

I heard that your pay increases once you have logged a certain number of accumulated safety driving hours. Is that true? (The driver usually responds that this is true.)

Well, this certificate should cover you for the next 2 years, if there is no change in your health status. Hopefully, when it is time for renewal, you will be making more money than now. (The driver usually will acknowledge this with a smile and a “Yes” or “I hope so.”)

However, 2 years from now, you might not be able to earn another full 2-year certificate. (This always gets the driver’s attention.)

Based on the DOT requirement, your blood pressure is normal and in the accepted range today. That is the good news. However, research shows that long-distance drivers usually smoke more cigarettes the longer they hold their job. Also, a daily average of 1 pack per day will increase your upper blood pressure number above 132 mm Hg, and even trigger heart problems. (This information is usually met with silence.)

I know you work hard. I do not want you to lose your job because of your health status. We still have time, and we can prevent this. You do have alternatives if you want to be in good health and quit smoking. (At this stage, it is up to the provider to negotiate a feasible plan based on the individual’s socioeconomic level.)

I’ve been working with DOT drivers since June 2014. During this time, 3 drivers have revisited the clinic requesting smoking-cessation plans and 2 more decided to quit cold-turkey.—Yeow Chye Ng, FNP, Huntsville, Ala. (195-2)

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