Assessing a patient’s fitness to drive

You warn John about the risks of driving, especially at night, while waiting for cataract surgery. He says he needs to drive to care for his elderly parents. Dr Patrick Clancy, MBBS, FRACGP, MHlth&MedLaw, Senior Medical Adviser, Advocacy, Education and Research, Avant, outlines your professional responsibilities.

Health practitioners quite often report feeling conflicted about assessing patients’ fitness to drive. On the one hand, you have a duty to protect the public where a patient may put others at risk by driving unsafely. On the other, you have a duty of patient confidentiality, and may be concerned about the effect on their wellbeing if they lose their licence.

It can be very difficult to navigate such situations. Key strategies are to:

• maintain a professional distance
• be alert to patient pressure
• start discussing driving early with patients with progressive conditions.

Patient responsibility

Patients are required to self-report to the licensing authority if they have medical conditions that would adversely affect their ability to drive – this includes vision issues such as cataracts.

Professional obligation to warn of risks

In this situation, the first step would always be to have the discussion with the patient about your assessment and your concerns.

Patients may focus on why they need to drive, the type of driving they will do and the costs of being unable to drive. You have a professional responsibility to warn them of the risks. That is, you must give clear advice to your patients if long or short-term health conditions, disabilities or treatments may affect their driving ability and pose risks to themselves or others.

This discussion is also important because a patient’s awareness of their condition, and ability to manage or accommodate it, will be factors in determining their suitability for a conditional licence.

It is also very important that you document this discussion and your advice in the patient’s medical record. Fitness to drive information should be shared between a patient’s healthcare team. This may mean including your assessment and discussion in your report back to the patient’s general practitioner.

The Queensland Coroner addressed this requirement in a recent inquest into a fatal accident involving a woman with insulin-dependent diabetes who had been certified fit to drive. The patient had reported a suicide attempt after her licence had been suspended previously. The coroner acknowledged the balance involved in maintaining a therapeutic relationship, which may make it difficult to address sensitive subjects directly. However, the coroner was critical that there was no evidence the woman’s doctors had discussed her fitness to drive with her.

Clear policies

We generally advise doctors to implement a practice policy for fitness to drive assessments. Having a checklist of criteria and clear steps to follow can help you to be objective. It can make it easier for you to empathise with the patient while satisfying your legal and professional obligations.

It can also help you explain to the patient the areas you are concerned about.

Refer for further assessment

Where the assessment is unclear, options can be to refer the patient for a specialist review, or for a formal driving assessment. Patients may be able to continue to drive with conditions on their license, or subject to regular reviews of their condition.

Reporting your concerns

Unlike the situation with temporary conditions affecting a patient’s ability to drive (such as sedation), practitioners may have a positive duty to report ongoing conditions.

In South Australia and the Northern Territory, the law requires health professionals to report to licensing authorities if they believe a patient they have examined is likely to endanger the public by driving with an injury, illness or disability.

In other jurisdictions, doctors have been the subject of complaints where they have not reported significant impairments to the state or territory licensing authority. All jurisdictions have laws that protect health practitioners from civil or criminal liability if they make such a report to a licensing authority in good faith.

Resources

State and territory licensing authorities have helpful resources for patients. This can also help to provide impartial information about risks of driving (to patients and others), patient obligations, and options such as conditional licences.

Additional resources include:

• Avant factsheet: fitness to drive
• Austroads: Assessing fitness to drive webpage. Austroads also released new national driver medical standards for assessing fitness to drive from 22 June 2022.

A version of this article first appeared in Insight magazine and has been republished with permission.