Driving a motor vehicle is a complex task involving perception, good judgement, adequate response time and reasonable physical capability. A range of medical conditions, as well as certain treatments, can impair any of these factors. Such impairment may adversely affect driving ability, possibly resulting in a crash causing injury or death. The newly published Assessing Fitness to Drive, 2003 gives guidance to healthcare practitioners faced with various clinical situations. It also provides specific guidance on conducting medical examinations required by the licensing authorities. The overall intent of these national guidelines is to help clinicians: 1) identify and manage patients who may not be capable of adequately controlling a vehicle (and who are thus a risk to public safety); 2) counsel patients regarding the impact of their condition on their driving ability; 3) inform patients of their legal obligations to report long-term or permanent illnesses or injuries likely to affect their driving to the driver licensing authority; and 4) if needed, because of inaction by the driver and immediate concerns about public safety, advise the driver licensing authority regarding the patient's fitness to drive. The new publication replaces the existing booklets Medical examinations for commercial vehicle drivers (1997) and Assessing Fitness to Drive (2001) for private vehicle drivers, and combines both these booklets into one reference for ease of use. The medical criteria for commercial drivers are more stringent than those for private vehicle drivers, reflecting their extensive time on the roads and the likelihood of more serious consequences of loss of control of, say, a petrol tanker or bus compared with a domestic car. These different criteria are set out in colour-coded format throughout the new book. In addition to combining the standards for commercial and private vehicle drivers, the content has been extensively revised to reflect advances in diagnosis, treatment, and prognosis of various conditions affecting driving ability. For example, increasing recognition of the importance of fatigue and sleep disorders in accidents5 has led to inclusion of the Epworth Sleepiness Scale as a screening tool in the health questionnaire, and the more accurate and cross-culturally validated AUDIT questionnaire has replaced the CAGE questionnaire for alcohol dependency screening. Similarly, advances in treatment of diabetes, epilepsy, and psychiatric disorders have been incorporated. Much attention has been given to "conditional licences", whereby a person who does not meet the medical criteria may be supported in retaining a driving licence that is conditional on supplementary criteria relating to compliance and response to treatment, possible driving restrictions, and a detailed plan for monitoring the patient's condition. This should help in rehabilitation of patients with various conditions, and address concerns about disability discrimination and equal employment opportunity issues. Several legal and ethical issues are also identified in the guidelines. The book emphasises the legal responsibility of drivers to notify the driver licensing authority if they have any permanent or long-term condition likely to affect their driving ability. The relevant state legislation in this regard is included as an appendix. The legislation relating to reporting by healthcare practitioners is also summarised in the book. Most states (with the exception of South Australia and the Northern Territory, where legislation is under review) do not require mandatory reporting by healthcare professionals. However, there remains a duty of care in cases where the healthcare practitioner is aware of the patient's continuing driving and there is a definite risk to public safety. Practitioners who are unsure about confidentiality and notification should consult their medical defence organisation or state driver licensing authority regarding their legal position. The introduction of privacy legislation in most states has also been a consideration, and has led to clarification of the information to be recorded and kept by the practitioner (and to be readily available to the patient/driver), as distinct from the medical information to be provided on a "need to know" basis to the licensing authority. The exception is information required to be provided to the authority under law. This has led to new forms and procedures to guide practitioners. Although overall there is a move to uniformity of licensing procedures in the different states and territories, there are still some important differences. Tables set out these differences for easy reference. In summary, Assessing fitness to drive 2003: 1) outlines clear medical criteria for driver capability, based on available evidence and expert medical opinion; 2) clearly differentiates national minimum standards for licensing drivers of commercial and private vehicles; 3) outlines the legal obligations for medical practitioners and drivers; 4) provides medical examination proformas to help guide the assessment process; 5) provides a reporting template to guide reporting to the licensing authority if required; and 6) provides links to supporting and substantiating information. The new guidelines have been developed through extensive consultation with the medical profession, the licensing authorities, the trucking industry and unions, and lay groups. The development of the book is one of a series of initiatives by the National Road Transport Commission to create uniformly efficient and safe transportation in Australia. In recognition of its importance, the book has been signed into force by the ministers of transport of all states and territories. The book has been assessed by general practitioners and found to offer clear clinical and procedural advice for various situations. It is intended the new guidelines will be useful to all practitioners, be fair to patients, and contribute to road safety. Copies of the new guidelines are being distributed to all GPs, and may also be obtained free of charge from state driver licensing authorities. The guidelines are also accessible online from the Austroads website (www.austroads.com.au), and an online tutorial package is being developed to support implementation. (Author/publisher)
Samenvatting