Unfit to drive

11/02/2008

Under Ontario law, practicing physicians must report all unfit drivers. Yet, physicians rarely submit such reports, possibly because of a mistaken belief that such drivers neglect their own health and rarely visit the doctor. A new Canadian study from the Institute for Clinical Evaluative Sciences (ICES) sets the record straight.

The ICES study identified drivers involved in a crash who were admitted to Canada’s largest trauma center between 1996 and 2001. Researchers assessed three chronic medical conditions reportable to vehicle licensing authorities: alcohol abuse, specific cardiac diseases and neurological disorders. Linking Ontario health and transportation databases, the ICES study assessed how many drivers were previously seen and reported by a physician in the community. Lead author and senior ICES scientist, Dr. Donald Redelmeier says, “Restricting driving privileges is a difficult process for both physicians and patients. However, our research suggests many missed opportunities to prevent serious crashes. There is widespread failure of physicians’ duty to inform authorities despite mandatory laws.”

The ICES study found the following results:

A total of 1605 injured drivers were identified of which 37% had a reportable condition
Those with a reportable condition had made a total of 20,505 previous visits to over 2,300 physicians during the five years before the crash
The majority of patients with a reportable condition (85%) had seen a physician in the year before the crash but few (3%) were reported to licensing authorities
Alcohol abuse was the most common underlying reportable condition and also the least common reason for submitting reporting (2% reported)
Unfit drivers accounted for over 8,000 hospital days corresponding to $3 million in hospital costs
Summary: Unsafe drivers often visit physicians and rarely are reported to licensing authorities, contrary to mandatory reporting laws.

Unsafe drivers contribute to more than a hundred motor vehicle fatalities a day in North America. Medically unfit drivers are a notable subgroup because chronic conditions can theoretically impair a person’s driving and increase the risk of a crash. Crashes in such cases receive substantial public attention if the driver showed earlier warnings and eventually causes the death of someone else. Medically unfit drivers worldwide, kill more than 5,000 pedestrians each year. Elderly drivers are often singled out because they tend to develop medical conditions later in life that impair their driving ability. All Canadian provinces and territories have enacted some form of legislation regarding physician reporting of a patient who is believed to be unfit to drive a motor vehicle. “The job of policing unfit drivers is no simple task,” says Dr. Redelmeier, “due to the size of the population, cultural attitudes toward mobility and the ambiguous definition of medically unfit. Balancing road safety with the rights of individuals to stay on the road is challenging.”

Policy Considerations:

Expanding regulations would extend societal participation by obliging others in the community to notify authorities of mishaps (e.g hospitals, insurers, or mechanics).
Reducing regulations would decrease the liability for physicians and might encourage attention toward alternative safety policies such as roadside police or driver testing. In the absence of policy changes, physicians seem mostly inclined toward resuscitation and treatment in the aftermath of a crash.

The study “Mandatory reporting by physicians of patients potentially unfit to drive” is in the January 2008 issue of Open Medicine.

Author affiliations: ICES (Dr. Redelmeier); (Drs.Redelmeier,Stanbrook) Department of Medicine, University of Toronto; (Dr.Venkatesh) Resident in Radiology at McMaster University; Toronto, Ontario.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.