Agony in licence for the unfit
From previous page drive than national guidelines said they should be. Three-quarters said they would report patients whom they suspected of driving despite being told they should not, but in reality most of them (64 per cent) rarely, or never, did.
Current guidelines suggest doctors should consider reporting patients counselled not to drive, but who ignore the advice. In SA and NT this reporting is mandatory.
While most states indemnify doctors for reporting someone, there’s concern that similar legal protection doesn’t apply if they don’t. And recent court cases have brought the issue to a head.
In one case in NSW, a coroner has referred to the Director of Public Prosecutions a case in 2002 in which an epileptic bus driver slammed into a tree, killing himself and three of his passengers. ANZAN says this referral to the DPP concerns the actions of a specialist doctor who had been treating the bus driver, and who certified him fit to drive.
According to Beran, this has raised some serious alarm bells in the medical profession. ‘‘ Doctors are scared,’’ he says. ‘‘ If action against a colleague who acted in good faith succeeds, then I don’t think any doctor would be prepared to assess fitness to drive.’’
The NTC has the unenviable task of considering these and other issues as part of its review of the national guidelines on assessing fitness to drive. While it’s not due to report until next year, an interim review found there were complex unresolved issues surrounding medical driver assessments and is seeking legal advice.
The review also called for the lack of a national approach to driver assessment to be addressed. But this could well be wishful thinking. Each jurisdiction has its own approach and the NTC has no power to force the states to comply.
Options for assessing driver competence differ across the country, and for elderly drivers the rules are many and varied.
In NSW for example, once you hit 80 you need a medical assessment to assess your fitness. In SA you are medically assessed at age 70, and in Victoria there is no age limit.
The NTC says there doesn’t seem to be any real will to address these inconsistencies, despite predictions from the Victorian Parliament’s Inquiry into Road Safety for Older Road Users of a marked increase in death and injury due to the ageing population.
One thing the states do appear to have in common is a lacklustre performance on educating drivers about their responsibilities.
Some patient groups, such as Alzheimer’s Australia, offer information on driving responsibilities (national helpline 1800 100 500), but proactive information coming from licensing authorities is limited.
In Beran’s study, three-quarters of neurologists believe displaying prominent warnings on drivers’ licences would help.
Geriatrician Mark Yates acknowledges the tough call neurologists must make, given the difficulty of assessing risk for epileptic drivers. However, he makes judgments on patients because there aren’t enough resources to refer every patient with a mild memory problem for outside assessment, costing up to $500 in the private sector.
‘‘ The relationship with patients can become fraught,’’ he agrees. ‘‘ This is a major, major decision and has enormous psychological and social impact on the patient you are treating. It is an absolute no-win.’’
Adelaide GP David Tye, however, accuses neurologists of being ‘‘ wimps’’. Tye, who helped devise the National Transport Commission’s current fitness-to-drive guidelines, agrees that deciding if someone should drive can be tough. But, he says, doctors who really don’t want to can suggest a second opinion. ‘‘ We all torment ourselves at times, but ultimately we are the best people to judge.’’
There may be scope for a national solution, however, in a model currently operating in Victoria, where expert medical panels review difficult driving assessment cases. The scheme runs through the Victorian Institute of Forensic Medicine, which contracts its services to VicRoads and reviews about 6000 files a year.
The institute’s head of clinical forensic medicine, associate professor David Wells, says anyone can refer a case — police, concerned family members, and doctors.
‘‘ These concerns [raised by neurologists] are absolutely legitimate,’’ he says. ‘‘ People can be highly motivated not to tell their doctor the whole truth [about their health].’’
The beauty of the Victorian system, he says, is that the expert panels have access to information that treating doctors don’t, such as driving records. And doctors can step back from the process and keep the trust of their patients. This model is being considered by the NTC and is supported by Austroads, the national peak body for road transport and traffic authorities.
But there’s no guarantee all states will agree to replicate the system, particularly since it is likely to cost them money.