Agony in li­cence for the un­fit

The Weekend Australian - Travel - - Health -

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.

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