“Well, Mr Terry I have some bad news. The results of your tests shows me that it is no longer safe for you to drive.”
“But why, young whipper snipper, you don’t understand, I’ve been driving since before you were born……”
One of the harder things I have do as a GP is to tells someone that they should no longer drive and they need to hand in their license. I have lost a few patients along the way because we have disagreed on their ability or competency. Generally during a consultation, I consider the patient before me, and sometimes their family. But in this situation, I have a responsibility to consider the wide community. In fact, you also have this responsibility as the F3172 form you gave me to sign for your drive medical stipulates.
“If you hold a Queensland driver licence, or are applying for a Queensland driver licence, you have a legal obligation to notify the department as soon as you become aware of any permanent, or long-term medical condition that is likely to adversely affect your ability to drive safely. “
Driving gives us freedom, flexibility and independence but Driving is a privilege not a right. Here is sobering review from the Victorian Coroner on why this part of my job so important and why I should not to be swayed by desire to keep the you happy.
The rule book I use is the Assessing Fitness to Drive handbook.
Some of these rules are black and white. You can’t drive if you can’t see the third line or 6/24 on the Snellen eye chart even with spectacles.
Other rules seem sensible. For example you cannot drive for 2 weeks after a heart attack, which will be extended to 4 weeks if you needed your chest opened for a coronary bypass graft. If you had a cardiac arrest you cannot drive for 6 months and if you have had an epileptic seizure then in general it is no driving for 12 months. Some decisions may need to involve specialist doctors.
Driving and aging
As you get older, how you process information, your vision, and your ability to move changes.
- change focus and see detail such as traffic signs
- see objects and obstacles such as pedestrians or cyclists
- deal with and recover from glare such as oncoming headlights or the afternoon sun
- see things in your peripheral vision
- adjust your vision when going from light to dark or vice versa
Medical conditions such as cataracts, glaucoma and diabetes can also affect your vision.
- muscle strength and speed
- flexibility and mobility
- range of movement
These changes, plus health problems like arthritis, can affect the way you drive. For example, you may find it harder to turn the steering wheel, change gears or jump on the brake in an emergency.
Consider these challenges,
- driving at peak hour
- merging onto a busy freeway
- changing lanes in traffic
- travelling an unfamiliar route
- dealing with a busy intersection or roundabout.
- visuospatial perception (depth perception)
- insight and judgement
- attention and concentration
- reaction time
Hearing impairment, although recognised as not as critical, can be a hindrance to driving safely.
Not all elderly people have dementia. Dementia is characterised by significant loss of cognitive abilities such as memory capacity, psychomotor abilities, attention, visuospatial functions, insight and executive functions. Some of the tests used to help with screening impaired cognition include the Mini mental State Exam (MMSE) or the Montreal Cognitive Assessment (MoCA), Trial A and B test, General Practitioner assessment of Cognition (GPCOG), the clock drawing test and taking history from family and friends.
Dementia may affect driving ability in a number of ways including:
- errors with navigation, including forgetting routes and getting lost in familiar surroundings
- limited concentration or ‘gaps’ in attention, such as failing to see or respond to ‘stop’ signs
- errors in judgement, including misjudging the distance between cars and misjudging the speed of other cars
- confusion when making choices, for example, difficulty choosing between the accelerator or brake pedals in stressful situations
- poor decision making or problem solving, including failure to give way appropriately at intersections and inappropriate stopping in traffic
- poor insight and denial of deficits
- slowed reaction time, including failure to respond in a timely fashion to instructions from passengers
- poor hand–eye coordination.
In some instances, it may remain safe for to drive with limitations placed, such as within a certain distance or home or during daytime hours. Having a passenger may not help.
Some people may benefit from having an Occupational Therapist assess driving skill. I have had to do this on a number of occasions usually to prove to someone that they indeed are no longer safe to drive. An OT assessment may not be cheap but it does test practical skills that I am not able to do in the consulting room. The major drawback of an OT assessment is the cost involved which may be several hundred dollars. Dementia Australia has several resources which may be useful.
Currently, in Queensland I am not mandated to report a medically unsafe driver, but in general I will. This may change as in South Australia I had to. Of course, I’m not able to take your car keys off you, but if you continue to drive despite a notification, it is illegal and your insurance will not be valid. As your doctor I am provided protection under legislation when giving information in good faith to the department about your fitness to drive.
Options may include walking, public transport, community buses, taxis, family and friends. Importantly, mobility scooters may not be the solution; they offer much less protection in the event of a collision with a car.
If you would like to listen to a podcast on this subject check out the GP Show.
RACV has a useful summary for older drivers.
Age or health related medical examinations to obtain or renew a licence to drive a private motor vehicle are eligible for a Medicare rebate, whilst a commercial license examination is not.
If you think a motorised wheelchair or mobility scooter may be an alternative you should first read the regulations for these. “In all cases, the person in control of the motorised wheelchair must be capable to safely operate the motorised wheelchair.” But this is self determine as a “medical certificates are no longer a requirement for getting your motorised wheelchair registered.”