Ophthalmic education, Practice management, Report

Assessing fitness to drive – responsibly

When an eyecare professional breaks news to a patient about their fitness to drive, it can be difficult, but the practitioner needs to understand their obligations, writes Karen Crouch.

An interesting case recently addressed in the Queensland Coroner’s court involved a 60-year-old veering off the road while driving his Landcruiser, colliding with gas bottles at the rear of a café which caused a fatal explosion, killing two and injuring 19 people inside the restaurant.

Karen Crouch. Image: Karen Crouch.

“A doctor’s reporting obligations with patients’ fitness to drive is discretionary in all jurisdictions except South Australia and the Northern Territory.”

The driver had a history of epileptic seizures for a decade and had been admitted to hospital on three occasions for mental health assessment. He was advised by hospital doctors not to drive and was referred to his GP for follow-up care.

The court found that while all doctors have a clearly defined duty to their patient, they have a less clearly defined duty to act in the public interest, to ensure public safety. In this case, the coroner declared the patient-doctor relationship is defined by trust and doctors have an ethical and legal responsibility to preserve patient confidentiality. Consequently, the coroner did not recommend a mandatory duty on doctors to notify the transport department.

Such cases being to light the grey areas that exist around fitness to drive obligations in Australia. Nevertheless, there are several matters eyecare providers, in particular, need to be aware of.

As Australia’s population ages, so does the rise in motor accident rates, so it is timely to review this sensitive, sometimes life threatening, situation. Understandably, older people strive for independence and are keen to retain their driving licences, sometimes posing a potential risk to other unsuspecting drivers. Some older drivers, in a conscientious effort to ensure safe driving conditions, restrict their driving habits to daylight hours, while others limit the time or distance they are at the wheel.

However, as we age, health challenges may affect one’s ability to drive safely. To ensure the safety of other drivers and pedestrians, it is important elderly drivers regularly and honestly monitor their health and general ability to drive responsibly. Older drivers may also find it difficult to handle challenges of increasing road rage. Drivers who express road rage generally take greater risks, harbour more hostile, aggressive thoughts, and demonstrate more anxiety and impulsiveness, which poses a challenge to older drivers whose reaction times may not be sufficiently responsive.

Health professionals, including, GPs, specialists, optometrists, ophthalmologists and allied health professionals, should regularly review fitness levels of elderly patients to assess their ability to drive, particularly in light of an increasingly ageing population. If it is apparent a patient has a condition that may affect their ability to drive, the attending health professional should inform them of the potential impact of their driving efficiency on the lives of others. Healthcare providers should be ever alert to underlying health conditions older patients may suffer, including diseases like age-related macular degeneration, cataract, glaucoma, diabetic retinopathy, sleep disorders, neurological disorders and heart disease.

Each state in Australia has specific regulations for assessing older Australians’ ability to drive. In all states and territories, vehicle licence holders have a statutory obligation to report any health conditions that may adversely affect a their ability to drive safely. In some circumstances wherein a patient/driver may be incapable of understanding – regardless of practitioner advice – and decides to continue driving, a health professional should consider reporting the matter to the relevant state transport authority. Of course, such action may negatively impact the ongoing practitioner-patient relationship, so the practitioner should address the situation appropriately.

A doctor’s reporting obligations with patients’ fitness to drive is discretionary in all jurisdictions except South Australia and the Northern Territory, where doctors have mandatory reporting obligations.

As a suggested starting point, it is advisable for a practitioner to advise a patient/driver who is deemed to be ‘unfit-to-drive’ of their obligation to report the matter to local state transport authorities. Naturally, health professionals should be aware of their responsibilities under relevant State Road Transport Acts.

Admittedly, these obligations involve careful consideration and exercise of discretion in adopting the most appropriate course of action. Health practitioners have two conflicting responsibilities that must be weighed against each other:

• duty to protect confidentiality of information collected from a patient; and;

• duty to protect third persons and/or the public from potential danger (and subsequent injury) that may be created as a result of a patient’s condition while driving.

It is advisable that health practitioners who – having counselled a patient appropriately and recommended they report an impairment to the local state transport agency – become aware when the patient has not done so, and report the matter themselves.

Assessing Fitness to Drive 2022 contains Health standards for licensing and Clinical Management guidelines.

About the author: Karen Crouch is Managing Director of Health Practice Creations Group, a company that assists practices with set ups, administrative, legal and financial management. Contact e-mail: kcrouch@hpcnsw.com.au or visit: www.hpcgroup.com.au

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