Unfit Drivers Research Articles

Physicians' warnings for unfit drivers and risk of road crashes.

Physicians' warnings for unfit drivers and risk of road crashes.

Multidisciplinary Assessment and Reporting of Fitness to Drive in Brain Tumor Patients: A Gray Matter

In some jurisdictions, there is a legal requirement for physicians to report medically unfit drivers. The objective of this study is to determine physician knowledge and attitudes on reporting legislation and driving assessment and to evaluate clinical decision-making with respect to fitness to drive in brain tumor patients.

Physicians' Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes

BackgroundPhysicians' warnings to patients who are potentially unfit to drive are a medical intervention intended to prevent trauma from motor vehicle crashes. We assessed the association between medical warnings and the risk of subsequent road crashes.MethodsWe identified consecutive patients who received a medical warning in Ontario, Canada, between April 1, 2006, and December 31, 2009, from a physician who judged them to be potentially unfit to drive. We excluded patients who were younger than 18 years of age, who were not residents of Ontario, or who lacked valid health-card numbers under universal health insurance. We analyzed emergency department visits for road crashes during a baseline interval before the warning and a subsequent interval after the warning.ResultsA total of 100,075 patients received a medical warning from a total of 6098 physicians. During the 3-year baseline interval, there were 1430 road crashes in which the patient was a driver and presented to the emergency department, as compared with 273 road crashes during the 1-year subsequent interval, representing a reduction of approximately 45% in the annual rate of crashes per 1000 patients after the warning (4.76 vs. 2.73, P<0.001). The lower rate was observed across patients with diverse characteristics. No significant change was observed in subsequent crashes in which patients were pedestrians or passengers. Medical warnings were associated with an increase in subsequent emergency department visits for depression and a decrease in return visits to the responsible physician.ConclusionsPhysicians' warnings to patients who are potentially unfit to drive may contribute to a decrease in subsequent trauma from road crashes, yet they may also exacerbate mood disorders and compromise the doctor–patient relationship. (Funded by the Canada Research Chairs program and others.)

Fitness to Drive in Patients with Brain Tumours: The Influence of Mandatory Reporting Legislation on Radiation Oncologists in Canada

Certain jurisdictions in Canada legally require that physicians report unfit drivers. Physician attitudes and patterns of practice have yet to be evaluated in Canada for patients with brain tumours. We conducted a survey of 97 radiation oncologists, eliciting demographics, knowledge of reporting laws, and attitudes on reporting guidelines for unfit drivers. Eight scenarios with varying disability levels were presented to determine the likelihood of a patient being reported as unfit to drive. Statistical comparisons were made using the Fisher exact test. Of physicians approached, 99% responded, and 97 physicians participated. Most respondents (87%) felt that laws in their province governing the reporting of medically unfit drivers were unclear. Of the responding physicians, 23 (24%) were unable to correctly identify whether their province had mandatory reporting legislation. Physicians from provinces without mandatory reporting legislation were significantly less likely to consider reporting patients to provincial authorities (p = 0.001), and for all clinical scenarios, the likelihood of reporting significantly depended on the physician's provincial legal obligations. The presence of provincial legislation is of primary importance in determining whether physicians will report brain tumour patients to drivers' licensing authorities. In Canada, clear guidelines have to be developed to help in the assessment of whether brain tumour patients should drive.

Multidisciplinary assessment and reporting of fitness to drive in brain tumor patients: A gray matter.

6130 Background: In some jurisdictions, there is a legal requirement for physicians to report medically unfit drivers. Objectives of this study are to determine physician knowledge and attitudes on reporting legislation and driving assessment, and review our institution’s experience in evaluating fitness to drive in brain tumour patients. Methods: Physicians caring for brain tumour patients in South-western Ontario were identified by public databases and surveyed by mail. Survey questions elicited demographics, opinions, and factors influencing the decision to report. Patients receiving brain radiotherapy at our institution between January and June 2009 were identified and details of driving assessment were extracted. Fisher’s exact test and a logistic regression model were used to determine differences in responses between specialists and family physicians and factors influencing reporting. Results: Surveys (n=467) were distributed with 198 (43%) responses. Most (76%) felt that reporting guidelines were unclear. Neurologists (43%) and Family Physicians (22%) were felt to be the most responsible to report unfit drivers. Compared to specialists, Family Physicians were less likely: to be comfortable with reporting (p=0.02), to consider reporting (p&lt;0.001), or discuss the implications of driving (p&lt;0.001). Perceived barriers in assessing fitness to drive included: lack of tools to assess (57%) and the impact on the patient-physician relationship (34%). 158 patients were retrospectively reviewed. Forty-eight patients (30%) were reported to the provincial licensing authority and 64 (41%) were advised not to drive. 53 patients experienced seizures, of which 36 (68%) had a documented discussion on driving. Only 30 (56%) of these patients were reported to the licensing authority despite legal requirements. Age, primary disease, previous neurosurgery and seizures were predictive of reporting (p&lt;0.05). On logistic regression modeling, seizures (OR 12.4) and primary CNS disease (OR 15.5) remained predictive of reporting. Conclusions: Despite guidelines and laws, the assessment of fitness to drive in patients with brain tumours is not routinely conducted or documented in a multidisciplinary setting.

Physicians’ knowledge and continuing medical education regarding fitness to drive: a questionnaire-based survey in Southeast Switzerland

Valid information for physicians in Switzerland concerning knowledge and continuing education in traffic medicine is not available. Also, their attitude to the legally prescribed periodic driving fitness examinations is unclear. In order to gain more information about these topics, 635 resident physicians in Southeast Switzerland were sent a questionnaire (response rate 52%). In a self-estimation, 79% of the queried physicians claimed to know the minimal medical requirements for drivers which are important in their specialty. Statistically significant differences existed between the specialties, whereby general practitioners most frequently claimed to know the minimal medical requirements (90%). It appears that the minimal medical requirements for drivers are well known to the queried physicians. Fifty-two percent of the physicians favored an expansion of continuing education in traffic medicine. Such an expansion was desired to a lesser extent by physicians without knowledge of the minimal requirements (p < 0.001). A clear majority of the medical professionals adjudged the legally prescribed periodic driving fitness examinations as being an expedient means to identify unfit drivers. A national standardized form for reporting potentially unfit drivers to the licensing authorities was supported by 68% of the responding physicians. Such a form could simplify and standardize the reports to the licensing authorities.

Discretionary medical reporting of potentially unfit drivers: a questionnaire-based survey in Southeast Switzerland

In Switzerland, every physician has the right to report a patient that is potentially unfit to drive to the licensing authority without violating medical confidentiality. Verified information regarding physicians' attitudes concerning this discretionary reporting and the frequency of such reports are not available. In order to answer these questions, 635 resident physicians were sent a questionnaire. The response rate was 52%. On average, the responding physicians--for all specialties--reported 0.31 patients (SD 0.64, 95% CI 0.24-0.38) in the year before the survey and 1.00 patient (SD 1.74, 95% CI 0.81-1.20) in the past 5 years. Seventy-nine percent of the responding physicians indicated knowing the current legal requirements for driving in Switzerland. In applied logistic regression analysis, only two factors correlate significantly with reporting: male sex (odds ratio 5.4) and the specialty "general medicine" (odds ratio 3.4). Ninety-seven percent of the physicians were against abolishing medical discretionary reporting and 29% were in favor of introducing mandatory reporting. The great majority of the questioned physicians supported the discretionary reporting of drivers that are potentially unfit to drive as currently practiced in Switzerland. The importance and the necessity of a regular traffic medicine-related continuing education for medical professionals are shown by the low number of reports per physician.

The American Medical Association Older Driver Curriculum for Health Professionals: Changes in Trainee Confidence, Attitudes, and Practice Behavior

Few gerontology and geriatrics professionals receive training in driver fitness evaluation, state reporting of unfit drivers, or transportation mobility planning yet are often asked to address these concerns in the provision of care to older adults. The American Medical Association (AMA) developed an evidence-based, multi-media Curriculum to promote basic competences. This study evaluated reported changes in practice behaviors 3 months posttraining in 693 professionals trained via the AMA approach. Eight Teaching Teams, designated and trained by AMA staff, offered 22 training sessions across the United States in 2006 to 2007. Trainees (67% female; mean age 46) completed a pretest questionnaire and a posttest administered by mail. Physicians were the largest professional group (32%). Although many trainees acknowledged having conversations with patients about driving at pretest, few endorsed utilizing specific techniques recommended by the AMA prior to this training. The posttest response rate was 34% (n = 235). Significant improvements in reported attitudes, confidence, and practices were found across measured items. In particular, posttest data indicated new adoption of in-office screening techniques, chart documentation of driver safety concerns, and transportation alternative planning strategies. Findings suggest that a well-designed, one-time continuing education intervention can enhance health professional confidence and clinical practice concerning driver fitness evaluation and mobility planning. Targeted dissemination of this Curriculum (in-person and online) will allow more to benefit in the future.

Licensing Authorities' Options for Managing Older Driver Safety—Practical Advice from the Researchers: Commentary

The authors present an overview of the Licensing Authorities Workshop, which dealt with safety concerns for the older driver and what can or should be done about them. Five key questions were posed at the workshop: 1) Due to medical conditions and subsequent driving-related ability deterioration, are there greater crash risks among older drivers? 2) Which older driver groups do licensing authorities need to specially manage? 3) How can those older drivers needing special management be best identified by licensing authorities? Are acceptable predictive powers for at-risk older drivers available in any assessment options? 4) How can potentially unfit older drivers be best dealt with by licensing authorities? and 5) When there is disagreement among research studies as to what is effective, what policies should licensing authorities follow?

Sleep apnoea and driving: how can this be dealt with?

Excessive daytime sleepiness has long been known to be associated with an increased risk of often particularly severe traffic accidents. Obstructive sleep apnoea (OSA) is among the most prevalent conditions leading to excessive daytime sleepiness, in addition to impaired cognitive function, both of which are likely to impair driving ability.An increased risk of traffic accidents has been demonstrated repeatedly, in association with OSA, as well its normalisation with effective treatment. However, it seems that not all patients are at equal risk, but it is not clear how to identify when and how at-risk patients can be identified.Nevertheless, some European countries have made specific regulations concerning OSA and/or excessive daytime sleepiness and the capacity to obtain or to keep a driving license. Most countries have the general rule that “a driving license should not be given or renewed to any candidate or license holder suffering from a disorder … likely to compromise safety on the road”, without a specific mention of sleepiness and/or sleep apnoea. However, the way in which such a statement is applied and the measures taken to identify unfit drivers vary greatly from country to country. In addition, in those countries that have made specific regulations, no evaluation of their efficacy in reducing sleepiness-related accidents is available.In practice, it is the physician's responsibility to inform the untreated obstructive sleep apnoea patient about the risk associated with their condition, and about the regulations that prevail in their country, if relevant; only in a few countries, is the physician allowed (or compelled) to report the unfit patient to the licensing authorities. Although it is generally accepted that the treated patient may be allowed to drive, the specific treatment conditions that eliminate the risk are not clearly established.

Mandated Reporting of Medically Unfit Drivers: How Reporting and Non-reporting Physicians Differ

Mandated Reporting of Medically Unfit Drivers: How Reporting and Non-reporting Physicians Differ

A Brief Look at Driver License Renewal Policies in the United States

Driver license renewal policies in the United States vary from state to state in terms of the length of the renewal cycle, requirements for accelerated renewal for older drivers, and other renewal provisions. This article briefly outlines some of these state-to-state differences and comments on the impact of those differences, particularly for senior citizens. The authors note that 17 states have special renewal provisions for older drivers, including requirements for in-person renewal, vision tests, or other testing or certification (e.g., written and road tests). Few states require physician or other professional reporting of unfit drivers to licensing agencies, although many encourage physician reporting or at least do not forbid it. Based on the outcomes of these special renewal provisions for older drivers, as well as other information available to licensing agencies, agency personnel have several choices: allow the driver to keep his or her license, refuse to renew the license or suspend, revoke or restrict the license (e.g., prohibit night driving), or shorten the renewal cycle. The article concludes by commenting on the lack of research data about how well these policies are doing in reducing crash-related injuries and deaths, particularly among older drivers. This lack of data on the effectiveness of specific renewal provisions, coupled with the expenses of additional testing and review, may explain the variations in policies in different states.

Predicting Practical Fitness to Drive in Drivers With Visual Field Defects Caused by Ocular Pathology

Vision, viewing efficiency, visual attention, and on-road driving performance were assessed in 100 participants with central and/or peripheral visual field defects caused by ocular pathology. Driving was evaluated by the Dutch driving license authority making use of the protocol for investigating practical fitness to drive. A smaller percentage of participants with central visual field defects passed the on-road driving test, in comparison with participants with peripheral or mild field defects. The predictive power of a model based on the current vision requirements for driving significantly increased when taking compensatory viewing efficiency into account. The results of the latter model were comparable to those of a model based on tests of visual attention and contrast sensitivity. Despite the increased explained variance of practical fitness to drive when taking higher-order visual functions into account, sensitivity and specificity remained quite low, limiting the use of these tests in identifying unfit drivers. Actual or potential applications of this research include the development of training programs to improve practical fitness to drive in drivers with visual field defects.

Instrumented Vehicles and Driving Simulators

Judgments on fitness to drive in older drivers should rely upon empirical observations of performance, because decisions based on age alone may unfairly deny patients their mobility or unwisely authorize licensure in unfit older drivers. Instrumented vehicles permit quantitative assessments of driver performance in the field, under actual road conditions. These measurements are not subject to the type of human bias that affects inter-rater reliability on a standard road test. Moreover, the internal network of modern vehicles makes it possible to obtain information from the driver's own automobile, providing an unprecedented window on driver strategy, vehicle usage, upkeep, drive lengths, route choices, and decision-making. Driving simulators make it possible to observe driver errors with optimal stimulus and response control in an environment that is challenging yet safe for the driver and tester, without the risk of driving on the road. Together, instrumented vehicles and driving simulators can provide a wealth of complementary information relevant to predictive models of driver safety, fair and accurate criteria for driver licensure, and effective injury prevention countermeasures in at-risk older drivers.

A survey of general practitioners' attitudes to older drivers on the New South Wales Central Coast

Objective: To investigate the attitudes of General Practitioners to older drivers on the New South Wales Central Coast.Method: Postal survey.Results: 275 General Practitioners (GP's) were surveyed, with a response rate of 173 (63%). 61% of GP's allowed an older driver with mild Alzheimer's disease to still drive a motor vehicle. 21% of GP's would allow the frail, medically unfit driver to still drive with a restricted licence locally if there was no public transport near by. Only 41% of GP's thought they had enough training to make an appropriate medical driver assessments. Only 29% of GP's routinely asked about driving habits and medical fitness to drive in all of their older patients. 55% of GP's felt that there should be another medical body to oversee all medical driver assessments rather than the GP.Conclusions: These survey results suggest that not all GP's are aware of the regulations for medical driver assessments, are not routinely screening older drivers, are not adequately trained in medical driver assessments, allowing medically unfit drivers to continue to drive, are concerned about the consequences of cancelling an older driver's licence and are unhappy in dealing with these issues.

Fitness standards for the transport industries.

The fitness standards required for drivers in the transport industries are discussed. Ways of reducing the risks imposed by unfit drivers and pilots range from automatic safety systems to the use of a copilot trained to spot signs of unfitness. The risk of sudden cardiac event has long been a cause for concern although there are no quantitative data identifying the frequency of attributable transport accidents. For airline pilot fitness a risk of less than 1% of a fatal event in the subsequent year is considered acceptable in the presence of a copilot. The risk ceiling is 20% annually for car drivers and 2% for bus and lorry drivers. The risk of hypoglycaemia from diabletes is more complex to assess. Sight defects correctable by the use of glasses are not considered a problem but useful field of view should be checked. Other stable vision impairments may be assessed using practical driving tests under controlled conditions. The risks from variable impairments such as alcohol and fatigue are discussed. The development of common criteria across transport modes is considered.

Psychotechnology and insanity at the wheel.

The article discusses psychological testing of automobile drivers performed by the Psychopathic Clinic affiliated with the Traffic Court of the Detroit Recorder's Court. Between 1936 and 1965 more than 15,000 drivers who had either run afoul of the traffic codes or been involved in a traffic collision. A statistical analysis of these cases reveals that the psychologists and psychiatrists working at the clinic were reinforcing existing ethnic, racial, and gender stereotypes in their pursuit of traffic safety. Patients who were deemed unfit drivers were recommended to the judges for sanctions ranging from license revokations to forced committment.

Reporting Unfit Drivers

Reporting Unfit Drivers

Reporting Unfit Drivers

Reporting Unfit Drivers