Fitness to drive assessment

Fitness to drive assessment is always difficult. Patients usually walk in with a smile asking you for a fitness to drive assessment. If you fail them, they become very angry and you and your patient's relationship can turn 360 just in 5 minutes. 

However, we do have the obligation to protect the community against incompetent drivers. There is a check program in 2012 dedicated to fitness to drive.

Should you allow a person with dementia to drive?

The diagnosis of dementia does not equal to a immediate ban to driving. It will depend on the severity of dementia. Most of them will have to give up driving in the near future. For those who are still at the very early stage, careful physical examination and referral to a fitness to drive by an OT is required. 

How about people with mental health illness?

People with mental health illness (especially schizophrenia, bipolar, depression and substance abuse) are at higher risks of involving in car accidents compared to the normal population. People with bipolar may not be suitable to drive a commercial vehicle and requires careful assessment before granting the permission to drive a private vehicle. 

How often do you need to review diabetics in regards to fitness to drive assessment?

Diabetics who are on diet alone treatment may be eligible for an unrestricted licence. 

Diabetics who are on oral hypoglycaemic agents may require 5 yearly review with a notification to DLA. 

Diabetics who are on insulin may require 2 yearly review with a notification to DLA. 

What should you do after a hypoglycaemic event?

The person should not drive for 6 weeks and may require a specialist opinion. 

Why is assessing elderly people for fitness to drive is difficult and how would you tackle those difficulties ?

Multiple medical co-morbidities, aged related changes leading to slow reaction time, poor mobility, hearing impairment and impaired vision. 

In country area, they often rely on their licence to shop and visit friends. Removing their licences may increase their social isolation. As pedestrians, they also have at high risks of getting hit by cars. 

Other management options: taxi card, get family members to drive them and conditional licence to drive within 5km radius. 

Here is the summary key points to help GPs in assessing patients fitness to drive:

References:

1. RACGP Check program 2012 fitness to drive.