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Doctors Rarely Report Patients Who Shouldn't Be Driving to Licensing Bodies

Posted on: Monday, 11 February 2008, 21:00 CST

By Helen Branswell, Medical Reporter, THE CANADIAN PRESS

TORONTO - Doctors in Ontario are failing to report patients who may be medically unfit to drive, even though provincial law requires them to do so, according to a study published Monday.

"The conclusion from our article is that the mandatory reporting laws do not achieve their intended purpose," said lead author Dr. Donald Redelmeier, director of clinical epidemiology at Toronto's Sunnybrook Health Sciences Centre and a senior scientist at the Institute for Clinical Evaluative Sciences.

Seven provinces and the three territories have laws requiring doctors to notify licensing authorities if a patient who drives develops one of a series of medical conditions which might make them unfit to drive. Depending on the illness, a licensing authority may require a driver to take a driving test, though some could trigger virtually automatic suspension of driving privileges.

In Nova Scotia and Quebec, reporting is left up to the discretion of the doctor. Alberta is the sole province where legislation doesn't address the reporting of drivers' medical conditions by doctors, Redelmeier said.

While this study is based on data from Ontario, he said the findings probably hold true in other provinces as well.

"I think chronic diseases are prevalent all over the nation," Redelmeier said.

"And there's no reason to believe that (for) alcoholism or cardiac disorders or neurological disease that Ontario is a hotbed of such illnesses. Nor is there a reason to believe that the roadways in Atlantic Canada or the Prairies are much safer than they are right now in central parts of Canada."

Published in the journal Open Medicine, the study looked at the medical records of 1,605 drivers brought to Sunnybrook for care after they had been involved in a motor vehicle collision. The hospital has Canada's largest trauma facility and cares for seriously injured patients from across Ontario.

The patients studied were brought to the hospital between June 30, 1996 and June 30, 2001.

If the attending trauma surgeon determined that one of three reportable medical conditions may have played a role in the accident, the researchers studied the medical records of the patient for previous health care visits and diagnoses.

The three conditions were alcohol abuse, neurological disorders such as dementia and certain cardiovascular conditions or procedures. The Ontario law lists additional reportable conditions, including sleep disorders and vision and hearing disabilities, but they were not included in the study.

More than one third - 37 per cent - of the patients had a reportable condition, but only three per cent had been reported to the provincial licensing authority.

Alcohol abuse was the most common of the reportable conditions in these patients; 72 per cent of those with a reportable condition had this diagnosis. But it was the least commonly reported of the three conditions.

Previous studies have suggested doctors are reluctant to report patients who may be unfit to drive, worrying that it may negatively affect the physician-patient relationship.

Dr. Ruth Wilson, president of the College of Family Physicians of Canada, admitted it is tough to tell a patient it's time to permanently hang up the car keys.

"It's a very difficult conversation to have to say that 'I'm going to have to report you as being medically unfit to drive,"' Wilson said from Kingston, Ont., where she practises.

"So much of the medicine we're able to do in a preventive way depends on the relationship. So we would far rather want to maintain the relationship and be able to work with the patient on improving their medical condition. And somehow reporting them does seem to interfere with that."

Redelmeier said some doctors insist that people who are unfit to drive neglect their health and rarely seek medical care. Therefore, the argument continues, people who are seeing a doctor regularly probably aren't the drivers who need to be taken off the road.

"They say: 'Well, you know, there are a lot of bad drivers out there but they're not in my practice,"' he noted.

But in the analysis, the researchers found that wasn't the case. Most of the drivers - 85 per cent - had seen a doctor in the year preceding their crash. In fact, 14 per cent had seen a doctor in the week leading up to the accident.

In the five years prior to their accidents, the 596 drivers who had reportable conditions had seen doctors a total of 20,505 times. That's an average of 34 times apiece over five years or nearly seven doctor visits a year each.

"Our main finding is that almost all of these drivers had previously seen a physician. So just because they're neglecting their driving does not mean they're neglecting their health," Redelmeier said.

"There's a huge missed opportunity to make our roads safer."

A commentary written by Dr. Shawn Marshall of the University of Ottawa's department of epidemiology and community medicine suggested it is difficult for doctors to know when to intervene.

"At the level of the individual patient, it remains challenging to assess the impact of a particular condition on driving ability," said Marshall, who is a lead investigator on CanDRIVE, an interdisciplinary research program aimed at improving the safety of older drivers.

"As the present researchers and others point out, continuing barriers to physician reporting include the lack of valid tools for physicians to use in determining medical fitness to drive."

Source: Canadian Press

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