The road to fitness-to-drive assessment reform is long, but the AMA has returned with new objectives.
A standardised, evidence-based tool to assess fitness to drive is essential for GPs moving forward, the AMA has told the National Transport Commission.
In all, there are six changes that the association wants to see put in place.
AMA vice president Associate Professor Julian Rait told The Medical Republic that the focus on medico-legal risks and evidence-based assessment tools was something “we’ve long been calling for”.
“Clinicians are expected to make high-stakes decisions affecting both public safety and individual liberty, often without access to the assessment services, referral pathways or implementation supports needed to make those decisions with confidence,” the report read.
The central objective? A nationally consistent fitness-to-drive assessment framework.
This would steer the conversation away from practitioners’ personal judgements and toward transparent discussions grounded solely in clinical guidance.
But the AMA said a “technically sound standard” could only extend as far as its consistent applicability in clinical practice.
Among the greatest challenges is assessing cognitive impairment, such as dementia or neurocognitive disorders, due to their murky clinical thresholds and “considerable uncertainty”, unlike those for conditions such as diabetes, epilepsy and visual impairment.
Patients with cognitive impairments may have limited insight into their driving, conflicting family reports, and variable functional capacity over time and across environments, according to the report.
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Assessment tools such as the General Practitioner Assessment of Cognition and the Standardised Mini-Mental State Examination weren’t designed to evaluate driving ability, necessitating investigation into other evidence-based tools, the report read.
The AMA firmly opposed replacing clinical judgement with a technological solution. However, Professor Rait said simulators could be deployed in clinical settings.
But it said an evidence-based standard would have little value if patients cannot readily access the required assessments, due to delays in occupational therapy driving assessments or on-road testing and a limited cohort to undertake these assessments.
“The consequences of losing a licence are not experienced equally across Australia… In rural and remote communities, licence loss can affect access to healthcare, employment, education and community participation,” the report reads.
In a submission to a previous consultation in 2020, the AMA raised concerns about the fitness-to-drive assessment’s complexity, access to specialist services, decision-making consistency, and the implementation burden.
The potential impact on GP-patient therapeutic relationships, including conflict, complaints, patient disengagement from continuity of care, and deterioration of trust, remains the most overlooked consequence, the report read.
As an ophthalmologist, Professor Rait said that responsibility must be shared in tense situations where conflict may arise by engaging other practitioners in the decision-making process to ensure a consistent professional opinion.
“I think it’s always reassuring to say to a patient, ‘Why don’t we get, you know, someone else’s point of view?’ If there’s a second or third opinion needed to reassure someone, at least responsibility is not burdened on one individual’s shoulders,” he said.
The AMA also called for improved education and training, clearer pathways for escalation and referral, and greater support for practitioners managing complex cases.
“There is provision in most jurisdictions as well, for the doctors particularly concerned to directly notify the authorities if someone’s posed a particular risk,” Professor Rait said.
He said further drafts and consultations will continue until July next year, with a final position expected shortly after.
Submissions to the National Transport Commission closed on Friday 17 July.
