This can be an area fraught with risks and challenges. See what an expert has to say.
In 2024, 1300 people died on Australian roads in what was the deadliest year in more than a decade.
It was also the fourth consecutive year that road fatalities had risen, a trend not observed in Australia for more than 50 years.
The toll far exceeds the National Road Safety Strategy 2021-2030, which is aiming for annual deaths to fall to 571 by the end of the decade.
Healthcare professionals have an important role to play in ensuring drivers are medically fit to drive regardless of their age. The responsibility often falls to GPs and specialists, in particular neurologists, psychiatrists and sleep physicians.
Assessing fitness to drive can be both challenging and problematic in general and specialty practices alike.
In fact the issue accounts for a high volume of calls to Miga, says Anthony Mennillo, the medical indemnity insurance and services provider’s Head of Claims and Legal Services.
“I think most GPs are aware of the importance of this assessment but there are some difficult situations that can arise. Quite often it’s a patient who comes in for the first time to see a GP for a driver’s assessment,” he says.
“So that’s the first ever consult and that may be a deliberate plan by the patient to avoid their usual treating doctor, who perhaps won’t sign the documentation clearing them to drive.
“They might think seeing another GP where they can control the information the GP has to assess their fitness to drive might result in a sign off on the driving assessment that they otherwise would not have.”
Mr Mennillo says some doctors will choose not to do the assessment if they don’t know the patient or their full medical history or may take a thorough patient history and complete the appropriate examinations and still deem the patient unfit. This can be a difficult situation.
“When they decline to do it, doctors can be faced with an abusive patient who feels that they’ve wasted their time,” he says.
“That’s where doctors can get into difficulty and it needs to be carefully managed.
“The other area, which can have some really significant risks, is if the doctor feels pressured into clearing the patient fit to drive, because the patient gives them an emotional story about the how they need the car and if they don’t have the ability to drive, their life will be over, or they need their licence to care for family members.
“Sometimes the doctor feels this intense pressure and signs the patient off when they know they shouldn’t. And that’s where doctors can get into real problems.”
Mr Mennillo points out that it’s not just elderly patients who can be required to undergo a fitness to drive assessment – it can include patients of all ages with diabetes, epilepsy, alcohol and drug dependence and other neurological conditions like cognitive decline.
“Sometimes it has a greater impact on younger patients that are otherwise healthy, but they’ve got epilepsy, and they’ve had a seizure, and they’ve been told not to drive until they’re seizure-free,” he says.
“So, it has a significant impact on an individual, and the doctor’s role becomes very pivotal, although the doctor is not the one that takes away their license, that’s the registration authority relevant to the state or territory.
“But the registration authority will rely very heavily on the doctor’s opinion and the certificate, whether they certify them or not. So, it is a really important role and affects not only the elderly, but all patients that have conditions that might impact their ability to drive.”
In 2022 the national driver medical standards Assessing Fitness to Drive were updated by the National Transport Commission and approved by Infrastructure and Transport Ministers.
The document includes improved guidance around principles of assessing fitness to drive in key areas such as roles and responsibilities of health professionals in advising drivers about the impact of their medical conditions/disabilities on driving in the short and long term; and older drivers, including improved guidance on how consideration of fitness to drive can and should be integrated into the general health and lifestyle management for older people. There are also sections on drivers with multiple medical conditions; drivers with disabilities; and medicinal cannabis.
Changes to fitness to drive criteria have also been made in relation to a number of conditions, including cardiovascular, musculoskeletal, neurological (including dementia and cognitive impairment and seizures and epilepsy, psychiatric, substance misuse and vision and eye disorders.
The full standards are available here, or by searching ‘Assessing fitness to drive for commercial and private vehicle drivers’ at austroads.gov.au.
Mr Mennillo says regulations can vary from state to state, and this information is also available in the Assessing Fitness to Drive guidelines. He highlights a case in Queensland about 10 years ago which underlines the need for vigilance.
In April 2015, the Queensland Civil and Administrative Tribunal found a Queensland GP behaved in a way that constituted professional misconduct, The doctor was reprimanded, fined and had conditions imposed on his registration.
The Medical Board of Australia referred the matter to the tribunal alleging the GP had certified a patient as medically fit to drive, despite advice from two neurologists that this was unsafe. The patient was later involved in a car accident that killed a pedestrian.
The doctor had worked as a GP for 20 years and had been treating the patient for several years. In mid-2005 the patient was involved in two car accidents. On both occasions the patient reported that he had had no seizures that may have caused the accident. Hospital records from the second accident provided evidence that this was not true.
After the second accident, the patient asked the GP to certify that he was fit to drive so that Queensland Transport would not revoke his licence. The GP referred the patient to a neurologist for assessment and stated that he would certify the patient if the neurologist approved.
The neurologist’s report concluded that the patient had likely suffered from seizures around the time of at least one of the car accidents, and that he would need to be seizure-free for at least two years before he could drive legally.
The patient continued to ask the GP to certify him as medically fit to drive until June 2006 when the doctor did so. In November 2009 he again certified the patient as fit to drive. Shortly afterwards, the patient struck and hit a pedestrian while driving.
The tribunal found the GP had engaged in professional misconduct, reprimanded him, and imposed conditions on his registration, including that he was prohibited from issuing certificates of fitness to drive, and must undertake a course of education for managing interaction by doctors with difficult patients. He was also fined $10,000 and ordered to pay the board’s costs.
The full judgement of the tribunal’s deputy president Judge Horneman-Wren SC is available here.
