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Managing unsafe drivers

Guidance on assessing a patient’s fitness to drive has been launched in Ireland for the first time: Sara Williams takes a closer look

Until recently, no national framework detailing the standards expected of drivers existed in Ireland. Medical decisions were made in a vacuum, pieced together using guidance from other jurisdictions.

Sláinte agus Tiomáint, the new set of medical fitness to drive guidelines, was developed by the National Programme Office for Traffic Medicine in consultation with the Royal College of Physicians of Ireland.

The updated guidance reflects recent developments in medicine, such as improvements in diagnosis and treatment of medical conditions. The standards relate to car and motorcycle drivers (Group 1 licence holders, categories A, A1, B, EB, M or W) and give clear guidance on implementing medical fitness to drive policies in Ireland.

The guidelines will also be used by driver licensing authorities (DLAs), Gardaí, legal professionals and other health professionals, including occupational therapists and optometrists.

The driver’s role

The guidance encourages drivers to report to a DLA and their insurance provider any long-term or permanent injury or illness that may affect their ability to drive safely.

Those patients must adhere to prescribed medical treatment and monitor their condition(s) with consideration of their fitness to drive. They must also comply with the requirements of their license, including periodic medical reviews.

The doctor’s role

Your responsibilities are:

  • Assess your patient’s medical fitness to drive based on the current Sláinte agus Tiomáint medical standards
  • Advise your patient regarding the impact of their medical condition or disability and recommend restrictions and ongoing monitoring
  • Advise your patient of their responsibility to report their condition to a DLA, if it may affect their ability to drive
  • Treat, monitor and manage your patient’s condition with ongoing consideration of their fitness to drive
  • Report to a DLA in the exceptional circumstances where there is a risk to the public and the driver cannot or will not cease driving. The DLA will attempt to make contact with the patient and if they cannot do so, they will contact the Gardaí.
Sometimes patients feel affronted by the possibility of restrictions to their driving or withdrawal of their licence, and may be hostile
DLAs will consider reports provided by health professionals and act on those reports regarding concerns of public safety relating to medical fitness to drive.

Progressive conditions

In cases where a patient has a progressive condition, it is important to give them as much lead time as possible to make the lifestyle changes that may later be required. Assistance from an occupational therapist may be valuable in such instances.

Examinations requested by a DLA

When a patient presents at the request of a DLA, the situation is different with respect to confidentiality. The patient will present with a form or letter from a DLA, requesting an examination for the purposes of licence application or renewal, or as a stipulation of a conditional licence.

The completed form will be returned by the patient to a DLA, thus there is no risk of breaching confidentiality or privacy, provided only information relevant to the patient’s driving ability is included on the form; a copy of the form/report should also be retained by the assessing clinician.

Managing the doctor–patient relationship

You should be aware of data protection and other applicable legislation when collecting and managing patient information and when forwarding such information to third parties.

If it is not possible to assess a patient’s fitness to drive, eg, where there may be the possibility of the patient ceasing contact or avoiding all medical management of their condition, you should be prepared to refer your patient to another practitioner.

You are required to assess your patient’s fitness to drive and recommend restrictions and ongoing monitoring

Sometimes patients feel affronted by the possibility of restrictions to their driving or withdrawal of their licence, and may be hostile. In such circumstances, you may refer the driver to another practitioner or refer them directly to a DLA without a recommendation regarding fitness to drive.

Under such circumstances consider:

  • The immediate risk to public safety
  • The risks of disclosure versus non-disclosure
  • Your ethical and professional obligations
  • Whether the circumstances indicate a serious and imminent threat to the health, life or safety of any person.

Future

This guidance has been welcomed across Ireland and sees clarity brought to the role of doctors in managing cases where a patient is unfit to drive.

In summary

You are required to assess your patient’s fitness to drive and recommend restrictions and ongoing monitoring. You are further required to advise your patient of their responsibility to report their condition to a DLA, if it may affect their ability to drive. Should a patient refuse to do so and it could pose a risk to the public, you must report them to a DLA.

The full guidelines are available here: www.rsa.ie/RSA/Licensed-Drivers/Safe-driving/Medical-Issues

At a glance: Roles and responsibilities of drivers, health professionals and driver licensing authorities

Driver
  • To report to the Driving Licensing Authority and their insurance provider any long-term or permanent injury or illness that may affect their ability to drive safely: if holding a licence from an EU country other than Ireland, or a recognised country for licence exchange, and developing a condition which could affect safe driving, the driver must contact the licensing authority to arrange for an exchange of their licence.
  • To respond truthfully to questions from the health professional regarding their health status and the likely impact on their driving ability.
  • To adhere to prescribed medical treatment and monitor and manage their condition(s) and any adaptations with ongoing consideration of their fitness to drive.
  • To comply with requirements of their licence as appropriate, including periodic medical reviews.
Health professional
  • To assess the person’s medical fitness to drive based on the current medical standards.
  • To advise the person regarding the impact of their medical condition or disability on their ability to drive and recommend restrictions and ongoing monitoring as required.
  • To advise the person of their responsibility to report their condition to the Driving Licensing Authority if their long-term or permanent injury or illness may affect their ability to drive safely.
  • To treat, monitor and manage the person’s condition with ongoing consideration of their fitness to drive.
  • To report to the Driving Licensing Authority regarding a person’s fitness to drive in the exceptional circumstances where there is a risk to the public and the driver cannot or will not cease driving.
Licensing authority
  • To make all decisions regarding the licensing of drivers. The Driving Licensing Authority will consider reports provided by health professionals.
  • To inform the driving public of their responsibility to report any long-term or permanent injury or illness to the Driving Licensing Authority if the condition may affect their ability to drive safely.
  • Will act on reports of third parties, Gardaí, general public and healthcare workers regarding concerns of public safety relating to medical fitness to drive.
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