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Doctors Must Report Medically Unfit Drivers

Under the BC Motor Vehicle Act “every legally qualified and registered psychologist, optometrist and medical practitioner in British Columbia who has a patient 16 years of age or older” with, in the practitioner’s opinion, “a medical condition that makes it dangerous to the patient or to the public for the patient to drive a motor vehicle,” and who “continues to drive a motor vehicle after being warned” of the danger by the practitioner, has a duty to report to the superintendent of Motor Vehicles the name, address and medical condition of this patient.

Seven other provinces (including Ontario) and all the territories in Canada have similar laws.
 
A study published in early February 2008 in the Canadian journal “Open Medicine” by three doctors in Ontario has concluded that drivers involved in serious crashes often have reportable medical conditions, frequently visit physicians, yet are rarely reported. They interpret the results as suggesting their applicability in all mandatory reporting jurisdictions.
 
Their study focused on the 1,605 drivers involved in life-threatening crashes admitted to Canada’s largest trauma centre, Sunnybrook Health Sciences Centre in Toronto between 30 June 1996 and 30 June 2001. Over one third of these drivers had chronic conditions reportable by law to vehicle licensing authorities: alcohol abuse, cardiac disease, or neurological disorders.
 
Those with reportable conditions had made 20,505 visits to 2,332 physicians during the five years before the crash. The majority of these had seen a physician in the year before the crash. Only 3% had been reported to licensing authorities. Alcohol abuse was the most frequent reportable condition contributing to a serious crash, but the least frequent reason for notification. Neurological conditions were the most commonly reported.
 
But what about all the drivers with reportable conditions who were reported, stopped driving, and therefore never showed up at the trauma centre? Maybe physician reporting is better than this study suggests. The authors concluded that this was unlikely for three reasons: (1) The total frequency of reporting is low, far below the prevalence of [reportable] conditions in the population. (2) Reportable cardiac and neurological conditions are common, and are the most commonly reported condition for drivers in the study. (2) Alcohol abuse is the most common reportable condition but in fact is under-reported because it is “notoriously difficult to detect in primary care and notoriously linked to poor compliance with restrictions.”
 
Why this underreporting? The authors of the report propose many possible reasons: the conflict between advocating for the patient and being a protector of society; uncertainty over what constitutes significant enough impairment by a medical condition; worries about patient dissatisfaction; limited time; lack of training; presuming that unsafe drivers rarely visit physicians; believing either that road safety is not a medical problem that merits such efforts by physicians or that the risk posed is speculative only. As the authors point out and as Road Rules has often noted, “healthy young adults still represent the majority of crashes and usually have no reportable conditions.”
 
Read the full report online at www.openmedicine.ca.
 

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