Clinical Communiqué Volume 2 Issue 3 September 2015
Download PDF: Clinical Communiqué September 2015 Edition
In this edition
Case #1 The Price of Ignorance
Case #2 History Repeating
Case #3 A Risk Unseen
Expert Commentary: Assessing Fitness to Drive in Australia
In this issue of the Clinical Communiqué we explore, for the first time in our publication, the important subject of fitness to drive. It is a question that is commonly raised for the patient who has had a seizure, stroke or degenerative muscular condition, but how often is it considered for the patient presenting to hospital with drug and alcohol-related problems, or for the patient suffering from a delusional disorder, or a ‘temporary’ medical condition such as a pulmonary embolus?
This is an area of practice that is pertinent to every healthcare professional and is not solely limited to a small group of medical experts whose role it is to determine a person’s suitability to hold a licence. Whether a patient is fit to drive is a clinical question, which should be posed every time we see a patient, whether in an acute hospital, outpatient, or general practice setting.
Many medical, psychiatric and toxicological conditions are capable of impairing a driver’s attention, decision-making abilities and reaction times. When the impairment is subtle or intermittent, the assessment of fitness to drive can be made even more difficult.
Across the country, there is no uniform approach to the reporting and assessment of fitness to drive, and the strengths and weaknesses of the various State-based systems have been strongly debated for many years. What is agreed is that assessing fitness to drive is a complex and challenging task for healthcare professionals. It is a heavy responsibility to bear. It can be a confronting scenario to advise your patient they should not hold a license, to recommend that they lose a vital part of their independence, mobility, and at times, their income. It can also be devastating to discover that one of your patients has been involved in a motor vehicle crash as a result of the medical condition you have been treating, and you had not considered the issue of driving or identified a significant risk.
This is also the first issue where senior forensic physicians at the Victorian Institute of Forensic Medicine (VIFM) have contributed to the expert commentary and two of the case summaries. The guest authors are all gazetted approved experts under Section 57 of the Road Safety Act (VIC) and medical consultants to VicRoads on matters of fitness to drive.
Each case has been selected to represent a different jurisdiction and involve a diverse range of medical conditions and practitioners. The common theme between them is that they were all, as one coroner noted, “an accident waiting to happen.” The first case depicts the condition of hypoglycaemic unawareness, the second is best described by the adage – “everything that happens once can never happen again, but everything that happens twice will surely happen a third time.” The final case is one to reflect on what might happen when your patient leaves the consultation room.
The inquests in fitness to drive cases have a distinctive format in that the investigation does not centre on the history and circumstances of the deceased. Instead, the purpose of the inquests is to examine the medical background and behaviour of the living – the drivers involved in the collisions.