Fitness to drive

Assessing fitness to drive can be challenging in general practice. When determining an individual’s fitness to drive, a clinician’s input may have legal, ethical, emotional and social ramifications.¹ 

Except in the Northern Territory and South Australia, there is no mandatory obligation for a GP to report to the driving authority health conditions likely to impact safe driving. Drivers are required to self-report illness and injury to the driving authority that may impact on safe driving. If a GP considers, based on their assessment, that a patient is unfit to drive but the patient does not self-report, the GP will need to consider whether they should report the patient to the driving authority. State and territory legislation protects GPs against civil or criminal liability if they make a report in good faith. It is not a breach of privacy or the GP’s duty of confidentiality to make such a report.² 

The aim of determining fitness to drive is to achieve a balance between:

• minimising any driving-related road safety risks for the individual and the community posed by the driver’s permanent or long- term injury or illness
• maintaining the driver’s lifestyle and employment-related mobility independence.

The national driver medical standards Assessing fitness to drive set out the considerations and medical criteria for safe driving. 

A practical driver assessment conducted by a suitably qualified occupational therapy driving assessor may be helpful where the impacts of injury, illness, disability or the ageing process on functionality are not clear.

Although advanced age in itself is not a barrier to safe driving, age-related physical and mental changes may affect a person’s ability to drive safely. Given the association between health outcomes, mobility and social connectedness, fitness to drive should be proactively managed, with the goal of enabling older people to continue to drive for as long as it is safe to do so.

Section 5 of the national driver medical standards provides a detailed figure focused on the medical decision-making process for assessing fitness to drive, as well as administrative requirements (figures 4 and 5) for medical professionals.

Section 6.1 – Dementia of the medical standards assessing fitness to drive has identified that dementia syndrome and symptoms are associated with a moderately high risk of collision compared with matched controls. However, the evidence does not suggest that all people with dementia symptoms should have their licences revoked or restricted. Throughout all stages of their condition, drivers require regular monitoring regarding progression of the disease. Although for some drivers the crash risk is minimised because they choose, or are persuaded by their family, to voluntarily stop driving, others with significant cognitive decline and limited insight may require careful management and support in this regard. Early conversations about managing the transition to non-driving are essential.

Section 6.1.2 – General assessment and management guidelines of the medical standards outlines different stages of dementia and how to assess fitness to drive.

Medico-legal issues, such as privacy, can be a concern for GPs (eg family members wishing to discuss issues with the GP, but not wanting the GP to disclose the source of information to the patient).

Drivers in most states and territories must make a medical self-declaration in relation to their fitness to drive at the time of licence application and renewal. The information obtained may result in a requirement for a medical assessment or refusal of the application. In addition, each state and territory has specific requirements for medical examinations or road testing depending on the driver’s age or the type of vehicle being driven, such as heavy vehicles, public passenger vehicles and dangerous goods vehicles. For example, in Western Australia, some occupational therapists (with at least one trained observer) provide a clinical assessment of people’s driving risks. 

Links to the regulatory requirements for driver testing in each state and territory are provided below.

• Australian Capital Territory
• New South Wales
• Northern Territory
• Queensland
• South Australia
• Tasmania
• Victoria
• Western Australia

Australian state and territory contact details for health professional enquiries are provided in Table 1. 

• Avant – Fitness to drive