The Last Word on fitness to drive
November 1, 2013 § 1 Comment
The Last Word: on fitness to drive
1 November, 2013 Dr Andrew Gunn
Frank Zappa was right – the world might not end in fire or ice. It could instead end in paperwork – like, say, The Apocalypse of Medical Assessments for Fitness to Drive.
I have zero inherent interest in decreeing whether elderly people should still be driving. Before a walking stick transforms into a walking frame, I generally give patients a choice: they can have, and probably fail, an expensive driving assessment with an occupational therapist; or they can let me clip their wings.
The angst starts when I cross out their motorbike and truck licences. Patients anxiously protest that these licences are still essential “for emergencies”.
I sadly explain that riding a motorbike at the age of 80 is more likely to create an emergency than resolve one. I also reassure them that the police will let them drive a truck if, say, a semi-trailer packed with singing nuns and orphans is being threatened by a hostile alien spacecraft. It’s a pity there’s no tick box on the form that covers that circumstance.
The tension then escalates at the hint of restricting their driving to within their local area and during the day.
I once reluctantly certified a patient as medically fit to drive after first checking with his psychiatrist and optometrist. Pleased as Punch (and more pleased than Judy), he drove straight to Queensland Transport’s offices. Staff watched him park through a window. This involved hitting a wall — twice — and ultimately parking slewed across two spaces.
The driving authorities twigged that things could get tricky and phoned me. My patient returned that afternoon with his version of events, insisting his car was undamaged. I showed him photographs emailed by transport officers that suggested otherwise. He angrily claimed they’d been doctored.
In an impressive but ultimately futile demonstration of functionality, he had his car repaired overnight and took it back to “those liars” at Queensland Transport. Regardless, I took his driving licence off him — so he took his medical file off me. I never saw him again although I did recently hear that he is now safely parked in the beyond.
Another elderly patient failed an occupational therapy driving assessment — but not too badly. He then attended a private driving school and obtained a letter attesting to his competency. I even talked to the driving instructor to check it was legit.
Initiative deserves reward, so I gave him temporary — but now revoked — medical clearance. He got another year or so of restricted driving without, as far as I know, hitting any singing nuns, orphans or Queensland Transport walls.
He’s still angry at the GP who sent him for the driving assessment and won’t see her again. Perhaps he won’t see me now either. Another GP phoned me this afternoon saying my (ex?) patient was asking for medical clearance to drive.
This is a stupid system, and one that destroys therapeutic relationships. I’d prefer everyone to sit practical driving tests every five years from age 70 (and yes, I’d also do revalidation to keep practising medicine).
Not that this would eliminate all problems. Another patient is an interesting guy but not the fullest stubby in the slab. It didn’t surprise me that he said he had two accidents while sitting his driving test. It did surprise me that he was passed.
I don’t know for sure if his story is true. I do know, however, that I dread Judgement Day — that’s the day he approaches me with fitness-to-drive paperwork.
Another highly entertaining column on a serious topic.
I agree that the current system has the potential to cause real damage to the doctor-patient relationship and that routine practical testing for older drivers would be a significant improvement.
Anecdotal evidence seems to suggest that some patients will doctor shop with their fitness-to-drive paperwork and lie and/or bully doctors into signing the forms. As a junior GP registrar I felt unprepared to deal with such demanding patients, and on a couple of occasions caved in against my better judgement. One of the most memorable was with “Betsy” (name has been changed).
Betsy was an exceedingly frail 88-year-old who hobbled painfully slowly and breathlessly into my room using her wheelie walker. Her list of medical problems was long and impressive, and included uncontrolled diabetes, heart failure and Parkinson’s. The medical certificate form for her driver’s licence renewal flapped almost comically in her shaking hand. Despite its being patently obvious that she was unfit to cross a road unaccompanied let alone get behind the wheel, I’m ashamed to say that I was bullied into signing the form, for lurking underneath that frail exterior was a very aggressive and manipulative woman. I didn’t sleep well that night, terrified that my cowardice might result in great harm to some innocent road user.
Less than a fortnight later I heard that Betsy had died at the wheel. Imagining the worst and having visions of being hauled up in front of the coroner to explain my negligent action, I spent the next few hours in a state of panic. To my immense relief, I discovered that far from causing an horrific multi-vehicle accident, Betsy had in fact executed a perfect parallel park in town, but failed to alight from her car. Cause of death: massive CVA.
I’ve never gone against my clinical judgement when signing a driver licence medical certificate again, much to the chagrin of several patients.