How to decide who's fit to drive.
I’m a bit of a Nazi about people who aren’t fit to drive but continue to get behind the wheel. While aware what a bummer it would be to lose your license, surely running over innocent people is even more of a bummer for all concerned.
Of course I might be particularly sensitive about the Mr Magoo types who struggle to park in our surgery carpark because I live in the same street. The idea of my children sharing a road with these incompetents is positively scary.
But a review in last week’s BMJ is a reminder against stereotyping the ability of older drivers. According to the article, the association between age and crashes per mile has been shown to be more related to low mileage than age and surveys reveal drivers over 80 to be consistently prudent behind the wheel.
Even people with early dementia are acceptably safe for around three years after diagnosis, the authors claim, by which time most have stopped driving. Which is lucky, because cognitive testing can’t discriminate well between early dementia patients who are safe on the road and those that aren’t.
One way to detect unsafe drivers is to ask family and friends about specific behaviours, such as driving the wrong way around roundabouts, getting lost in familiar areas, miscalculating speed and distances and poor judgement, the authors suggest. Sounds good in theory, but in my experience loyalty to the patient is often a barrier to honest disclosure about their driving ability. Similarly it seems doctors sometimes turn a blind eye out of concern about a patient’s loss of independence.
In short, recommending a patient lose their license is a balancing act between patient independence and population safety, and it’s probably among the harder decisions we have to make as doctors.
At least in our area there’s now a subsidised cab system for the elderly, and it’s this type of system that should be expanded so that independence and mobility isn’t totally dependent on being able to drive.
BMJ 2007; 334: 1365-69.
Of course I might be particularly sensitive about the Mr Magoo types who struggle to park in our surgery carpark because I live in the same street. The idea of my children sharing a road with these incompetents is positively scary.
But a review in last week’s BMJ is a reminder against stereotyping the ability of older drivers. According to the article, the association between age and crashes per mile has been shown to be more related to low mileage than age and surveys reveal drivers over 80 to be consistently prudent behind the wheel.
Even people with early dementia are acceptably safe for around three years after diagnosis, the authors claim, by which time most have stopped driving. Which is lucky, because cognitive testing can’t discriminate well between early dementia patients who are safe on the road and those that aren’t.
One way to detect unsafe drivers is to ask family and friends about specific behaviours, such as driving the wrong way around roundabouts, getting lost in familiar areas, miscalculating speed and distances and poor judgement, the authors suggest. Sounds good in theory, but in my experience loyalty to the patient is often a barrier to honest disclosure about their driving ability. Similarly it seems doctors sometimes turn a blind eye out of concern about a patient’s loss of independence.
In short, recommending a patient lose their license is a balancing act between patient independence and population safety, and it’s probably among the harder decisions we have to make as doctors.
At least in our area there’s now a subsidised cab system for the elderly, and it’s this type of system that should be expanded so that independence and mobility isn’t totally dependent on being able to drive.
BMJ 2007; 334: 1365-69.
Labels: driving
posted by ozdocblog at 12:09 AM
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