New medical fitness-to-drive guidelines should make our roads safer

Readers who have applied to have their driving licences renewed in the past few weeks may have noticed a significant difference in the medical aspects of the process. That's because, in a joint venture between the Road Safety Authority (RSA) and the Royal College of Physicians of Ireland (RCPI), a new set of guidelines – Sl áinte agus Tiom áint – are now used to assess a person's fitness to drive.

The new guidelines were developed by the National Programme Office for Traffic Medicine. Established in 2011 and headed by director of traffic medicine Prof Des O’Neill, it formed a multidisciplinary working group which has spent 18 months fine-tuning the guidelines in time for their launch in February. Until now many doctors have felt that the guidelines available to them were too brief, especially in light of what was available to GPs in the UK and elsewhere.

Faced with a patient with significant heart disease or someone with a serious psychological illness, in the past a doctor had to make a decision on the person’s fitness to drive with little in the way of specific guidance. Not surprisingly, then, the new guidelines have been broadly welcomed by the profession.

Writing in the current issue of the Journal of the Irish College of General Practitioners (ICGP), its representative on the working group, Dr Gerry Cummins, says he welcomes the clarity and detail they provide as well as "clarification on the roles of patients, health professionals and the driver licensing authority".

This is one of the major strengths of the initiative: it is crystal clear in its guidance to drivers who are advised “to report to the driver licensing authority and their insurance provider any long-term or permanent injury or illness that may affect their ability to drive safely”.

Health professionals must "advise the person regarding the impact of their medical condition or disability on their ability to drive and to recommend restrictions and ongoing monitoring as required". And in exceptional circumstances where there is a risk to the public and the driver refuses to stop driving, to report this to the driver licensing authority.

Public safety concerns
Under the new guide, the licensing authority, in turn, must make all decisions based on the licensing of drivers and undertakes to act on reports from the Garda, health professionals and the public where there are concerns about public safety relating to fitness to drive.

Prof O’Neill emphasises the underlying philosophy of promoting safe driving rather than one of looking to keep people off the road. “Our primary focus is an enabling one; we looked at the best of the international guidelines in drawing up our recommendations.” He points out that, in general, the new guidelines are more liberal than those that apply in the UK. For example, if you have had an uncomplicated elective cardiac stent inserted, in the Republic you will be advised to stop driving for two days; in the UK, you will be off the road for a week.

So what will the medical aspects of applying for a driving licence be like in practice? The application form for a Group 1 licence (most cars) now contains a detailed suite of health questions.

If you answer yes to any of these (see panel) you will be required to obtain a medical report from your GP. At your doctor’s surgery you will be asked, for example, whether “you have in the past suffered or currently suffer from epilepsy, and if so to please indicate the date of your last seizure”. A medical examination will follow, with an emphasis on the illness you have detailed in the original application form.

The doctor will then state whether or not you are fit to drive the class of vehicle you have applied for; specifically, the form asks the medical practitioner to state whether you have a limb prosthesis, whether you need visual aids such as glasses or contacts and if you need adaptations to your car to accommodate any physical disability you may have.

The completed form must be sent by the applicant to the licensing authority within one month of the medical.

Medical fitness decisions
There is a new patient advisory form which doctors can use to formally inform their patient of the need to advise the driving licensing authority that they have a condition which may impact on their fitness to drive.

It is expected that the vast majority of driving licence medical fitness decisions will be made by family doctors.

However, the new guidelines do encourage onward referral for a specialist opinion if there is any doubt in the GP’s mind as to whether someone can be certified fit or not. Another useful tool is a facility to refer the patient for an on-road assessment of their driving ability.

Is there any evidence that the new approach works? Prof O’Neill points to Canadian research published last year which found that crash rates among drivers with medical conditions were reduced by 45 per cent when systematic guidelines such as the new Irish ones were introduced.