Original Article

Journal of General Internal Medicine

, Volume 22, Issue 4, pp 531-543

First online:

Family Physicians’ Attitudes and Practices Regarding Assessments of Medical Fitness to Drive in Older Persons

  • Raymond W. JangAffiliated withDepartment of Medicine, University of Toronto
  • , Malcolm Man-Son-HingAffiliated withDivision of Geriatric Medicine, Department of Medicine, University of OttawaClinical Epidemiology Program, Ottawa Health Research InstituteCanadian Institutes of Health Research (CIHR) CanDRIVE Research Team, Élisabeth-Bruyère Research Institute
  • , Frank J. MolnarAffiliated withDivision of Geriatric Medicine, Department of Medicine, University of OttawaClinical Epidemiology Program, Ottawa Health Research InstituteCanadian Institutes of Health Research (CIHR) CanDRIVE Research Team, Élisabeth-Bruyère Research InstituteCT Lamont Centre for Primary Care Research, Élisabeth-Bruyère Research Institute
  • , David B. HoganAffiliated withDivision of Geriatric Medicine, Department of Medicine, University of Calgary
  • , Shawn C. MarshallAffiliated withClinical Epidemiology Program, Ottawa Health Research InstituteCanadian Institutes of Health Research (CIHR) CanDRIVE Research Team, Élisabeth-Bruyère Research InstituteDivision of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa
  • , Julie AugerAffiliated withDepartment of Family Medicine and Continuing Care, Timmins and District Hospital
  • , Ian D. GrahamAffiliated withClinical Epidemiology Program, Ottawa Health Research InstituteSchool of Nursing and Department of Epidemiology and Community Medicine, University of Ottawa
  • , Nicol Korner-BitenskyAffiliated withSchool of Physical and Occupational Therapy, Faculty of Medicine, McGill University
  • , George TomlinsonAffiliated withDepartment of Medicine, University Health NetworkDepartment of Public Health Sciences, University of Toronto
    • , Matthew E. KowgierAffiliated withDepartment of Public Health Sciences, University of Toronto
    • , Gary NaglieAffiliated withDivision of General Internal Medicine, University Health NetworkGeriatrics Program, Toronto Rehabilitation InstituteDepartments of Medicine and Health Policy Management and Evaluation, University of TorontoToronto Rehabilitation Institute Email author 

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Abstract

Background

Higher crash rates per mile driven in older drivers have focused attention on the assessment of older drivers.

Objective

To examine the attitudes and practices of family physicians regarding fitness-to-drive issues in older persons.

Design

Survey questionnaire.

Participants

The questionnaire was sent to 1,000 randomly selected Canadian family physicians. Four hundred sixty eligible physicians returned completed questionnaires.

Measurements

Self-reported attitudes and practices towards driving assessments and the reporting of medically unsafe drivers.

Results

Over 45% of physicians are not confident in assessing driving fitness and do not consider themselves to be the most qualified professionals to do so. The majority (88.6%) feel that they would benefit from further education in this area. About 75% feel that reporting a patient as an unsafe driver places them in a conflict of interest and negatively impacts on the patient and the physician–patient relationship. Nevertheless, most (72.4%) agree that physicians should be legally responsible for reporting unsafe drivers to the licensing authorities. Physicians from provinces with mandatory versus discretionary reporting requirements are more likely to report unsafe drivers (odds ratio [OR], 2.78; 95% confidence interval [CI], 1.58 to 4.91), but less likely to perform driving assessments (OR, 0.58; 95% CI, 0.39 to 0.85). Most driving assessments take between 10 and 30 minutes, with much variability in the components included.

Conclusions

Family physicians lack confidence in performing driving assessments and note many negative consequences of reporting unsafe drivers. Education about assessing driving fitness and approaches that protect the physician–patient relationship when reporting occurs are needed.

Key words

survey older drivers medical fitness to drive family physicians