Fit to drive? Spotlight on GPs’ role in assessing older drivers

Victoria could follow in the footsteps of other states and territories with age-based fit-to-drive requirements, after two people died and a toddler was hospitalised after being struck by a car last week. 
 
On 10 July, on a suburban street in Melbourne’s eastern suburbs, a 91-year-old driver lost control of her car and mounted a footpath, hitting a 59-year-old woman, a 60-year-old man and their two-year-old grandson.
 
The woman died at the scene, and the man was hospitalised, later succumbing to his injuries. The boy was also hospitalised with non-life-threatening injuries.
 
According to Victoria Police, after hitting the pedestrians, the car continued down a hill, hitting a street sign and smashing through a fence before hitting a bench and coming to a stop.
 
The driver was hospitalised with minor injuries.
 
The incident has subsequently raised questions about whether Victoria should follow in the footsteps of other states and territories where age-based fit-to-drive tests are mandatory.
 
The state’s Acting Premier Ben Carroll said the prospect of assessing elderly drivers’ fitness to drive is ‘a valid question’, and one that he would be discussing with Victorian Roads and Safety Minister, Melissa Horne.
 
‘No doubt, this tragedy has brought it into focus – we do need to look at this,’ he said.
 
‘Having said that, there will be a thorough investigation underway, and we will wait for that to run its course.’
 
The fatal incident follows the death of a six-year-old boy in regional Victoria in March, who died after being struck by a car driven by an 84-year-old.
 
Currently in Victoria, the licence renewal period shortens to three years from age 75, but the state does not have mandatory medical assessments or driving tests for people over a certain age, unlike other parts of the country.
 
In New South Wales, the Australian Capital Territory, and Queensland, drivers aged 75 and over are required to undergo annual medical assessments to keep their licence. Western Australia also requires medical assessments once drivers are over 80.
 
However, RACGP Victoria Chair Dr Anita Muñoz does not believe introducing age-based health assessments is the answer, and has concerns about the onus being placed on GPs.
 
‘The decision to drive a car and the responsibility for what happens when somebody drives a car, rests on the shoulders of the person driving the car,’ she told newsGP.
 
‘There is a role for health assessments for older people, I do not think that should signal to drivers that the responsibility for whether or not they get behind a wheel rests with a GP in a 20- or 30-minute consultation – it rests with them every single time they get behind the wheel.’
 
While Victoria does not mandate age-based driving assessments, the state does require drivers to notify VicRoads if they develop any conditions that could affect their driving, for which they may be asked to complete an assessment with a doctor.
 
Dr Muñoz believes this should be taken one step further, suggesting a mandatory annual self-assessment be introduced for people over a certain age.
 
The Melbourne-based GP believes this could help signal to the community that driving is a personal responsibility, one that she says cannot be outsourced to a third party.
 
‘There is a role for a yearly declaration by an older driver that they believe themselves to be fit to drive, and if not, I certainly think that there is a role for a GP to be involved,’ Dr Muñoz said.
 
‘But a once-a-year statement on a piece of paper does not mean or guarantee that the next year of driving will be safe every single time it occurs and that’s the danger with these kinds of outsourcing of responsibility for this decision to third parties.
 
‘There is a danger that people say, “well if the doctor said I can do it, I can do it” and no, in actual fact, the person who has to make that decision on every single occasion is the driver themselves.’
 
Fit-to-drive assessments are not a new concept. While there is not an age-based assessment requirement in Victoria, people who live with various chronic conditions are required to undergo an assessment with their doctor annually.
 
But Dr Muñoz says the system does have its flaws, with one of the challenges being that it relies on the patient’s honesty about what has occurred in the past 12 months.
 
If the requirement were to be extended to all people over a certain age, she is concerned that people who are determined to keep driving may seek an assessment from a doctor who is not familiar with them or their health history.
 
‘A GP can only issue a fitness to drive based on what information they have at hand and there can be missing elements, especially if the person has more than one healthcare provider,’ Dr Muñoz explained.
 
While a GP is within their rights to refuse to fill out any paperwork if they do not believe they are in possession of the patient’s full history, Dr Muñoz says GPs face the threat of aggressive behaviour and a formal complaint being made against them.
 
While Acting Premier Carroll says he will be discussing driving requirements, a Herald Sun report says there are no current plans underway to introduce testing for elderly drivers.
 
If, however, age-based assessments were to be introduced across the state, Dr Muñoz said the State Government would need to consider its rollout and how it will be funded.
 
‘Like everything in general practice, there’s significant underfunding and an assumption that all of the new policies … will be automatically rolled out by general practice and that it will all be done by the MBS rebate system,’ she said.
 
‘The reality is that if you’re doing a thorough driving assessment, that takes time and the older the person, the more complex the conditions they have, the more time it’s going to take.
 
‘As we’ve said over and over, if you want GPs to spend good, quality time with people then that needs to be funded correctly because what is being funded at the moment just falls woefully short.
 
‘There’s currently no specific driver MBS number, so if Victoria wants to roll this out, they would have to consider how they can make that a reality if they want it to be equitable across all of the people in Victoria who can’t afford to pay out-of-pocket fees for general practice.’
 
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