Healthcare Providers

You should consider your patient’s ability to drive safely if your patient:

• Has a medical condition that could affect cognitive, motor or sensory function including:
  • Alzheimer’s Disease
  • Other Dementias
  • Parkinson’s Disease
  • Alcoholism or other substance abuse
  • Multiple Sclerosis
  • Diabetes
• Has had a medical event like CVA or MI where you suspect or have identified an impairment of their cognitive, motor or sensory functions
• Has an injury that affects cognitive, motor or sensory functions e.g Traumatic brain injury
• Is experiencing any decline in functional abilities related to driving
• Has mental health symptoms which could affect driving competence e.g. depression, anxiety, etc

Contact us to learn more or to refer your patient for a DriveFit Evaluation.

DriveABLE is the only scientifically developed and validated cognitive assessment specific to driving. It can be used to:

• Determine if a patient has the cognitive abilities to drive safely.
• Support your need to warn a cognitively impaired patient not to drive
• Monitor patients diagnosed with progressive disorders (e.g. Alzheimer’s Disease) to ensure driving cessation happens at an appropriate time. Being proactive will also help your patient, their family and caregivers to manage driving and allow time to prepare for eventually stopping.

Some government driver licensing authorities use DriveABLE to help make driver licensing decisions for those with a cognitive impairment. DriveABLE is a fee for service assessment (see the DriveABLE referral form for information on fees in BC).

The prevalence of psychological distress following a motor vehicle crash is well documented in the research and widely known amongst those working with crash survivors.

Left unmanaged, psychological injuries can have a marked impact on a survivor’s quality of life and can contribute to the development of mental health disorders like post-traumatic stress disorder (PTSD) or Major Depressive Disorder (MDD), or exacerbate negative outcomes such as social disengagement.

Psychological injuries are often overlooked or not addressed. This can be due to the focus on physical injuries, fear of malingering or the stigma placed on mental health that prevents patients from self-reporting symptoms. Poor management can lead to a more difficult and prolonged recovery period.

The Insight Post-Crash Anxiety Screen can be used to identify symptoms and through its comparative reporting feature, monitor your patient through the recovery period and identify any latent onset of symptoms. This will help support timely interventions which is a factor in preventing a prolonged recovery.

Most people depend on being able to drive to participate in many activities in their lives. Not being able to drive can result in health issues from the emotional stress, loss of independence, and financial consequences. And if your patient is an unsafe driver, it puts all other road users at risk. Therefore, determining the impact a medical condition or injury has on your patient’s ability to drive is important to your patient’s overall health and to the public’s safety.

There are a few situations you, as a health professional, could be faced with related to driving:

• Your patient has a medical condition or injury that you:
  • Think could affect driver safety but you are not certain
  • Know will eventually affect their ability to drive
  • Know has affected their functional abilities to drive
• A family member or caregiver has reported to you a concern about your patient’s driving
• Your patient has recovered from a medical event or injury and you would like to find out if they're ready to return to driving.

If you aren’t sure if a medical condition or injury is affecting your patient’s ability to drive then screening and assessments specific to driving could help make that determination. Some of these are specific to certain functions e.g SIMARD-MD and DriveABLE for cognitive functions related to driving, and others look at all the functions like a full functional driving assessment or on-road functional evaluation.

If you know your patient’s medical condition will eventually affect their driving then monitoring their driving through regular screening and assessment will help you determine when their driving becomes affected. In some jurisdictions it is mandatory for some health professionals e.g physicians to report certain medical conditions that are known to affect driving abilities. However, any health professional can report a patient they know or suspect is unsafe to drive. It’s the driver licensing authorities responsibility to make the definitive determination of whether a driver’s licence needs to be revoked, not the health professional.

If you know or suspect your patient’s functional abilities to drive are permanently affected either from results of driving assessments or your patient’s medical status, then you should warn your patient not to drive and report your patient to the driver licensing authority. If the medical condition affecting your patient’s functional abilities is temporary e.g. recovering from surgery or a medical event where recovery is expected, then you might not need to report to the driver licensing authority. Refer to the regulation in your jurisdiction to determine what needs to be reported.

According to the Canadian Medical Association's Driver's Guide (9th Edition):

Physicians have a statutory duty to report patients whom they believe to be unfit to drive to the relevant provincial or territorial motor vehicle licensing authority. This duty may be mandatory or discretionary, depending on the province or territory involved. This duty to report is owed to the public and supersedes the physician’s private duty with regard to confidentiality.

In British Columbia, according to Section 230 of the Motor Vehicle Act, reporting is mandatory if in your opinion your patient:

Has a medical condition that makes it dangerous to the patient or to the public for the patient to drive a motor vehicle, and continues to drive a motor vehicle after being warned of the danger.

However, remember that reporting a patient who you are concerned about their ability to drive safely is always permitted in any jurisdiction.

This can be confusing as there is some controversy over which screens to use for cognitive abilities related to driving. There is no paper/pencil screening tool that will tell you definitively if your patient's cognitive abilities are impaired. And no screen should be used alone to make driver fitness determinations.

A screening tool or tools should be used to provide you with some objective information on whether your patient potentially has an impairment of the cognitive abilities related to driving. This can help you determine if further testing is needed e.g. an in-clinic or on-road functional assessment of cognitive abilities related to driving.

It is important that no single screening tool be used to make driver fitness determinations. As with any screen, they should be used, along with other information to identify those who would benefit from further testing or investigations. Most commonly used screens are impacted by education and language and therefore have false positives and false negatives that need to be considered.

Following are commonly used screening tools related to cognitive abilities:

• SIMARD-MD: Currently, the SIMARD-MD is the only validated screening tool specific to the cognitive abilities related to driving. There is some controversy related to its use as since its release, there have been some studies that question its validity based on the methodology used. However, the quality and motivation of some of these studies have also been questioned. The bottom line is, if you use it as a screen and not to make driver fitness determinations, it can provide you with some objective information to help determine if further investigation is needed.
• MoCA: The Montreal Cognitive Assessment is not validated specifically for driving. A MoCA score within the range of normal does not rule out impairment of the cognitive abilities related to driving. However, if your patient has a MoCA score outside the range of normal it is an indicator for you to consider their ability to drive safely. As with other screens, it should not be used in isolation to determine driver fitness.
• MMSE: The Mini-Mental Status Exam has been the main cognitive screen for a long time to identify moderate cognitive impairment. Because it is not sensitive enough to mild impairments where driving can be impacted, its correlation to driving is poor. However, that does not make it useless - if you are conducting an MMSE for other reasons and have a patient who scores outside the range of normal, driving safety should be questioned.
• Trail Making Test A & B: Studies related to the reliability of these tests for driver fitness is somewhat mixed. However most agree that the correlation with driving is not strong and their use is better with healthy patients vs patients with known cognitive impairment. And as with other tools, they can be a useful tool to augment other information but not on its own.
• Clock-Drawing Test: The Clock Drawing Test has shown some correlation with ability to drive safely. It actually requires a high level of brain functioning to draw a clock. Errors can show impairment with visual perception and short term memory which are both important to driving. As with all the screens, it should not be used in isolation but can be an indicator that more investigation is warranted.

According to the Canadian Medical Protection Association:

Legislation provides protection for physicians from civil actions when a report is made in accordance with the legislation and in good faith, but it does not prevent patients from filing a College complaint. It may be helpful for physicians to inform other healthcare providers in the patient’s circle of care. Certainly, physicians should document the steps they have taken.