Doctor warnings to unfit drivers pay off

Since the late 1960s, Ontario doctors have been required by law to report unfit drivers – but studies have often shown that actual reporting of patients unfit for driving falls significantly below the occurrence of chronic diseases within the population.

Starting in 2006, doctors began receiving a small fee ($36.25) for each patient they advised to stop driving and reported to the Ministry of Transportation.

It was at this point that Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences in Toronto, set out to discover what effect these warnings might have on the risk of a road crash.

The study, published in The New England Journal of Medicine, looked at more than 100,000 patients who had received warnings from 6,000 doctors between April 2006 and March 2010.

Researchers evaluated each driver’s need for emergency care to treat serious injuries from car accidents in the four years prior to the doctor warning, as well as one year after. Overall, the drivers collectively had been involved in 1,700 accidents.

In the one year following the warning, they found a 45 per cent drop in severe trauma from car crashes, down from 1,430 road crashes involving the patient as the driver to just 273 after receiving their physicians’ advice.

“We found that each warning led to about a 40 to 50 per cent decrease in the risk of a serious road crash for the patient. This decrease was immediate in onset, profound in magnitude and sustained in duration. An effect of this magnitude is about two times larger than the combined effects of modern trauma hospitals on saving people’s lives,” wrote Redelmeir.

While the findings aren’t particularly surprising, the significant drop in accidents is something worth taking note of as doctors’ warnings don’t always lead to the driver giving up their license.

Only about 10 to 30 per cent of unfit drivers reported ended up with their license suspended, and the others merely received a stern warning letter from the Ministry of Transport. The study suggested that those who do keep their license often lose their peace of mind when driving, and are likely spending much less time behind the wheel.

While road safety increases, the study also revealed a few downsides. For those patients who could no longer drive, the rate of severe depression increased by 25 per cent. Researchers also found that these warnings tend to disrupt the doctor-patient relationship, which could be why doctors sometimes hesitate to give them out.

“About one out of every five patients never makes a return visit to the physician responsible for giving the warning, so they don’t leave the system, but they do take their business elsewhere,” the study noted.

This is an issue that not only involves older drivers. While 75 per cent of patients with the kind of chronic diseases that would make a doctor advise to stay off the road were over 65, the study also found a significant portion of patients were 45 or younger. Diseases such as schizophrenia, alcoholism, attention-deficit disorders and substance abuse were common illnesses among this age group for patients who received the warning.

Sources: New England Journal of Medicine, Globe and Mail, Vancouver Sun

How would you feel if your doctor advised you to stop driving? Any recommendations for how doctors can approach this subject without upsetting patients? Let us know in the comments.

Photo © Hamilton

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