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For Healthcare Providers
Physician Reporting
A summary of the problem, derived from collaborative material reported by the Pennsylvania Department of Transportation
The Transportation Research Board of the National Academies
TransAnalytics
As the driving population grows older, medical impairments associated with normal aging and diseases more common among older people will become an increasingly important public health issue. This is especially true for Pennsylvania, which is second only to Florida in the percentage of citizens 65 and older among all U.S. states. One of the ways that the Pennsylvania Department of Transportation (PENNDOT) identifies individuals—of any age over 15—who are sufficiently impaired that they place themselves and others at higher risk when they drive is through reports by their personal physicians.
A researsch report produced by TransAnalytics, posted on the website of the American Association of Motor Vehicle Administrators, sought to determine reasons why physicians may fail to comply with the directive to report impaired drivers, and to identify and implement strategies to insure better compliance with Pennsylvania’s physican reporting law.
Among the report’s findings:
Failure by physicians to report patients with driving
impairments could become an increasing problem—not just in Pennsylvania but
across the nation.
Physicians need to be able to identify and document
physical or mental impairment(s) that clearly relate to the ability to drive.
They must also understand when such a patient/driver poses a clear risk to
public safety.
Physicians need guidance http://www.ama-assn.org/ama/pub/category/10791.html on
what should be assessed to determine medical competence to drive, and what tools
were available to perform the prescribed assessments.
Detection of driving impairments should focus upon the
loss of functional ability, not the diagnosis of a medical condition per se.
Possible reasons physicians don’t report a driver who is at-risk due to medical/functional impairments:
Physician is aware of reporting requirements, but
doesn’t have enough information to conclude that the patient’s condition clearly
poses a safety risk behind the wheel.
Physician is unaware of reporting requirements,
protections and immunities, or penalties for non-reporting.
Possible reasons physicians might choose to delay reporting or not report drivers who they know pose risk due to medical/functional impairments:
Physician feels the patient has made appropriate
adjustments in his/her driving habits to mitigate the risk associated with a
particular impairment (e.g., patient no longer drives at night), and out of
respect for patient’s privacy decides it is not necessary to “get the government
involved.”
Physicians understand the negative impact that loss of
driving privilege (due to medical impairment) can have on patients, especially
older persons in rural areas where mobility options are few. Driving cessation
sharply restricts access to essential services and has been shown to be a
significant predictor of depression, nursing home admission, and death among the
elderly.
A patient may communicate that, if a physician reaches a
judgment that he/she cannot drive safely or should be restricted in some way, it
will be easy to find another doctor—one unfamiliar with the individual’s medical
history—who will provide a clean bill of health. Faced with this likelihood, and
motivated by the consequent loss of opportunity to manage the patient’s
treatment, a physician may decline to report.
A patient may communicate that a physician report will
be regarded as a breach of confidence, and that he/she will cease doing business
with and/or sue the doctor.
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