Health professionals completing medical reviews

Fitness to drive information for medical practitioners

This fact sheet explains the medical review process for medical practitioners, including patient responsibilties.

Key points

Fitness to drive may be an important consideration for people with some health conditions.
The medical practitioner’s role is to provide advice about the impact of these conditions on driving and to recommend strategies for management and monitoring.
The medical review process provides a mechanism for assessment and decision making about licensing, and for facilitating ongoing review if required. It aims to optimise driver capacity to drive in conditions that suit abilities, providing drivers are safe to do so.
All drivers have a legal responsibility to notify Medical Review of significant long term health or vision conditions that may affect driving safety. Health professionals can advise patients of this responsibility and educate them about the medical review process.
In most cases, referral to Medical Review does not result in licence cancellation. It may result in driving restrictions or medical monitoring to optimise future fitness to drive.
Health professionals are not legally mandated to notify Medical Review if a patient drives despite advice to the contrary. However they are ethically obliged to act in the interest of public safety. If they make a report to Medical Review they are protected from liability under Victorian Road Safety law.

Health conditions and fitness to drive

Driving is a complex task, which requires good vision, judgement, perception and physical abilities. Many health conditions may affect these attributes, so fitness to drive is an important consideration when you are managing your patients’ health.

Examples of conditions that may affect safe driving include:

vision and eye disorders
blackouts
cardiovascular conditions
diabetes
dementia and cognitive impairment
seizures and epilepsy
neurological conditions
musculoskeletal conditions
psychiatric conditions
sleep disorders
alcohol and other substance misuse.

Fitness to drive should be considered in both the short and long term. For a person diagnosed with a progressive condition (e.g. dementia), early discussions about driving will help the person prepare for non-driving, even though they may initially be safe to continue driving.

Regular medical monitoring is required to assess how the condition’s progression affects driving skills.

For other conditions (e.g. seizures or cardiovascular events), fitness to drive will require immediate consideration. The cumulative impact of multiple conditions and treatments (e.g. sedatives) also requires management.

Assessing and managing fitness to drive can be complex and challenging due to needing to balance driving for an individual’s independence, social contact or employmentwith community safety.

What is my role as a medical practitioner?

Your role is to provide advice to patients, carers and families about the impact of health conditions and their treatments on driving as well as making recommendations for management and monitoring.

To assist you, Assessing Fitness to Drive (AFTD) is a national publication containing information about assessing and managing fitness to drive.

It focusses on long term medical conditions as distinct from short term conditions requiring temporary driving abstinence (e.g. acute injuries, post surgery). Information is provided for both private and commercial licence holders.

The document is also used by Medical Review to make decisions about licensing.

Reporting obligations

In Victoria, there is no mandatory reporting requirement for health professionals. However, you have an ethical obligation to support public safety.

Thus, if you believe a patient lacks insight/judgement, and/or isn't heeding advice to cease driving or self-report, you may report directly to Medical Review using the online medical report form. You can report anonymously.

If you believe the driver poses an immediate risk to public safety, you should report directly to Victoria Police.

Always keep up to date records in the patient’s file of the advice you give, copies of report forms and any actions you instigate regarding fitness to drive.

What are the drivers’ responsibilities and how can I help my patients fulfil these?

You can explain to your patient that drivers are required by law to notify Medical Review of any long term or permanent medical or eyesight conditions or disabilities that may impact on driving in the longer term:

when they apply for, or renew a licence, or
as soon as possible when they become aware of new conditions/disabilities.

Such a notification will initiate the medical review process. Medical Review will request a fitness to drive medical report.

You can assist your patient to notify Medical Review by completing the medical report online.

When you complete and submit the online medical report, you’ll get a reference number. You can give the reference number and/or a PDF copy of the medical assessment report to your patient. You can also download, save or print the report.

What is Medical Review’s role?

Medical Review has a role in supporting health professionals to fulfil their patient advisory responsibilities.

Medical Review assists you by providing fact sheets that support conversations with patients about:

some specific conditions (e.g. dementia, sleep apnoea,
seizures and diabetes)
the medical review process
driving tests (medical review drive test and occupational therapy drive test)
older driver issues (e.g. ageing and driving, health conditions and driving, retiring from driving)

While health professional’s role is to provide advice about fitness to drive, Medical Review is solely responsible for issuing, renewing, suspending, refusing or cancelling, or reinstating a person’s driver licence (including a conditional licence).

Most importantly, patients should understand that having a medical condition doesn't necessarily lead to a loss of licence. Licensure can be achieved through options such as conditional licences and regular reviews to monitor health conditions.

Diagram showing an overview of the medical review process and case-by-case assesment process

What is a conditional licence?

A conditional licence provides a mechanism for optimising driver and public safety while maintaining driver independence under certain conditions.

Licence conditions may specify:

medical management (e.g. medication, periodical reviews)
vehicle modifications
to drive within a certain radius from home (e.g. 5km)
no night driving
auto transmission
zero blood alcohol content (BAC).

Early discussion of the concept of a conditional licence will help allay concerns and raise awareness of licensing options especially for patients with long term/deteriorating conditions.

What happens if a driver doesn’t follow my advice?

If a person continues to drive despite advice and they don't report their condition to Medical Review, they aren't fulfilling their legal responsibility.

If they are involved in a crash under these circumstances and it's determined that their health condition was a contributing factor, they may be prosecuted and their insurance may not be valid.

If you have concerns about a patient’s ability to drive safely you can make an anonymous report to Medical Review using the online medical report.

What happens when a patient is referred to Medical Review?

When Medical Review receives a medical report, all information together with the patient’s licence history and any other information (e.g. from Victoria Police, Courts, on-road test results) is considered.

The majority of people with a first notification retain driving privileges, often with a conditional licence.

Medical Review makes licensing decisions on a case-by-case basis with reference to the national AFTD guidelines. Complex cases maybe reviewed by external medical advisors.

Are there special requirements for commercial drivers?

Reflecting the increased risks associated with driving commercial vehicles, more stringent health standards apply to commercial drivers (e.g. truck, bus, taxi, bulk/dangerous goods and heavy vehicle drivers).

These requirements are outlined inAustroads' AFTD guidelines.

It's important for health professionals to ask about possible driving requirements for work so that the relevant standards can be applied. A person who does not meet the commercial vehicle medical or eyesight criteria may still be eligible to retain a private vehicle driver licence.

Resources

Austroads
Advice in this fact sheet is based on Austroads' Assessing Fitness To Drive guidelines.

AFTD is the national publication containing detailed information about clinical assessment and management of drivers, including criteria for determining fitness to drive for particular medical conditions.

Download a PDF of this page: fitness to drive information for medical practitioners (PDF).