Current fitness to drive decisions a conflict of interest

People with epilepsy should have their fitness to drive decided by driver licensing authorities (DLAs) rather than relying solely on the treating doctor’s opinion, neurologists say. In calling for a national system to take the entire onus off doctors, Associate Professor Ernest Somerville, a neurologist at Prince of Wales Hospital, Sydney and the chairman of the driving committees of the Epilepsy Society of Australia, and colleagues say there is currently a conflict of interest in that some doctors are pressured by patients to allow them to drive, particularly if they need a licence for work. The authors also say that the present situation can be detrimental to doctor patient-relationships and hamper effective treatment. It is also open to abuse because patients are able to shop around for opinions in an attempt to regain their license. “[This can] lead to suppression of information and ultimately result in injury or death of the patient or other road users,” they wrote in the MJA. The article cites an example of one fatal, seizure-related motor vehicle accident (MVA) to highlight the medico-legal ramifications for doctors. In this case the coroner referred the treating neurologist to the NSW Director of Public Prosecutions. The authors noted that most drivers were also unaware they were legally obliged to tell the relevant DLA in their state when they were declared unfit to drive. It was also not mandatory in NSW for doctors to inform the authority. Transport authorities in each state should set up an independent expert body, Dr Somerville said, to review information provided by a driver's doctor and make any final call on their licence. ''A review mechanism to deal with uncertain or exceptional cases is important in any certification system. Ideally, this should be an expert panel of neurologists, indemnified by the [driver licensing authorities],'' they wrote....