Physicians are the license gatekeepers

When Stephanie ran into her father’s doctor in town one day, she made her concerns about his driving very clear.

His doctor has the same feelings, but still didn’t want to report Stephanie’s father to the RMV. The doctor was worried reporting him would harm the relationship she had with Stephanie’s father, the doctor told her – people don’t tend to like someone who takes away their license, especially when driving is required for daily life.

His doctor wanted to have Bill assessed by a gerontologist instead.

But, it took three months to get an appointment – an eternity for Stephanie, who had daily anxiety about her father being on the road.

Bill’s doctor isn’t alone in her concerns about balancing the doctor/patient relationship and reporting people to the RMV.

Dr. Chris Simpson, a professor at Queen’s University and the president of the Canadian Medical Association, has had the conversation more times than he’d like.

“It’s an extraordinarily difficult task,” he said.

He’s had patients cry, yell at him, become violent and threaten to keep driving anyway.

“I can’t think of a single person who said, ‘Thank you for taking my license away’,” said Simpson.

Balancing a patient’s freedom, independence and future medical care with public safety is a difficult line to walk, he said.

Unlike most other provinces, medical professionals in Nova Scotia are not legally required to report drivers they don’t think are fit to drive to the RMV – the duty to report is considered discretionary.

But if physicians are the main mediators of who is reported to the RMV based on medical grounds, and it’s a duty they don’t necessarily want, identifying people who pose a danger on the road becomes difficult.

“We’re in a profession that’s used to helping and advocating for people,” said Simpson. “And when we’re cast in this role, it’s directly working against that.”

The idea behind the physician reporting system is that doctors interact with patients on a regular basis and are the most capable of identifying medical changes.

In Nova Scotia, 96 per cent of people over the age of 65 have a family doctor, but that rate varies across the province and between age groups, according to Statistics Canada information. On the South Shore, for example, it drops to 89 per cent.

When it comes to people who have actually seen a doctor in the past year, those rates drop even lower.

On average in Nova Scotia, 91 per cent of people over the age of 65 have seen a doctor in the past year, according to Statistics Canada. The number drops to 85 per cent in Colchester-East Hants. Rates for people 80 and older were not available.

Several national studies also suggest that doctors often don’t feel they know enough to recommend taking away someone’s license.

Nova Scotia has a thorough assessment program doctors can refer their patients to if they are unsure, but the program is expensive.

The assessment, which is done by specially trained occupational therapists, includes a physical screening, a reaction test, a cognitive and perception screening and a road test.

The point isn’t to take people off the road, said Jennifer Mason, one of the program’s therapists, but often to find solutions or adjustments that will help keep them safe. Sometimes, it’s not that a driver isn’t capable, it’s that they’ve never been taught how to drive to today’s standards and have developed bad habits.

Watch Jennifer Mason explain some of the tests she uses:

This test is only done in Halifax, and also takes patients from PEI and New Brunswick.

In 2011, the assessment switched to a cost-recovery program, which raised the price from $40 to $440, paid for by the patient.

Before the cost increase, an average of about 200 people went through the program each year. The numbers dwindled in the years after the increase, dropping to 19 in 2012, but they’ve started to recover since: 140 people used the program in 2014.

Arsenault, the Registrar of Motor Vehicles, said there is little evidence to suggest that mandatory systems make doctors report more than discretionary systems. Plus, he said, doctors take an ethical oath, making them ethically obliged to report. He feels the province’s doctors are reporting enough.

When a patient knows certain symptoms could get their license yanked, however, “it encourages them to lie,” said Simpson, giving the example of someone who suffers from seizures, but wouldn’t report it to their doctor for fear of having their license taken away.

“Not only are they still driving,” he said. “But, they’re on inadequate medical therapy as well.”

In provinces that legally require physicians to report, “the doctor is on the hook,” said John McKiggan, a Halifax personal injury lawyer. That creates a legal incentive for doctors to report their patients.

A doctor in Nova Scotia can still be held accountable for failing to report a patient, but making the legal case is much more difficult, he said.

Many provinces also require several other health care professionals – such as occupational therapists, nurses and optometrists – to report drivers they feel could be unsafe to the relevant department.

The Canadian Association of Occupational Therapists publically called for provincial governments to increase the onus of reporting to other health care professionals – not just physicians.

While the report acknowledges that other health care professionals might not feel equipped to make those judgments, the idea “is to widen the opportunity to identify those at risk of unsafe driving.”

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