Medical aspects of fitness to drive a guide for medical practitioners

1.2
General factors for medical practitioners
to consider
In assessing an individual’s fitness to drive, remember that the issue is often not
whether the individual has a particular medical condition, but whether the condition
has produced significant risk factors in respect to an individual’s ability to drive safely
and whether they are a danger to themselves or others.
Medical practitioners should consider the following general factors, in addition to the
guidance outlined under each section, when assessing an individual for fitness to drive:
• Individual’s ability to drive safely, eg some individuals may not respond well to
treatment, and therefore may not be able to drive at the end of the recommended
minimum period of refraining from driving
• Risk of serious motor crashes due to sudden driver failure, eg presence of any factors
that may cause sudden loss of vision or sudden impairment of driving ability
• Type of licence held and type of driving undertaken – professional drivers spend up
to an entire working week in their vehicle, and that vehicle can weigh greater than
25,000kg or carry many passengers. A crash involving such a vehicle could put
many people at risk. In addition to the type of licence or endorsement held, the type
of driving an individual undertakes should also be considered, eg if an individual
regularly drives buses or unloads heavy vehicles
• Medication – consider the effects of medications, and likely compliance with
medications, on the individual’s ability to drive safely
• Individual’s motor vehicle crash history (if known) – medical practitioners may need
to recommend a longer period of refraining from driving if an individual has a history
or pattern of crashes that may be associated with their condition. Where a medical
practitioner is aware of a medically related crash, they must inform the Agency if
the individual’s medical condition remains unresolved and the individual is likely to
continue to drive (refer to section 1.4)
• Presence of multiple medical conditions – where an individual has one or more
medical conditions, consider any possible combined effects on their ability to
drive safely.
1.3
Medical examinations
Medical practitioners must recognise their role in conducting the examination. Driving
is not a right and the medical practitioner has a legal and ethical obligation to ensure
that the safety of other road users, as well as the individual, is the primary concern in
making any decision on fitness to drive.
It is tempting for the medical practitioner to act as an advocate for their patients
but this is inappropriate. In situations where this cannot be resisted, medical
practitioners should be prepared to disqualify themselves and refer their patients
to another medical practitioner. This may be a wise procedure under other
circumstances as well, especially when there is a risk of damaging an established
therapeutic relationship. Nonetheless, as a normal rule, the examiner is expected
to be the patient’s regular general practitioner.
Part 7 and part 13 of the Land Transport (Driver Licensing) Rule 1999 requires medical
examinations to be carried out with regard to the guidance contained in this booklet.
The approved form of medical certificate requires the medical practitioner or a
registered optometrist, as appropriate, to sign that the examination has been carried
out with regard to this booklet and that the requirements for certifying a person fit to
drive have been followed.
Changes in medical assessment practices
Technology or knowledge on assessing fitness to drive may change over time.
Therefore, where this guide recommends a particular test or examination, if a different
test or examination is subsequently generally used that achieves a similar level of
assessment, then this can be used.
Medical practitioners, optometrists and occupational therapists are expected to keep
themselves apprised of major changes in medical knowledge that may influence their
assessment or treatment of drivers.
Medical certificates
The Agency has developed a medical certificate for medical practitioners to use.
Copies of this certificate are available on the automated ordering system or from
the Agency’s Transport Registry Centre in Palmerston North (0800 822 422 ext 8089).
6 1. General matters | Medical aspects of fitness to drive | NZTA July 2009
July 2009 NZTA | Medical aspects of fitness to drive | 1. General matters 7