In Jennie Russell’s news article No Driving for Miss Daisy Dr. Malcolm Man-Son-Hing discusses the problem of assessing driver capacity.1 He states that there is no scientific standard for making the call and that some doctors are too strict and others too lenient. “That kind of variation in practice is rather unfair. … It puts a huge strain on the physician–patient relationship,” said Hing. Cognitive impairment is one of the conditions where variability and guesswork may occur. This places physicians in a difficult position if they are to rely on clinical judgments about fitness to drive. A better approach is to evaluate the effects of comorbidities, polypharmacy, age and other factors using a relevant, functional assessment of driving competence.
The British Columbia Office of the Superintendent of Motor Vehicles’ (OSMV) new guide, 2010 BC Guide in Determining Fitness to Drive states that if a physician makes a diagnosis of dementia or has a suspicion that there is cognitive impairment, he may perform a SIMARD-MD test and, based on the result, refer patients to the OSMV for testing.2 The OSMV then decides whether to cancel the driver’s licence.
Dr. Hing’s research, or the research of others, may lead to the development of more effective tools for assessing driving capacity. For now, I know that I am responsible for making the best possible decisions for my patients. The approach outlined in the 2010 BC OSMV guidelines helps me to do that.