Re: Driver assessment

Issue: BCMJ, vol. 52, No. 8, October 2010, Page 386 Letters
By: Robert Shepherd, MD

A doctor who never examines his or her patients is doing a poor job. The Office of the Superintendent of Motor Vehicles (OSMV) tests young drivers repeatedly. The OSMV does not test older drivers. Dr Jensen wrote, “The physician has no authority to have the driver’s licence cancelled. The decision to… deny a licence to operate a motor vehicle rests solely with OSMV” [“Driver assessment and the duty to report.” BCMJ 2010;52:122].

Patients do not understand this. The only contact older patients have with the OSMV is a letter requiring them to get a medical exam. As far as the patients are concerned, this exam is a routine visit that they happen to have to pay for. Several patients have left my practice because I required them to have an evaluation at DriveABLE (www.driveable.com). 

One such patient is Mr B., a gentleman who enjoyed driving. I used to look forward to his visits, and he en­joyed his visits with me when he would tell me about the history books he had been reading. When I asked him to go to DriveABLE, he scored far below normal on “Identification of driving situations.” 

Now his wife tells me that he sits around at home complaining about the doctor who took away his driver’s licence. He almost never comes to see me, so I cannot examine him.

On the OSMV “Driver’s medical examination” is a request that the doctor check a box “cognitive impairment MMSE score.” The Folstein Mini Mental Status Examination does not evaluate executive function. It is possible for a person to score well on the MMSE, but have sufficient loss of executive function that he or she should not drive.

The OSMV “Driver’s medical examination” requires the doctor to evaluate visual field. Kerr and colleagues demonstrated that “most confrontation visual field tests were insensitive to the identification of field loss.”1

The current method by which the OSMV evaluates older drivers is inadequate to assure safe driving. The current method by which the OSMV gathers information about older drivers, the driver’s medical examination, destroys the trust between patient and doctor. 

The OSMV should require older drivers to have their vision checked by an optometrist by the automated static perimetry. The OSMV should examine older drivers and do a screen of cognitive ability. The only test that assures that a person can drive safely is a road test.
—Robert Shepherd, MD
Victoria

Robert Shepherd, MD. Re: Driver assessment. BCMJ, Vol. 52, No. 8, October, 2010, Page(s) 386 - Letters.


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