Being in possession of a driver’s license is a near universal privilege in our society with virtually only two ways this entitlement can be removed. Obviously irresponsible behaviour behind the wheel will inevitably lead to confrontation with a local law officer, followed by a punitive judicial process; but the more prevalent reason for loss of a driving license is medically determined incompetency. It’s a good law but not well understood. In the 60’s the Canadian Medical Association with its provincial counterparts approached the provincial legislatures requesting clarification of MOT rules in an attempt to create consistency and fairness for every driver. What has not been well understood is the
OBLIGATION to report medical issues that might affect driving ability. There are substantial penalties for not doing so. There are many ailments that MAY be reported. In many circumstances the determining factor is the severity of the disease as well as the unstable state of the disease. Examples would be uncontrolled seizures, recurrent diabetic coma or insulin reactions, strokes severely affecting motor skills, even certain unstable psychiatric diagnoses to name a few obvious ones. At the time of diagnosis, the physician is required to inform the patient of the decision, request the patient not drive and forward the diagnostic information to the Ministry where it is reviewed by the government medical experts. The patient does have the right to appeal and not all revocations are permanent if treatment stabilizes the diagnosis. The greatest number of patients and family comply with the ban; understanding the safety issue. A few are not, and for those their medical information will become available to MOT personnel on a confidential basis. Very few patients ignore the medical advice and risk the inevitable legal and insurance issues should there be an accident.
Recently, in response to our changing demographics, the Ontario government has introduced an innovative testing program for seniors. Testing is mandatory at age 80 but may be required earlier, depending on one’s driving record. There is actuarial reasoning for all this. Everyone knows the young male driver is statistically the likeliest offender but a senior over age 70 is a close second. Worse for the senior is the severity of an accident because seniors have greater severity of injury and healing time. Our reaction times are slower, and, well, to state it bluntly, we don’t collectively bounce so well anymore. Recent demographics show ten percent of the population already have some degree of cognitive impairment by age 65. With life expectancies now reaching the mid to late 80’s there comes an inevitable line in time when our skill levels do not meet the required standards.
Under this new program, driver records are automatically reviewed by birthdate. You will have a standard eye test. This you can practice in advance with your own physician and receive new glasses if you require. You will participate in a group study reviewing the new laws –and there are many. The two new components of testing address cognitive impairment issues particularly visual-spatial integration (Big word just means how you recognize and organize new information.) The testing is done in a non-confrontational and education orientation setting with most parts in group discussion format. This new testing structure recognizes the plus side of seniors behind the wheel, the greater sense of responsibility innate in seniors and their life experience and life situation judgement skills but it also carefully analyzes limitations in reaction times, vision acuity and fields and motor skills.
The successful candidate is then green lighted for two years then retested and every two years after that. I endorse the new system because it is fair, standardized and removes some of the burden weighing heavily on the personal physician who may have a thirty or forty year relationship with a private practice patient. On the few occasions when I heard grumblings, I reminded the driver they have led an exemplary life in the community. Nobody wants to be remembered as the cause of an accident headline.
Dr. David Carll