Doctors’ advice to unfit drivers is lifesaving, study finds

When a physician tells a patient it’s time to hang up the keys to the car, there’s an “immediate, substantial and sustained” reduction in that patient’s likelihood of being in a motor vehicle accident that requires a trip to the emergency department, a new study finds.

There is a cost though: Almost 30% of patients who got such unwelcome news visited the doctor who delivered it less often in the year following their office visit -- and 10% of that group didn’t come back at all in the following year. In addition, the patients who received such advice from their physicians were more likely to experience depression in the following year.

Compared to older drivers who had not (yet) been urged by their physician to curtail or discontinue their driving, those who had received such counsel were 45% less likely to be behind the wheel in a car accident that resulted in a trip to the hospital, said the study, published in the New England Journal of Medicine on Thursday.

“These data suggest that warning drivers who are medically unfit to drive may reduce the risk of road crashes,” wrote the authors.

But, the authors wrote, “patients often overestimate their driving skills, believe that statistical data do not apply to them, and fail to take protective actions to reduce trauma” -- in short, they ignore the doctor. So, the authors added, physicians do face an ethical conflict in taking on the role of “bad cop” for their patients who have begun to suffer mental lapses or physical disabilities due to age or disease: Not everyone will follow the physician’s advice, but heeded or not, it can cause a rift in the patient-doctor relationship and a decline in the patient’s mental health.

The study emerged from a unique experiment in the Canadian province of Ontario. In 1968, the province made it an obligation of physicians to issue a warning to patients whom they considered to be unfit to drive owing to a medical condition. Few physicians obeyed the new law. So in 2006, Ontario instead became the governmental authority in North America to offer physicians a financial incentive -- a payment of $36.25 -- to issue those warnings where appropriate.

Those financial incentives did seem to increase the frequency with which physicians counseled their patients to stop driving, the authors said. But they may also have resulted in the delivery of harsh and unnecessary warnings to drivers who are still competent, they added.

Among the authors’ recommendations: further research on the effectiveness of graduated licensure for older or medically impaired drivers. A variant of the graduated licensure that allows new drivers expanded freedom with more experience, such measures would gradually pare the circumstances under which such drivers would be allowed to drive -- after dark, for instance, in adverse weather conditions or on major highways.

Do you need to have “the talk” with an elderly parent or loved one about driving? Read this: How to Have ‘The Talk’: Understanding and diplomacy when suggesting lifestyle changes can be vital, experts on aging say.

and: Older drivers overlook streetside pedestrians almost twice as often as younger drivers