otherwise license would be cancelled
Doctor warnings to unfit drivers reduce serious crashes, study finds - Published on Wednesday September 26, 2012
The number of car crashes that sent potentially medically unfit drivers to hospital with serious injuries has dropped by 45 per cent ever since the province began paying doctors to issue warnings, according to a study in the New England Journal of Medicine.
But the intervention also had a downside, with an increase in emergency department visits for depression by these drivers and a decrease in return visits to the physicians responsible.
“Our findings suggest that medical warnings to patients who are potentially unfit to drive are both effective at saving patients’ lives and saving costs to society,” said lead investigator Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences.
The accident reduction translates into $7 million saved annually from avoided health-care costs, property damage, and premature mortality and morbidity, the study states.
In 2006, the province began paying physicians $36.25 each time they issued warnings to patients deemed possibly unfit to drive. A warning consists of having a talk with the patient and then notifying the Ministry of Transportation that the patient has a condition that could affect driving ability, such as sleep apnea, alcoholism, drug dependency, seizure disorder, dementia or a combination.
The ministry then sends a notice to the patient, advising that a letter from a doctor is needed to verify that the condition in question is under control. Patients who cannot produce such letters can have their licences suspended.
Between April 1, 2006 and Dec. 31, 2009, more than 100,000 patients received medical warnings from 6,098 physicians. Of those, 10 to 30 per cent had their licences suspended.
The warnings appear to have an impact even on drivers who don’t receive suspensions, explained Redelmeier, who is also a senior scientist at the Sunnybrook Research Institute and a professor of medicine at the University of Toronto.
“At the extreme, some individuals probably stop driving. At the other extreme, they probably drive the exact same number of miles; they just stop driving recklessly. They stop at stop signs, they yield right of way, they minimize distractions,” he said.
Some drivers become more vigilant about taking care of the medical conditions, which in turn makes them better drivers, he added.
In calculating the 45 per cent drop in serious trauma from road crashes, researchers looked at the driving records of the 100,075 motorists in the study. They compared the number of serious crashes that sent drivers to hospital before and after warnings were issued. Before the warnings, there were 4.7 serious crashes per 1,000 drivers a year. After, that ratio dropped to 2.7 per 1,000.
Meantime, the study found a 25 per cent increase in serious depression among the drivers issued warnings. Before the warnings, there were 19.1 emergency department visits for every 1,000 drivers annually; afterward, 23.9 ER visits per 1,000 drivers.
Redelmeier hypothesizes that is because of the loss of freedom associated with no longer driving, and the bad news that poor health could be affecting driving ability.
Patient visits to the physicians who had issued warnings dropped by 23 per cent in the year afterward, the study found. This suggests that the warnings could affect the doctor-patient relationship.