Section 2

Functional assessment — emerging emphasis

Various authors have described and explained the role of physicians in determining fitness to drive (e.g., Dow, 2006). Physicians in a medical office setting can assess their patients’ fitness to drive when the patients are clearly either capable or incapable of driving. This guide provides information to assist with those decisions. In less clear-cut situations, it may be necessary for the physician to employ other means of testing to perform a functional assessment. This usually involves on-road testing.

It should be emphasized that, with the exception of temporary restrictions for short-term medical situations, the physician is not required to determine whether a licence will be granted or suspended. The physician’s responsibility is to describe the situation, and the licensing authority will make a decision based on the physician’s observations, other available information (such as police reports), and its own interpretation of the regulations.

A functional assessment is appropriate when the medical condition in question is present at all times. A functional assessment is not appropriate when the driver has a medical condition that is episodic (e.g., seizures) and known to be associated with increased risk.

Licensing authorities make their own decisions about the evidence and opinions on which to base their decisions to grant or suspend a licence. There is a role for specialized road testing and computerized screening, as well as some self-administered tests (provided the patient has insight). Physicians may choose to refer a patient for additional assessment when such resources are available.

The decision to refer for assessment can be deferred to the licensing authority. Assessments are usually available through private companies and are paid for by the driver. Some public health care facilities offer driving assessments free of charge, but access is limited and waiting lists tend to be long.

Some jurisdictions use off-road evaluations, based on tools such as driving simulators or batteries of tests, to predict on-road behaviour. Computerized testing may provide useful, objective information about functions believed to be important for safe driving. However, there is insufficient evidence to support licensing decisions based solely on the results of this type of testing.

Most Canadian jurisdictions have some form of formal road testing in place, often conducted by occupational therapists who specialize in the functional testing of drivers. In some jurisdictions, certified technicians do the testing. Assessments are typically limited to drivers of non-commercial cars. Drivers of commercial vehicles and motorcycles usually cannot be evaluated in private centres, although some specialized centres have developed testing protocols for drivers of these vehicles.

Currently, there is insufficient evidence to recommend for or against any specific testing method, although authoritative research in this field has demonstrated clearly that the novice driver’s road test is inappropriate for experienced drivers. Any road test for experienced drivers must include driving in unfamiliar surroundings, to test how the driver reacts to situations that differ from their daily routine. Although use of the driver’s own vehicle may reduce the level of stress, difficulty driving an unfamiliar vehicle may indicate cognitive inflexibility that could have a negative effect upon fitness to drive.

Geographic limitations (i.e., restricting drivers to their local area) are not recommended for drivers with cognitive problems, especially those with dementia. In fact, recent guidelines on dementia (e.g., Rapoport et al., 2018) recommend that any driver with dementia who requires the imposition of licence restrictions to ensure driving safety should be suspended from driving completely (see Section 8, Dementia).