Mandatory reporting by physicians of patients potentially unfit to drive

BACKGROUND One strategy for the prevention of motor vehicle crashes is physician reporting of medically unfit drivers to vehicle licensing authorities, as mandated by law in Ontario, Canada. We studied drivers involved in life-threatening crashes who required hospital admission to determine how many had previously been seen and reported by a physician in the community. METHODS We identified consecutive drivers involved in a crash who were admitted to Canada's largest trauma centre between 30 June 1996 and 30 June 2001 to assess the prevalence of 3 chronic medical conditions reportable to vehicle licensing authorities (alcohol abuse, cardiac disease, and neurological disorders). We then conducted a case series analysis of linked health and transportation databases to determine how many drivers had previously been seen and reported by a physician in the community. RESULTS A total of 1,605 injured drivers were identified, of whom 37% had a reportable condition (95% confidence interval [CI] 35-39). Those with a reportable condition had made a total of 20,505 previous visits to 2,332 physicians during the five years before the crash. The majority of patients with a reportable condition (85%, 95% CI 82-88) had seen a physician in the year before the crash but few (3%, 95% CI 2-4) had been reported to licensing authorities. Alcohol abuse was the most common underlying reportable condition (prevalent in 72% of trauma patients with a reportable condition) and the least common reason for a previous report (reported in 2% of those with a reportable condition). INTERPRETATION Unsafe drivers often visit physicians and yet are rarely reported to licensing authorities even under mandatory reporting laws for preventive medical reporting.