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After 9 years, Austroads has published new guidelines for fitness to drive. The guidelines have a preamble, which includes a legal disclaimer denying any culpability for those who designed the guidelines. They also warn of the legal responsibility for health professionals to satisfy their obligations, the need to be current with both relevant medical and legal expectations and if in doubt to seek guidance from Medical Defence Organisations. The guidelines are divided into Parts A and B, with A providing broad overview and background information while B deals with specific entities, such as blackouts, epilepsy or sleep disorders. This paper examines the guidelines and offers an appraisal of their content, their relevance to health practitioners and an assessment of their role in assisting to improve road safety. [ABSTRACT FROM AUTHOR]

Following the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed ‘... the identification and application of world best-practice...’, they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving. [ABSTRACT FROM AUTHOR]

Introduction: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines. Methods: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed. Results: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with <9% not doing so – establishing ∼77% response for eligible neurologists. Most questions achieved 90% response. Almost 90% respondents assessed epilepsy and 70% found the guidelines helpful. Seventy-seven per cent endorsed doctor assessors although half discounted General Practitioners as insufficiently knowledgeable and half advocated that only neurologists evaluate potential drivers with epilepsy. Most respondents supported reporting recalcitrant patients; yet only <30% did so. Three-quarters favoured licences carrying a warning to self-report and two-thirds felt that product information should identify driving implications. Although many questions attracted expected responses, the surprise was the large undecided numbers, which were greater than expected. Neurologists were more lenient than prescribed by the guidelines with neither consensus for controlled epilepsy nor mandatory driving restrictions. Conclusion: Respondents supplied predictable answers regarding ideal circumstances; yet most did not report recalcitrant patients. Most claimed to adhere to the guidelines and yet advocated more lenient driving restrictions that may allow preventable accidents. There was agreement between neurologists and guidelines for more rigourous restrictions for commercial drivers although again neurologists were more lenient. There is need for prospective research on epilepsy and driving. [ABSTRACT FROM AUTHOR]

AbstractGuidelines on fitness to drive were released by AUSTROADS and the National Road Transport Commission in September 2003. No recognised legal medical authority was cited. There are three parts in the document: (i) background information, (ii) specific medical conditions and (iii) appendices of relevant documents and contacts. This paper analyses the relevance of the guidelines for physicians and notes that the disclaimer exonerates its authors from potential repercussions. Guidelines for both private and commercial drivers are combined in the document and the basis for such delineation is defined. A lack of universal Australian standards with no State indicating the driver's responsibility to report changes in health standards on the issued licences is confirmed by the guidelines. Not all States indemnify physicians for reporting contrary to patients’ wishes, while South Australia and the Northern Territory mandate reporting those at risk. Much of the language is patronizing, expecting‘... conciliatory and supportive ...’ behaviour even with recalcitrant patients. No allowance is made for patients who may not fulfil the guidelines but whom the doctor may consider fit to drive. Ambiguity regarding responsibility to report, as identified in the background section, may leave the doctor vulnerable for not reporting a patient who subsequently may cause injury. Attempt is made to differentiate the role of the specialist from the family general practitioner (GP), advocating specialists for commercial drivers, although this is largely left to the discretion of the GP. There is an implied onus on doctors to report all patients with the conditions under review. Some diagnoses, such as syncope, are discussed in different sections with application of conflicting limitations. Inappropriate language, such as reference to a seizure being‘... an isolated non-epileptiform event ...’, or withdrawal of medications failing to be restricted to anti-epileptic medications confounds interpretation. Some sections, such as that on sleep and epilepsy, are effectively analysed, while illnesses such as dementia are considered superficially. The guidelines are an attempt to assess fitness to drive, but contain serious flaws and provide limited information upon which to base decisions. Ambiguous language complicates application of the guidelines and places the health care professional at risk, despite a disclaimer protecting its authors. (Intern Med J 2005; 35: 364–368) [ABSTRACT FROM AUTHOR]