A Proposed Algorithm to Determine Fitness to Drive in Patients With Epilepsy
Background: Certification of fitness to drive by the treating doctor may create a conflict of interest which can result in damage to the doctor-patient relationship, inappropriate certification decisions and legal vulnerability for the doctor. The Epilepsy Society of Australia and ANZAN believe that certification is the role of the driver licensing authority (DLA) rather than the treating doctor.
In order to facilitate certification of epilepsy patients by DLAs, a decision tree was developed to allow non-medically trained clerks to determine fitness according to the Austroads national standards, using information provided by the treating doctor on a questionnaire. This approach was accepted by the Austroads Registration and Licensing Taskforce, representing all driver licensing jurisdictions in Australia.
Methods: The standards contained in Assessing Fitness to Drive 2003 were converted to a list of questions. The answers are then processed in a logical sequence to form an algorithm, yielding outputs including: “Fit to drive”; “Unfit until [date] and requires recertification at that time”; and “Requires formal review”. The algorithm was converted to a computer program.
To reduce the risk of accidental determination that a driver is fit, based on inconsistent or incomplete information on the form, or incorrect data entry, a number of safeguards and consistency checks were included.
Conclusion: The Austroads standards can be applied by non-medically trained clerks, using information supplied by treating doctors. However, an expert neurological review mechanism is essential to decide cases where fitness to drive is unclear or where additional information is supplied by the treating doctor.