Self-Reporting by Unsafe Drivers Is, with Education, More Effective than Mandatory Reporting by Doctors

Abstract

Study Objectives: Health professionals are frequently required to report to relevant authorities all drivers who are potentially unsafe due to medical conditions. We aimed to assess both the effect of mandatory reporting (MR) on patient self-predicted behavior and what factors might encourage unsafe drivers to self-report to these authorities. Methods: We included 5 questions in the South Australian Health Omnibus Survey, an annual, community based, face-to-face survey. We asked (1) how subjects would behave towards their doctor in light of MR if they believed their licences were at risk due to a medical condition; and (2) which factor(s) would cause them to self-report to the same authorities. Results: Responses to 3,007 surveys (response rate 68.5%, age 15-98) showed that 9.0% would avoid diagnosis, lie to their doctor, or doctor shop in order to keep their licence; 30.8% were unaware of the legislated requirement to self-report; and 37.9% were unaware of potentially jeopardizing insurance support if they failed to comply. If educated in these 2 areas, warned about the dangers of driving against medical advice and instructed to do so by their doctor, then 95.8% of people would self-report to the authorities, a number significantly higher than could be reported by their doctors (91.0%). Conclusions: MR causes 9.0% of people to predict to behave towards their doctor in a manner that reduces road safety. With education and encouragement to do so, more people will self-report to the authorities than could be reported by their doctors via the MR pathway. Commentary: A commentary on this article appears in this issue on page 287.

Mandatory reporting by doctors of medically unsafe drivers is unpopular and poorly adhered to: a survey of sleep physicians and electro‐physicians

“…Again substantiating their warning, our study showed that the majority of doctors suspected some of their patients of attempting to doctor shop (25/35), discouraging others from seeking medical help (23/35) and withholding information (33/35) because of the fear of MR leading to loss of licence. Given that between 5 and 20 out of 35 doctors ‘frequently’ suspected patients of these behaviours, these results lend weight to our voiced suspicion that our previously reported figure of 9% of the population who reported being likely to behave in an unsafe manner if their licence was at risk was an underestimation …”

“…Given that between 5 and 20 out of 35 doctors 'frequently' suspected patients of these behaviours, these results lend weight to our voiced suspicion that our previously reported figure of 9% of the population who reported being likely to behave in an unsafe manner if their licence was at risk was an underestimation. 9 Our earlier research also highlighted the importance of the legal obligation of patients to self-report to the DPTI when their health may affect their ability to operate a motor vehicle safely. Concurrent with MR, selfreporting provides an alternative and possibly superior pathway.…”

“…Self‐reporting would help prevent the damage done by MR to doctor–patient relationships. Highlighting the value of a multifaceted approach, it has been shown that more individuals would self‐report if made aware of the fact that if they failed to do so they may be un‐insured in the event of an at‐fault accident where a non‐reported medical condition contributed to the crash . Certainly, AFD recommends that drivers should be aware of their common law liability and potential ‘long‐term financial, insurance and legal consequences where there is failure to report’…”

“…Severe (and untreated) obstructive sleep apnoea syndrome has been shown to increase accident risk by 1.2-4.9 times. 8 Recently, we showed that 9% of the SA population reported being likely to behave in an unsafe manner if their licence was at risk due to MR. 9 What is not known is: (i) how SA doctors view MR, (ii) the extent of adherence and their reasons for non-adherence and (iii) what their experience is of patients' behaviour as a consequence of MR. To investigate these questions, we surveyed two groups of doctors whose patients would frequently mandate being reported: respiratory sleep physicians and electro-physicians (specialists in cardiac electrical rhythms).…”

Truth or Consequences

“…This issue of JCSM includes a provocative paper by Elgar et al 1 that has implications for all of us who drive. These investigators analyzed responses of more than 3,000 individuals from the face-to-face South Australian Health Omnibus Survey, and concluded that 9% would avoid diagnosis, lie to their doctor or doctor shop in order to keep their license.…”