Steps in the Driving Assessment
Step 1: Consider the Type of Licence Held or Applied For
- Determine whether commercial or private standards apply.
- Check licence type from:
- Driver licensing authority request form, or
- Patient history (esp. if in therapeutic relationship).
- Commercial standards are more stringent.
- Both sets of standards may be relevant in borderline cases.
- Health professionals should know the patient’s occupation to anticipate mobility implications.
Step 2: Establish Relevant Medical and Driving History
- Take comprehensive history including:
- Prior fitness-to-drive decisions.
- History of epilepsy, syncope, impaired consciousness, sleep/neurological/psychiatric/cardiovascular/metabolic disorders.
- Alcohol or drug misuse.
- Medication affecting cognition or motor function.
- Visual/hearing/motor impairments.
- Motor vehicle crashes or offences.
- Insight into driving capability.
- Driving habits: frequency, distance, night driving, purpose.
- ‘For cause’ exams may be requested after incidents.
- Consider interactions of multiple conditions.
- Use specialist referral when needed.
- For review assessments: focus on stability/status of known condition(s).
Step 3: Undertake a Clinical Examination
- Comprehensive physical and cognitive assessment.
- Routine neuro exam: Not required for every assessment.
- Targeted neuro exam: Required if clinical history, symptoms, or functional concerns are present.
- Use clinical judgment to assess risk of loss of vehicle control or delayed reaction.
- Focus on ability to safely control a vehicle and respond appropriately.
- Consider cumulative effect of multiple co-morbidities.
- Additional investigations or specialist referrals as required.
- In review assessments: focus on stability of condition and any new medical issues.
Step 4: Evaluate All Findings
- Integrate medical, driving, and functional information.
- Possible conclusions:
- Temporarily unfit (short-term, self-limiting).
- Meets unconditional standards.
- May drive with a conditional licence (with treatment or modifications).
- Does not meet standards (conditional or unconditional).
- Uncertain — consider specialist review or practical driving assessment.
- Investigate undiagnosed but suspected conditions (e.g. angina).
- Refer to licensing authority for borderline or unclear cases.
Step 5: Inform and Advise the Patient
- Educate on how condition affects driving safety.
- Temporary impairments: advise not to drive, involve family if needed.
- With licence authority requests: explain findings and implications.
- In therapeutic settings: clarify that the authority makes final decisions, not the clinician.
- Encourage voluntary reporting to licensing authority.
- Discuss alternatives (e.g. taxis, disability parking).
- Provide support materials and brochures as needed.
Step 6: Report to the Driver Licensing Authority (as Appropriate)
- Use the form provided by the licensing authority or medical notification form.
- Include only driving-relevant information.
- Provide the completed report to the patient; retain a copy.
- No additional consent needed for authority-requested exams.
- In therapeutic assessments, encourage patient to self-report.
- Report directly if:
- Patient refuses to report, and
- There’s significant risk to public safety.
- May need to notify police in cases of immediate danger.
Step 7: Record Keeping and Sharing
- Maintain complete records of assessments and advice.
- Share findings with the patient’s GP and involved specialists.
- Use standardised forms to enhance communication and coordination.
Step 8: Follow-Up
- No obligation to check whether the patient reported.
- Revisit driving status during future consultations.
- If unsafe driving persists, consider mandatory reporting.
- Health professional liability only arises if aware of:
- Patient’s continued driving, and
- Imminent and serious risk.
Clinical examination:
In Step 3: Undertake a Clinical Examination from the Austroads “Assessing Fitness to Drive” (2022) guidelines, the essential goal is to determine whether the person can safely operate a motor vehicle, considering physical, cognitive, and sensory function.
✅ General Principles
- Comprehensive, systematic clinical exam tailored to:
- The nature of the licence (private vs commercial)
- The patient’s medical conditions
- Their functional capacity to drive safely
- Examine for any signs of deterioration, progression, or risk factors impacting driving.
🧠 1. Cognitive Function
- Orientation (time, place, person)
- Memory (short and long-term)
- Executive function (planning, judgement, decision-making)
- Attention and concentration
- Insight and ability to self-monitor
- Consider using screening tools:
- MMSE
- MoCA
- GP Cog
- RUDAS (especially in CALD populations)
👁️ 2. Visual Assessment
- Visual acuity (meets minimum standards: e.g. 6/12 or better in better eye for private licence)
- Visual fields (check for hemianopia, quadrantanopia)
- Contrast sensitivity and glare recovery (if indicated)
- Look for signs of:
- Cataracts
- Macular degeneration
- Glaucoma
- Retinal disease
- Diplopia
💪 3. Motor and Musculoskeletal Function
- Upper and lower limb strength
- Range of motion (esp. neck, shoulders, knees, ankles)
- Fine motor control (for gear operation, steering)
- Gait and balance
- Functional mobility (getting in/out of vehicle)
- Any prostheses or aids and how they affect driving
🧍 4. Neurological Function
When indicated based on history or condition(a full neurological exam is not routinely required for all fitness-to-drive assessments.):
- Coordination (cerebellar function)
- Reflexes
- Power, tone, sensation
- Cranial nerves (esp. visual fields, facial weakness)
- Signs of Parkinsonism, MS, MND, stroke sequelae
❤️ 5. Cardiovascular Status
- BP, HR, rhythm (especially arrhythmias)
- Evidence of ischaemic heart disease or heart failure
- Any syncopal episodes (orthostatic BP, pulse check)
- Pacemaker or ICD status
🫁 6. Respiratory Function (if relevant)
- Evidence of hypoxia, sleep apnoea, or CO2 retention
- Consider overnight oximetry or sleep studies for suspected OSA
💊 7. Medications Review
- Sedating medications (e.g. opioids, benzodiazepines, antiepileptics)
- Polypharmacy
- Drugs affecting attention, cognition, coordination
⚠️ 8. Functional Status and Insight
- Ability to safely perform driving tasks
- Awareness of limitations
- Willingness to comply with treatment/monitoring
- Ask about:
- Driving history (incidents, near misses)
- Self-assessment of driving ability
📌 Special Considerations
- If conditional licence in place: focus on current condition and new developments
- If multiple comorbidities: assess additive impact on function
- Refer for OT driving assessment or specialist opinion if borderline