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VIEWS Fitness to drive can be difficult to determine ARE THEY SAFE TO DRIVE? A client-centred approach to comprehensive driver evaluations By JENNIFER MASON, OT Reg(NS), and TOBI FLEWWELLING, OT Reg(NS) O ne of the most emotion- ally charged issues a family physician faces is whether someone is medically fit to drive. The CMA Driver’s Guide identifies “a statutory duty on physicians relating to the reporting of patients deemed unfit to drive.” In Nova Scotia, reporting to the Registry of Motor Vehicles is discretion- ary; however, a physician may be considered liable if a patient with a medical condition is not reported and is subsequently involved in an accident. Fitness to drive can be difficult to determine. For those with suspected cognitive impairments, there is poor evi- dence linking paper-and-pencil tests to on-road performance. And individuals with physical limitations may be able to safely operate a vehicle equipped with the appropriate adaptations. The gold standard for evaluat- ing driver performance is an on-road evaluation. The Driver Evaluation Program, based at the Nova Scotia Arthritis 22 March 2018 | doctorsNS and Rehabilitation Centre in Halifax, is the only program of its kind within the Nova Scotia Health Authority, providing physicians with a comprehen- sive evidence-based evaluation of driving ability. The evaluation is carried out by occupational therapists with extensive training in driver rehabilitation. A driving assessment takes approximately 2.5 hours and includes both a clinical evaluation and on- road assessment. Participants undergo a physical assessment, cognitive and perceptual screens, and a trial on a driving simulator, when appropriate. All clients participate in an on-road evaluation by the occupational therapist and a Certified Driving Instructor in a dual-brake vehicle. If needed, the car can be equipped with common mechanical adapta- tions: hand-controlled gas and brake, left foot accelerator, and steering adaptations. There are two routes for the on-road evaluation; the client’s route is selected based on their typical driving environment. Evaluation results are reviewed with the client and any family members in attendance. All clients are advised that they require final confirmation from their physi- cian. If it is recommended that the client stop driving, clients are provided with emotional support and help identifying transportation options beyond driving. Every effort is made to keep the responsibility for the decision within the program, in order to maintain and support family relationships, as well as the relationship between client and physician. The final report is sent to the referring physician and family physician (when the referral is initiated by a specialist.) No report is sent to the Registry of Motor Vehicles without the client’s consent, as occupational therapists in Nova Scotia do not have the same legal protection as physicians. Like similar programs else- where in Canada, the program is not covered by MSI. The cost of the program is $440 and may be covered in full or in part by private insurance that includes occupational therapy coverage. Physician referrals are required. Further information and referral forms are available at under Driver Evaluation Program. Find out more Medical Fitness to Drive CMA Guide drivers-guide.aspx Brochure: Driving safely as you age older-driver-safety/ Canadian Association of Occupational Therapists – Safe Driving drivingtips?nav=sidebar The Association of Driver Rehabilitation Specialists