Guidance

Assessing fitness to drive: a guide for medical professionals

Advice for medical professionals for assessing fitness to drive.

Introduction

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The impact of medical conditions on driving

Driving involves a complex and rapidly repeating cycle that requires a level of skill and the ability to interact simultaneously with both the vehicle and the external environment.

Information about the environment is via the visual and auditory senses and is operated on by many cognitive processes (including short- and long-term memory, and judgement) to effect decisions for the driving task in hand. These decisions are enacted by the musculoskeletal system, which acts on the controls of the vehicle and its relation to the road and other users.

The whole process is coordinated by complex interactions involving behaviour, strategic and tactical abilities, and personality. In the face of illness or disability, adaptive strategies are important for maintaining safe driving.

Safe driving requires, among other elements, the involvement of:

  • vision
  • visuospatial perception
  • hearing
  • attention and concentration
  • memory
  • insight and understanding
  • judgement
  • adaptive strategies
  • good reaction time
  • planning and organisation
  • ability to self-monitor
  • sensation
  • muscle power and control
  • coordination

Given these requirements, it follows that many body systems need to be functional for safe driving – and injury or disease may affect any one or more of these abilities for safe driving.

The guidelines and their development

The drivers’ medical section within the DVLA deals with all aspects of driver licensing when there are medical conditions that impact, or potentially impact, on safe control of a vehicle.

To do this, the DVLA develops and works within guidance, and this publication summarises the national medical guidelines on fitness to drive. It is intended to assist doctors and other healthcare professionals in advising their patients:

  • whether or not the DVLA requires notification of a medical condition
  • what the licensing outcome from the DVLA’s medical enquiries is likely to be

Some of the guidelines – for example, those around diabetes mellitus, epilepsy and vision – are set against legislative requirements (see Appendix A for details) but others are the result of advice from the six Honorary Medical Advisory Panels to the Secretary of State, which cover:

  • cardiology
  • neurology
  • diabetes
  • vision
  • alcohol or substance misuse and dependence
  • psychiatry

Each panel consists of acknowledged experts in the relevant area and includes DVLA and lay membership. The panels meet biannually and, between meetings, give continual advice to the Secretary of State and the DVLA.

The medical standards are continually reviewed and updated when indicated in light of recent developments in medicine generally, and traffic medicine in particular.