The Primary Care Physician and the Unsafe Older Drivers

Older adults receiving care from a primary care physician have complex biopsychosocial needs. It is estimated that 50% of these patients suffer from at least three chronic conditions, 15% have cognitive impairment, 65% report musculoskeletal pain, 31% feel anxious, and 21% are hospitalized annually. 1,2 The primary care health system is the main site of health care delivery for these older adults. However, this health care system is facing a major challenge of delivering safe, highquality, and cost-effective services to its patients in general and to those with complex biopsychosocial needs in particular. 3–6 The physicians in a primary health care system have insufficient time to spend with their patients and feel overworked and dissatisfied. 4 Any suggested add-on assessment, intervention, or change to this system must take into account this reality. In this issue of our journal, Dr. Jang and his colleagues 7 provide very useful information related to the physician’s role in decreasing the societal burden of unsafe older drivers. The investigators surveyed 460 English-speaking Canadian family physicians and collected data on the physicians’ attitudes and practice’s patterns related to assessing the driving fitness of patients aged 65 years and older. The methodological quality of this survey had no fatal flaw. Surveying primary care physicians is a challenge and thus, the ability of the investigators to accomplish a response rate of 67% is impressive. The responders’ characteristics did not differ for those of the physicians who were originally targeted for the survey. Furthermore, the authors presented their survey findings in accordance with the guidelines of the American Association for Public Opinion Research. The survey found that the majority of primary care physicians are not confident in their ability to assess the driving fitness of their older patients and that they do not consider themselves the most qualified professionals to perform such an assessment. Moreover, the physicians felt that reporting unsafe drivers negatively affects their relationships with their patients and that revoking patient’s driving license is not a benign intervention and may lead to negative consequences for both the patient and the family. 7 Despite these attitudes and the perceived needed resources of time and education to perform the driving fitness assessment, 88% of the primary care physicians held themselves legally responsible for reporting unsafe drivers. The paradox of taking the responsibility of an action without having the needed skills and the resources to execute such an action may be unique to the primary care physicians and their mission of addressing the various medical needs of their patients. Another interesting finding from this survey is the fact that the presence of a legally mandated policy may lead to higher reporting of unsafe drivers, but this might simultaneously be a disincentive to perform a driving fitness assessment, thus leading to lower rates of identification of unsafe drivers. Using the findings of their survey, the authors concluded that reducing the burden of unsafe drivers demands the development of further educational interventions that could improve the primary care physician’s skills in conducting driving fitness assessments and counseling unsafe drivers to stop driving. However, such an intervention might be ineffective for several reasons. First, there are educational materials cur