AMA Proposes Overhaul of National Fitness-to-Drive Assessment
The Australian Medical Association has submitted a report to the National Transport Commission proposing six changes to the national fitness-to-drive assessment process, calling for a standardized, evidence-based framework to replace reliance on individual clinical judgment.
Submissions for the current consultation closed on July 17, with further reviews and consultations expected to continue until July next year.
Proposed Framework Changes
The AMA's submission outlines six key proposals:
- Establishment of a nationally consistent, standardized assessment tool
- Improved education and training for medical practitioners
- Clearer referral pathways for complex cases
- Greater support for practitioners managing high-stakes assessments
- A mechanism for shared decision-making, such as second opinions in disputed cases
- Opposition to replacing clinical judgment solely with technology, though support was expressed for using driving simulators in clinical settings
Assessment Challenges Identified
The report identifies specific difficulties in evaluating certain medical conditions. According to the AMA, assessing cognitive impairments—such as those related to dementia—presents challenges due to unclear diagnostic thresholds and variable patient insight.
This contrasts with conditions like diabetes, vision impairment, or epilepsy, which have more established assessment criteria.
The AMA noted that existing cognitive screening tools, such as the GP Assessment of Cognition (GPCOG) and the Standardised Mini-Mental State Examination (SMMSE), were not designed to evaluate driving ability.
Access and Rural Impact
The submission highlights disparities in access to specialist assessments, including occupational therapy driving evaluations and on-road testing. The AMA stated that these services are limited, particularly in rural and remote areas.
The report also notes that loss of a driver's license disproportionately affects individuals in rural and remote communities, where it can impact access to healthcare, employment, and education.
Practitioner Support and Medico-Legal Context
AMA Vice President Associate Professor Julian Rait stated that the focus on medico-legal risks and evidence-based tools has been a long-standing concern. The report suggests that high-stakes fitness-to-drive decisions affect both public safety and individual liberty.
To reduce the burden on individual clinicians, the AMA proposed engaging multiple practitioners in decision-making processes, particularly in tense or disputed situations. This approach aims to ensure a consistent professional opinion and share responsibility.
Background and Timeline
The AMA previously raised similar concerns in a 2020 submission, highlighting issues of assessment complexity, access to specialists, consistency, and implementation burden.
Following the closure of submissions on July 17, the NTC will conduct further drafting and consultation phases until July next year. A final position from the NTC is expected shortly after that period.