In Dr Shepherd’s response1 to Dr Laycock’s argument for the debate “Should family physicians assess fitness to drive?”2 he seems to accept Laycock’s (mis)understanding of the meaning of the term fitness to drive, and perhaps the purpose of and limitations inherent in providing reports on patients.
Dr Shepherd denies having been asked about a patient’s fitness to operate a lathe or a crane. Has he never counseled a patient to not operate dangerous machinery when taking a medication that might interfere with reflexes or judgment? Has he never told patients they are sufficiently recovered from illness or injury to resume their former jobs (or that they cannot do so)? Has he never provided similar information to an employer (with the patient’s consent, of course) or to the Workers’ Compensation Board?
Rather than comparing “fitness to drive” with these situations, he contrasts it to his role as a teacher—quite a different thing. As a teacher he is expected to comment on students’ competence—and can do so by considering their training, knowledge, and performance.
In advising about fitness to work or to drive, neither training nor competence are in the domains to be assessed by the physician. Rather, the physician applies his or her medical knowledge to an assessment of the medical factors relevant to performing the task. Just as an employer might not accept the advice of the physician, the licensing authority has the responsibility and authority to decide whether or not to grant a driver’s licence.
Perhaps physicians’ reluctance to perform these assessments stems from a misunderstanding of their role and the difference between fitness and competence.
- Copyright© the College of Family Physicians of Canada
