While I acknowledge the differing opinions expressed by those responses supporting the concept of the FP’s ability to assess fitness to drive,1,2 their supportive reasons are addressed either in the debate3 or in the rebuttal4 and are challenged or refuted. Yes, FPs are able to diagnose medical conditions that could, or do, affect some aspects of driving ability; and when they do so, the physician should bear a responsibility to report those finding to the Office of the Superintendent of Motor Vehicles or the Ministry of Transportation. And, indeed, they should support patients and their families at the time of possible loss of driver’s licences. Yes, there are different ways to interpret fitness to drive, and my expressed opinion clearly extends beyond simple medical diagnosis, although I do not think the Yes side of the debate5 or some of the responses have done so. Irrespective of the contrary opinions expressed, the reality is still that important aspects of physiological function that relate to safe driving cannot be tested in an FP's office. As they cannot be tested, should they simply be ignored? I sympathise with Ms Hickey and her unfortunate experience with the Ministry of Transportation; both she and the FP acted appropriately. The apparent lack of knowledge and ability of the instructor to adequately assess Ms Hickey’s husband is regrettable and difficult to understand. However, that example does not alter the validity of simulated or on-road driving tests remaining the criterion standard for testing driving ability. That test should come first; if it is failed and there is a possibility that an extant medical condition is, in part or in whole, a factor in that failure, then it should be addressed in a way that considers the patient's autonomy and the collective community's safety.
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