Emergency physicians' knowledge and practice in reporting medically unfit drivers in Atlantic Canada

Emergency physicians frequently encounter patients with medical conditions affecting their fitness to drive. Emergency physicians have legal and ethical duties to report medically unfit drivers. However, many report low confidence in making these decisions. This may lead to underreporting. We aimed to assess knowledge, practice, and barriers regarding reporting of unfit drivers by Atlantic Canadian emergency physicians.

We conducted a cross-sectional survey of emergency physicians from four Atlantic Provinces. The survey contained 62 questions across four categories: 1) Demographics (seven), 2) General knowledge (five), 3) Scenarios/practice (34), 4) Barriers/needs (16). Where appropriate, participants rated answers on a five-point Likert scale.

Seventy-eight emergency physicians (response rate 20.6%) completed the survey: male (59.0%), age 35-44 (37.2%), formally trained in emergency medicine (74.7%). Overall, 88.5% lacked formal training to determine fitness to drive. Familiarity was low regarding provincial regulations (61.5% "slightly" or "somewhat" familiar) and the Canadian Medical Association Driver's guide (85.9% "not at all" to "somewhat" familiar) while most (80.8%) use clinical judgment to guide decisions. Half indicated they report (56.4%) and document (50.0%) unfit drivers only "sometimes" or less frequently. When presented with clinical scenarios where reporting is indicated (first seizure, recurrent seizure), most (100% and 96.2%) would advise the patients not to drive, but a third (33.4% and 37.2%) would either not report or leave it to another physician to do so. Lack of guideline knowledge was the most significant barrier to reporting, while pocket cards, an electronic app and electronic method to report were identified as enablers. Most emergency physicians (85.9%) would like formal education on this topic.

Atlantic Canadian emergency physicians expressed low familiarity with guidelines for determining medical fitness to drive and disclosed potential underreporting. Efforts should focus on targeted education and streamlined tools to improve reporting and enhance road safety.