Driving Medicals

Patient Information (explaining the process)

Driving Medicals

Who needs a medical assessment and why?

The New Zealand Transport Authority requires renewal of driving licenses when you turn 75, at age 80, and every two years after that.

Our ability to drive safely decreases over time, and at some point, all of us will no longer meet the fitness criteria to keep driving. Older age in itself is not a contra-indication to driving, but many medical conditions may affect how safely we perform this function.

Renewing your licence includes getting a medical certificate from your doctor. Your doctor is legally tasked to ensure that you are medically fit to drive safely. This is a legal and ethical obligation to the New Zealand Transport Authority, the patient and the public to ensure the safety of other road users, as well as the individual that is driving. Driving is not a right, and a balance must be struck between the quality of life of the individual person and keeping them and other road users safe on the roads.

Your doctor will need to consider many aspects: Medical conditions that may lead to sudden incapacitation, your eyesight, your memory, how quickly you can make decisions, how quickly you react when you are driving, and how likely you are to become fatigued during driving. This evaluation may be quite complicated.

Note that Class 2-5 licenses (Trucks and heavy vehicles) and P (Passenger) and FTWR endorsements have more stringent requirements than Class 1 (Light motor vehicles). Maintaining some of these licenses may require specialist sign-off if you suffer from certain conditions.

Medical Assessment Appointment

The process for driver medicals at Masterton Medical consists of a two-part assessment:

A health care assistant or nurse appointment and a doctor’s appointment. You should make an appointment with a nurse and your usual doctor (at times this is may not be possible, and you may need to see someone else).

Please note that we cannot attend to other medical problems or issue prescriptions during these appointments.

1. Nurse/Healthcare Assistant assessment:

The first appointment will include the following tests:

- A scientifically validated assessment of your memory, concentration and your ability to think clearly. This assessment takes about 15 minutes. You are welcome to bring a family member or support person with you.
- You may also be asked questions about your driving habits, sleep habits and alcohol consumption.

Following this nurse appointment, you need an appointment with a doctor.

1. Doctor’s assessment:

During this appointment the doctor will:

- Perform a physical and eyesight examination
- Review your memory/concentration test results
- Review your current medications and medical history
- Check your mobility, coordination and reactions
- Ask a series of health-related questions.

If you see an eye specialist you will need to obtain an eye-sight certificate from them (important for sufferers of glaucoma and cataracts, or if you only have vision in one eye).

Outcome of the assessment:

You will either be deemed

1. Completely fit to continue driving
2. Fit with restrictions (such as no night-time driving, or limited to a certain radius, e.g. locally only) or place a limited duration on the validity of the document (such as 6 monthly or annual health review)
3. In need of further assessment
4. Unable to meet the medical fitness for driving criteria as determined by NZTA.

If there are any aspects of this medical that we are concerned about, we will discuss your options. You may wish to obtain a second opinion by completing an on-road driving test, either with an Occupational Therapist or a private provider skilled at driving assessment.

Please note: Continuing to drive without a valid licence is an offence under the Land Transport Act, and your doctor is legally bound to inform NZTA if they become aware of this.

What is the cost of a Driving Medical?

Driver medicals are not funded by any government subsidy. (unlike standard GP consultations)

Driving medical costs are: $75 in total

Note: Paying for an assessment by your doctor or by an occupational therapist will not necessarily guarantee that you will remain eligible to continue driving.

Driving Medicals: Failed or in need of further assessment. What Now?

If the examination reveals medical conditions that need further assessment to determine your fitness to drive your doctor will inform you on the next step(s).

The most common reason is eyesight that does not meet the minimum criteria stipulated by NZTA:

1. Eyesight not good enough.

If this occurs, your GP will send you to an eye specialist or optometrist with better equipment to see if your vision meets the required standard or can be improved to make the grade. They may be able to manage treatable eye conditions (e.g. prescribe driving glasses, treat cataracts or glaucoma) and enable you to meet the eyesight standard again.

After treating or evaluating your eyes and finding that you do make/meet the minimum accepted eyesight requirements, they will then give you a NZTA Eyesight Certificate. This needs to be brought back to your GP to complete your DL9 Medical Certificate to confirm you are fit enough to drive.

If you do not meet the eyesight requirements, we unfortunately cannot declare you fit to continue driving, even if you are otherwise in good health.

1. A memory test indicating that some memory problems may be present.

We use scientifically validated screening tests to measure some of the complex brain functions required to safely operate a vehicle. Driving is a very complicated process and requires full engagement of our higher functions (cognition). We are quite often able to manage the mechanics of driving quite easily. But that does not necessarily make us a safe driver.

It is not sufficient to be able to physically drive the car – we must also be able to react quickly, safely and effectively to situations that may occur on the road. We also need to be sure we are not causing accidents by mistakes and slower reactions.

- Minor memory/cognition problems: A borderline screening test will indicate to your doctor that something MAY be amiss with your memory. It may not be significant enough to stop you from driving. If your doctor finds this is the case, they may simply refer you for an on-road assessment. If you pass that, they will issue your medical certificate.
- More significant memory/cognition problems: Should the AA assessor be unable to form an opinion, or if your screening test indicated that something more serious is amiss, your doctor will not renew your medical certificate.

Should you wish to evaluate your ability to drive further, you can ask your doctor to refer you to a specialist Occupational Therapist (OT) for a full assessment of your ability to drive. They will issue your certificate if you pass this assessment.

OT assessments are not funded and will cost you approx $600 or more.

A low score on the screening test would indicate a high likelihood of failing the OT Driving assessment.

Your doctor is legally obliged to inform NZTA of failed OT assessments and if you should refuse to undertake the recommended test. You may simply accept that your driver’s license has lapsed, and not seek to renew it at this point.

1. Medical reasons for failing the Driving assessment and/or specialist clearance required.

NZTA has a list of conditions that are incompatible with the safe operation of motor vehicles on NZ roads. Restrictions are very tight on Class 2-5 drivers, but less so on Class 1 licenses.

Improving symptoms or impairment could result in a return to /continuation of driving. In certain conditions (and classes of license) a specialist’s clearance is required to return to/continue driving.

These conditions include certain neurological conditions (Strokes, Recurrent TIAs, Epilepsy, Loss of Consciousness, Neuromuscular disorders, including Parkinson’s disease, Dementia and other memory impairments), shortly following heart attack, irregular heartbeat, severe high blood pressure, heart failure and cardiomyopathy, uncontrolled diabetes and certain mental health conditions, among a number of other conditions.

1. Options if your doctor feels you are unable to meet NZTA fitness requirements and declines to issue a medical certificate to support your application for a driver’s licence:

- You are entitled to a second opinion from another doctor in this practice who has access to your health records, or another doctor outside of our practice. The usual (non-subsidised) fee applies of $75.
- You may seek an opinion from a specialist in the field that affects your ability to meet the standard (E.g. Cardiologist, Psychiatrist or Geriatrician). As a rule of thumb these assessments are not provided by the public health sector, and you will need to make a private appointment.

Please note: Failing to disclose your pre-existing medical conditions or a failed cognitive screening test to such a doctor is an offence under the Land Transport Act, and could be punishable by law (using a document by deceit).

We are bound by law to report such acts to NZTA should our practice become aware of such a failure to disclose.

1. So I am no longer allowed to drive due to medical conditions. What transport options are available to me now?

- Mobility scooters and power chairs
- Vehicle modifications and Lottery grants
- Total Mobility Taxi scheme
- Subsidised off-peak public transport
- St Johns Health Shuttle. This service will pick you up and take you to any medical appointments you have.

We are happy to help and provide advice on this.

Please note: Continuing to drive without a valid license is an offence under the Land Transport Act, and your doctor is legally bound to inform NZTA if they become aware of this.