Clearly define and publicize the role of the physician (as well as the driver, the family and the state licensing agency) in the process.
Know what the current legal responsibilities are in the physician's jurisdiction: is reporting voluntary or mandatory, and for what conditions or impairments? Also, who does one report to and what happens when someone is reported? A contact person in the state agency with a well-publicized telephone number or e-mail address may facilitate the process.
Know what to look for to raise suspicion about whether someone is at increased risk for driving safety problems. This does not mean that physicians must determine whether someone should or should not drive or be licensed. However, physicians can detect and intervene if medical conditions, medications and functional impairments relevant to driving safety are present. Considerable research is under way to improve the tools physicians may use in making such a determination.
Know where to refer patients to determine whether conditions or impairments are likely to affect driving safety. Identify the resources for driving assessment and retraining in the area, as described by Carr, or investigate whether such an assessment can be performed by the licensing agency. In this process, it is helpful to know the cost of the assessment and who is responsible for payment. Also, it is often helpful to have a responsible family member ride with the patient to get a sense of their interaction with traffic and safety behaviors. Because families are often entrusted with ensuring compliance with driving recommendations or licensing decisions, particularly for patients with cognitive impairment, such an experience can help the family understand the need for change or for ongoing monitoring. Once all of the information is obtained, it may be up to the physician to synthesize the information and make a recommendation to the patient and the family regarding driving or alternative transportation. Having a contact person available, possibly a case manager or a social worker associated with a local hospital or a geriatric assessment center, can be a valuable resource in helping patients and families adjust to driving limitations or cessation or in identifying viable alternative sources of transportation. Ultimately, society needs to do a better job of identifying or developing such transportation resources and coordinating services among different agencies.