 But as this was a legal sort of emphasis, what I want to understand is if Vic Rhodes asks a driver to get a medical assessment and then the driver takes that to their GP and the GP makes an assessment, what additional legal risk is that GP or for that matter me as a specialist in a catam's clinic exposed to when I say yes you can drive. I mean it's all right to talk about oh yeah you can just ring up and say oh yeah you can just sort of hide away behind the privacy and say yeah sure you know we want to get rid of this guy's license. But I want to know most of my people I manage in the in the memory clinic with MSc scores of 26 I think are quite safe to drive but I don't do an on-road assessment to prove that. I make a clinical assessment and until the rules have just changed it was then the Osroad rule said if there was an impairment sufficient to interfere with driving now it's not can't have an unconditional license you've got to go and get a conditional one. I want to know what exposure we have now as medical practitioners if we don't do an on-road assessment and we say they're safe to drive not what exposure I have if I say they're not safe to drive. I'll talk first and then have it tomorrow's. When you're feeling out that medical report form you you're not saying fit to drive you're saying it meets the medical guidelines for fitness to drive or doesn't and then VicRoads is making a decision. You can tick the box to recommend an OT on-road driving test but at the end of the day we're weighing up the information on the medical report with all the other information we have be it a police report or whatever else came in and working out whether that person needs to go for an on-road test or not. Sometimes there's conflicting information sometimes the police report will come in and say that this driver can't drive to save themselves and the medical report can't everything's fine hang on a minute and in that case we'll probably do an on-road test but yeah you're not making the decision on fitness to drive we are you're just saying do they meet the medical guidelines of fitness to drive in other words is there anything wrong with this person that you think is not going to is going to be out effect their driving so I guess that the thing that I was going to open up with is the problem real of older drivers so we've heard already that the proportion of deaths of older drivers isn't a different distribution that different groups have a different level of risk is it that we're just worried about the legal consequences and is that what Mark Yates has articulated for us that you know we're very nervous about driving because should something go wrong will be held to account as the health professionals. Look I think that the thing that you've got to bear in mind is that it is VicRoads that makes a decision and VicRoads makes it on the basis of medical information and the more information that VicRoads gets the better quality decision that they're going to be able to make. There's a revision going on at the moment of the form that gets sent out to doctors for medical information once they've become known to VicRoads and the revised form has been trialled with focus groups of GPs and so on and it's much more detailed than the current form and the intention of it is to get better information to make better quality decisions. I don't think that doctors are going to get in trouble for providing accurate information about their patients basically what you know about you can put on the form and and you know ultimately I suppose if you think about it with a lawyer's hat on if this ends up in court all I can do is get your notes and you know perhaps check and see that what's in your notes is on the form and if there's correspondence there and if you've done the right thing and been honest and given VicRoads the best possible information note that I don't necessarily say advice but information then that's fine. People are getting into trouble for not disclosing appropriate information that case in 2006 in New South Wales was a case where a doctor told the patient something but didn't tell the the licensing authority the same thing and where that sort of thing happens then obviously you can get a bit of trouble about it but I think that if you do the right thing and provide as much information as possible and that might mean getting a phone call from someone like me to discuss it then doctors aren't putting themselves in danger or in fact any other health professional is not really putting themselves in danger. Well look we get lots of doctors who will send things into VicRoads you know will send forms into VicRoads and VicRoads will send them on to us because they seem to be a bit uncertain or perhaps there's some contradictions in them sometimes you ring up the doctor and say look I'm a VicRoads medical advisor and I'm just ringing you up about Mr. So-and-So and they say oh thank God you've hugged me about him you know you shouldn't be driving why didn't you say so well he was sitting right in front of me at the surgery and I really didn't feel I could so you know sometimes people write I would be happy to discuss this in person if necessary we see that as a code for please ring me up and get the real truth about things the other the other areas where we get to talk to doctors is where doctors actually do ring us up and they get given our phone number by VicRoads medical review okay phone number on the form that you know people can always ring up VicRoads medical review and if they want to talk to us they can be given the number and we are totally happy to answer any question. Well my doctor's been my doctor for 20 years so I don't think he's nervous at all. Would you go back and see him if he well if he if you disagree with his reporting you know to VicRoads. I'd still go and see him. I'm one of four lead clinicians in cognition in town and I've got a 65 year old farmer who lives out the bush who's got an MSE score of 26 he's still harvesting and he's still doing all the things he wants to do and I've said I don't think you need a driving assessment at this point. Where do I stand? If he then had an accident might right now and so I might hear him maybe am I out on a medical legal limb right now he goes and has an accident. Stop there let's where am I. Look I don't think that you're out on a medical legal limb if you can justify your opinion that this chap doesn't need to have an assessment and have it all documented adequately in your notes and that's fine. I think it's also important to realize that the medical review process can't aim to prevent every crash. I mean people will have crashes people will go and see you know a top specialist you know go and have a specialist OT assessment all the rest of it whatever it might be and the very next day they might have a crash. You cannot predict all crashes to a certain extent they're unpredictable and there's all sorts of odd conditions that can contribute to them and so it's unrealistic to expect that any medical opinion will be absolutely 100% correct. What what people want to see is that opinions are based on professionalism and a reasonable amount of data that's caused you to come to that decision and if that can be recorded and can be documented then nobody can be criticized for that or you can do as your best. So I guess what I wanted to say to Mark was I suppose what we're asked or what Vic Rhodes is asking you in a feeling on that form is not your determination or your estimation of whether that person is safe to drive. It's not real I know it it seems confusing because you are making an assessment or about the person's skills in relation to driving about their medical conditions that could impact on driving but that ticker box thing at the bottom that I know raises the anxiety a lot which basically there's two questions that say you have to complete both of these questions one of them is does the person meet the medical guidelines to drive a car and do they meet the medical guidelines to drive a truck and I know that's the one that you hate that bit and you usually write pending OT assessment or something like that in there. What the GP is saying is that in that blue book this person doesn't have any of those medical conditions that is going to preclude them from driving. So there are some set conditions that say this means you cannot drive and so the doctor's role is to find those people and say according to that blue book do they meet the medical guidelines to drive not I'm guaranteeing by signing this form that they're never going to have a crash for five years it's not the same thing. If someone has a dementia now we're taking a unitary at the moment form of dementia because that's what the that's what Osrose has said any dementia doesn't matter whether MSc score of 30 as long as they've got a memory problems as an abnormality in one cognitive domain however mild you know that's a dementia in in in medical language and and they're saying then that's a not there has to be a conditional license only and I'm expected to tick a box the whole reason I this piece might have got anything wrong with their eyes there they're not no diabetes no cardiac failure not had epilepsy nothing else only reason that there's a concern is because they have a dementia isn't that as equally as a medical condition as much as cardiac vascular is anything else so then you still have to tick the box to say that that they have they meet the criteria if they want to say they meet the physical criteria to drive rather than the cognitive criteria I'm happy with that but on the one hand I'm asked to say they can drive on the other hand that they or they're safe to drive on the other hand I'm saying I don't know to assessment but to me that's not the problem because I'm the time problem I have is that it goes around in jolly circles if I say I want an assessment you know or is I've writes the rec rows and say I think this person is unsafe maybe it can it comes back round again to say can I see a geriatrician well who is it gonna be is it gonna be the other person who sits in the desk beside me because there's only about two of us in town who can do it you know it's particularly if it's cognitive as opposed to anything else and the second question is and I come back to it is it's I mean let's talk about the evidence about which cognitive assessment I'm gonna do that actually makes them an evaluation of someone's driving is it gonna be trials be is it gonna be a free recall test is it going to be a visio spatial test I mean I do those in global assessment but we know we already know that the MSE score you know nobody could make a rule the London there was a lookbook the Ludberg group said okay an MSE score less than 10 no driving I think I could probably cope with that but after the MSE score less than 10 it wasn't clear whether it was going to be 18 or 26 or anything else you know then they said well maybe it's 26 plus another neurological condition you should get it get it reviewed by a specialist well I need to understand and I think that we're going to all need to understand which cognitive tests we can do other than an on-road driving because there aren't enough OTs in the world to do it we can use to make that evaluation and what are the lawyers going to say at the end of it I mean I think you're right Mars I'm I just hold out my hat hopefully that there's a professional acceptance of the fact that we're doing what we can with the limited limited limited evidence but I'm not sure that a lawyer in a court is necessarily going to want to accept that when they're working for a plaintiff there's a difference between firstly there's a difference between working for a plaintiff and the criminal jurisdiction in criminal jurisdictions that's much more black and white and it's got to be beyond reasonable doubt and it's going to be very hard to prove in a civil case where you're being sued for damages well it goes on the balance of probability and if you can argue about the probabilities of your decision about how you came to them then then that should be enough to get you out of trouble bearing in mind that you can never predict the outcome of a court case I think there's also the issue of sort of medicines and art and it's an overall assessment of a person I mean you can do as many tests that you can and get numbers at the end of them and scores but ultimately part of that has got to be your own impression of a person coming from years of experience as a specialist in the field seeing people with cognitive deficits all the time and you know you do get a certain part of that which is you know something that you can't easily quantify there will always be a chunk of patients that are really easy to say no such as your you know person below a score of 10 and there'll be a chunk of people that it's easy to say yes you might have an MMSC of you know 30 or 29 or something and just have a problem with mental arithmetic and everything else is fine and then there's going to be this gray area in between and there will always be the need to have further assessments the the aim of getting it over the desk medical test that's going to predict crash risk all the time is the holy grail of you know cognitive assessment and will probably never happen so the best you can do is really the best you can do is to is to you know give an assessment based on your knowledge and experience and if you think a person needs a test so be it and if they don't well if you've documented the reason for your decision also so be it I just think that there's something that's missing here and I think that your point is quite valid however it is a shared responsibility and if somebody is going to be held accountable for a death then they're going to make sufficient inquiries into all all the shared all the people that are involved in that shared responsibility they're not I know from my past experience when I need to go to court to give evidence that I'm giving an opinion based on my experience as a police officer so I think that that's what they would be looking for your experience as a surgeon doctor whatever and therefore they'll take that on board accordingly but there's more than one element to finding out fault in an inquiry and it is a shared responsibility and I don't think that if if you've done everything that you believe is professional then I don't believe how anybody I don't see how anybody could be seriously criticised or crucified for making the decisions that they've made yeah I look I'd have to agree and just just to add a little bit Mark I think that Morris is right if particularly in the in the face that there's no statutory obligation to to report I think that if it's a well considered medical opinion a well documented opinion I think from a legal perspective it would be fairly easily able to defend that there are gray areas in the law is uncertain though so I've got a question that actually follows on from what you're discussing at the moment I'm a geiatrician out at Western Health and have been looking quite closely at the new guidelines and looking particularly at the medical condition notification form because we're going to be using this on quite a regular basis now that we have to notify all cases of dementia and I just had a question for Morris and Trisha about the the requirement in this I'm an other form is just a guide but it says that when we are notifying that somebody has dementia we have to document any licensed conditions or restrictions that we would advise for the person I'm just wondering how broad that is and how much we should be expecting to advise as geiatricians considering we haven't done an on-road assessment we've done a cognitive assessment and an assessment of their health in the in the clinic room they've given a few examples but I'm just wondering how far we actually go with that and if there's any guidance going to come out about what we should be recommending massively broad-ranging question because every patient is different you know sometimes you'll see someone and it's really obvious you know that you need to give him some sort of restriction and sometimes it's not so obvious and perhaps they might need some other kind of assessment in order to guide you you know they might need to have an OT test or a vision test or whatever and the primary diagnosis which you've just made of dementia is enough to notify them or you know the fact that they you know that they need to be told in the first place that they've got this diagnosis if it's a very early stage they might still have enough insight to understand their their own responsibility you're not the one with responsibility to report and you know actually specifying what their what their restriction is is not I think all that important if you have specified restrictions well and good otherwise it's just enough that Vic Rhodes finds out about them the intention of having regular review now of people with dementia is an acknowledgement that the condition will probably deteriorate over time nobody really knows how much it's going to deteriorate or how fast it's going to deteriorate and that these people shouldn't be lost to follow-up you know that's the real worry that you know somebody gets a diagnosis and then it's never heard about again until something nasty's happened so the intention is that one day sure these people might need to have further investigation or have an OT test or whatever but just the fact that they've been diagnosed doesn't necessarily mean that they're going to end up in this whirlpool of investigation and bureaucratic hassle I guess Vic Rhodes as Morris said before is just after all the information they can get so if you have an opinion on what sort of restrictions would suit this person then Vic Rhodes would like to know what your opinion is at the end of the day will decide the restriction I mean you could tick you know you might tick OT test not required but we might decide it is and vice versa and yeah so I think if you you've got insight into this person and you think that perhaps it's early onset dementia at this stage and that's surely you know be safe to drive in their own area but perhaps you wouldn't like them driving to Melbourne then you then it's a recommendation that you can make to Vic Rhodes but at the end of the day Vic Rhodes will decide what sort of restrictions they have but they are interested in your medical opinion you might get a phone call that says well you know we've got five police reports saying that this person's been having little bingles you know that aren't necessarily known to you at the time too it's always a good practice to to report and and get a professional to actually do the evaluation is again like I said if you're a medical doctor you're not expected to be an expert in driving yeah and expert in medicine so it's your duty to report the medical condition and let Vic Rhodes or OT actually decide what to do with that information is it's the same a lot of our engineers or told to go out and inspect the road and they will go and see how big a pothole before you actually need to close down the road I mean you just report that there is a whole this size or the slope is a bit too steep is so so many degree someone should actually come out and do something or have a second look yes I think that's what they are looking for from auditor or from the first frontline people who do the inspection or the frontline people who do the initial report I think if you are called out to explain yourself and you documented that this is based on this information and I send this information up yeah I think that's what a normal jury or judge will say okay you did your your duty correctly or professionally and then I think you're safe that way is Vic Rhodes equipped to deal with the large I guess the volume of notifications that are likely to come through they're always short staffed at Vic Rhodes and at the moment there's a sustainable government initiative being conducted where we have to lose 400 staff from Vic Rhodes and as do other government departments so we're probably going to have less resources rather than the ones we've got now or more so but it doesn't mean that we don't want you to report people into our system we really we really want the high-risk people reported into our system so that we can deal with them so let us worry about the resources and you just report people that haven't reported themselves I'm working in acute hospital and I recently had a patient who had a temporary diagnosis of vertigo and is under investigation now I brought to the doctor's attention his ability to drive that was impaired after doing a functional assessment and he couldn't even walk or turn his head without falling off the chair so the recommendation was made that he temporarily stopped driving until a formal diagnosis had been made he was non-compliant according to the social worker where do my when am I obligation stand when it is a sort of an acute diagnosis it hasn't a diagnosis as such hasn't been made you said to report things that are a major medical conditions if something like vertigo that doesn't have a cause or a label attached to it what where do I stand I have to say that as a member of the Victorian police force we've got a very thankless job which I'm sure a lot of doctors and surgeons have as well and the one thing that we're taught from the very first day that we walk into the academy is to keep good notes and I think that the elephant has walked out the room is major saying that because if you're Britain if you you are keeping a very good diary there is not one person that could come back and criticise you if you've done the right thing and you've kept notes about it the thing that worries me is that we're so concerned about our professional responsibility we're not thinking about the persons leaving the hospitals got vertigo is going to drive I've written all of my notes and I've notified Vic Rhodes by post and I said oh the GP will take care of it and then I'm sitting thinking oh lucky I don't live in town and can I call the what do I what do I do then so so do I call the police and how much more work does that make for you you're well within your rights to do that like as a health professional if somebody's left your office and you've got some grave concerns in regard to how that person may behave on the road as a police officer we will attend to that call our power to take them off the road there and then is probably non-existent however we can push it up with that license review and try to start the process in regard to getting that person off the road if they are a danger on the road we can certainly we can what's the correct word we can certainly stall their activity on the road so don't don't don't hold back by giving the police a call and saying that you've got concerns the other thing to I guess is the other people on the road that that may be endangered by that person's behaviour or driving ability that's obviously of a concern as well nine times out of ten if they've left the the clinical or surgery and you've made a phone call and we've gone around to investigate it just to do a welfare check if not anything else that nine times out of ten will probably intimidate that person to the point that they may think that the risk is higher than the actual gain so it there there's no right or wrong answer in regard to any of this however you've just got to do what you think is best at the time back your judgment and keep notes that that firstly I mean I a thousand percent endorse the comment about keeping notes you you must keep good notes it's the the best protection anybody can have just write it down so many times we see crappy notes you know it and in you know serious cases where there are serious medical issues in all sorts of forensic and police cases and you know could all have been afforded by just writing it down properly and you know I think sometimes using computerised notes doesn't help because people tend to not write as much when they've got to type into computers back in the old days when doctors write everything down even if the handwriting was terrible at least they write it down you know you must keep good notes as far as people with an acute disability like this is concerned the section of the road safety act about notifying conditions really applies to long-term chronic conditions but if Vic Rhodes gets notification especially from a health professional that a person's not safe they can act quickly to suspend a license I don't think they can act instantaneously if somebody in the health profession sends them a fax that says so as I was unsafe they won't get a fax back by return saying they're cancelled Vic Rhodes is obliged to give people a certain amount of time and that can be kept to a minimum I'm not sure what the minimum is but it's several days at least I think just to cover letters in the post and other bits and pieces but Vic Rhodes can act quickly and insist on a supportive medical report before they get their license back again once Vic Rhodes has acted the police can then act because they've got a legal basis to stop a person driving if they haven't got a license thank you I think my question was mostly answered in that last discussion but I just wanted to clarify in terms of working on a busy say neurological ward where we constantly have patients coming in who are expected to comply with driving restrictions for a certain period of time and most of the time it would be on the background of a chronic medical condition just wanting to check we usually only fill out this Vic Rhodes medical form sorry I'm an occupational therapist and I would only ever you fill out that form or a request to doctor to fill out that form if there were significant concerns about a driving assessment being needed an OT driving assessment or concerns about a client's capacity and the fact that they won't inform Vic Rhodes am I okay to explain to the patient their expectations and the legalities that they're not meant to be driving and for them to say yes I'll tell Vic Rhodes myself and I'll document that and expect and be happy with them telling Vic Rhodes themselves like do we do we have to fill out a form for everyone it just seems like a whole lot more work if you tell people that they shouldn't be driving or that they need to notify Vic Rhodes and they're worried they'll often say oh that's fine I'll do it and and you can't be certain that they do look if you've got doubts it doesn't hurt to try and check up you know give them a call in a week or two and just say I just want to make sure and look if you've got any doubts you can't get yourself into trouble by notifying Vic Rhodes you can't yeah you can't be sued and and if and if you go good notes keep notes make sure you write it all down and if you really are concerned it doesn't hurt to send a form into Vic Rhodes sure as a health professional that you can obviously like you say if you had doubts but at the end of the day if the person's got capacity it surely is their individual responsibility. Just to give you an example there's a fellow I saw at some of these last year who was a truck driver who had epilepsy now he was completely fine when I saw him but his seizures were coming fairly frequently and I told him he couldn't drive his truck and he had to notify Vic Rhodes said sure I'll do it I'll do it and he had full cognition but he also had a really powerful motive for not notifying Vic Rhodes and in fact he didn't and I ended up doing it about a week or two later because you know there was a public health issue concerned. On the issue of documentation is all well and good but you've still got to behave reasonably and so that if you see a risk to your patient or a risk to the community I don't think that someone's got capacity is enough to say that I did everything I could that that's not everything that you can and I think it's about recognising some people need a bit of time to comprehend the idea the follow-up but we've got to be reasonable through all of this so writing notes saying that I've told him and I'm absolved of it and I know he's just gonna isn't be behaving reasonably and as a health professional the expectation is that we will take into account both the individual and the community's health. I mean maybe it's the geriatrician in me but I think we lose the patient-centered focus of this discussion. I mean in certainly in my experience in the Catam's clinics 90% of older people choose I think there's some evidence about I don't know whether it's 90% but certainly a very high proportion of older people choose to stop driving at the right time and if and so that's the first thing I think we ought to assess the second thing is in relation to that particular case you know the social worker said that so-and-so was gonna drive you know how the hell do we know I mean and so if the patient themselves if the patients themselves have got insight I mean okay let's try and work out what the patient's background is and let's try and understand the patient a bit more but if the patient has got capacity and has got insight into the problem and there are really significant issues for this patient they know if they turn their head they get vertigo but I can drive using my mirrors without turning my head and this is what I'm going to try and do and they want to try and do that what well I mean you know I've seen a lot of people turn corners slowly but you know if they if they live if they live up in the country and there's no other way to get some basic supplies I mean maybe they shouldn't have gone home in the first place but I think we've got to be thinking a little bit more around the needs of the patient and try and balance risk and we do this all the time that's the question I'm really answering because I think I have to balance risk every day in my catam's clinic in relation to driving and that's about trying to manage the risks of the loss of independence to a person with the potential risk and all look at small if you look at the total number of people here even in total people over the age of 75 have no more risk than 25 year olds on the road now you know do we take every do we reassess every 25 year old until they become safe enough to drive we don't so I think that we have to take a logical approach and my problem with the way the system works is that if we drive this down guidelines where everybody who thinks oh we're going to just send a note into Vic roads Vic roads for all their for all their kindness we see here and the true human nature of Vic roads the bureaucracy doesn't act like that and I've had numerous patients who are in absolute distress because they've been given three weeks to get a geriatrician assessment and there's not a hope and hell of getting a geriatrician assessment in this town in under six to eight so I just want to go back to relaying information to the patient and how we can do this better on the ground and you may have alluded to this earlier is there an actual quick reference source that I can access on my ward rounds and which for example I can just click on a condition and it will bring up a guideline for that I can then print out and supply to the patient on the ward rounds and then I know that that's done and I can then document that in my medical notes is there such a resource or is there a plan for resource can I ask is it reasonable to be making the decision in hospital and should we so if we use the example of home oxygen so you know people are hypoxic in hospital but we don't say that you're going to be on home oxygen forever until they've had a time to recuperate and recover and so is it reasonable to say I'm not going to make a formal assessment or a notification of it grows we really need to wait six weeks and see what your recovery is like absolutely if you think that this is a temporary condition and they're going to recover you don't need to notify the grades about it and if that's your professional opinion and you're confident that that's going to happen then there's no need to notify the grades they're only really interested in chronic conditions forever I've got a patient at the moment has had lots of episodes of syncope and so I'm giving him advice he's got to be symptom free for a period and then go to his GP to then actually sort of make sure that he's actually okay to go back and drive I'm not going to notify Vic road straight away and that would seem to follow your approach there as well in the UK some years ago the survey I think was printed I think was printed in the British Medical Journal of people who had syncope to see whether they followed their doctor's advice and they found a hundred percent non-compliance rate so the legislation is worded it says any long-term or permanent injury or illness that may affect driving so that's that's what you're going to keep in mind when you're working at what to report thank you we saw graphs this morning about the very high risk age group of people having motor vehicle accidents or injuries and it was in that from memory the first year after a license was granted and for those whose mandate includes improving road safety I'm just keen to know what else as a community we can do to reduce that 28% of fatalities among 14% of the drivers in the 18 to 25 year age group please I think it was mentioned earlier that well a lot of the folks he's been on older drivers you're exactly right that the real problem on our roads is young drivers and a lot of that comes around in experience and a false sense of confidence that comes with that so the big thing that we really try and push with the younger drivers is education is why there's 120 hours for under the learner permit scheme at the moment before a person can even get their license we've got lots of education programs in the school in all the school programs and that they start from early in the high school years we have even even in primary school we have a much different type of education program but I think for those younger drivers it is all about education and experience and so we try and push that from a prevention point of view with our marketing campaigns with our programs safety campaigns that we have in the communities and in the schools we work with Vic Roads and Victoria Police in other areas in terms of road design we work with vehicle manufacturers in terms of trying to design safer cars so it's a multi pronged approach to that but in terms of your specific question about younger people I think it's give them as much experience as you can and give them as much education as you can. Many years ago when my children were younger there was a program out at the airport where they it was just a bike program but something like that where they go on to have so many classes sessions whatever for the first 12 or 18 months to where they come into situations that they're not going to come into with their mother besides them for 120 hours or whatever when they're on their own and they've got a they've got these new accidents or skidding or those sort of things where they can have extra education. The types of programs you're talking about are commonly known as defensive driving programs and TSE aren't in favour of those. The research that's I don't work in our road safety area but I work very closely with them but some of the research certainly suggests that it can actually increase the overconfidence of younger drivers and that's a concern. So the idea isn't a bad one and but there's some mixed thoughts about whether that's the right approach or not. Certainly with the driver programs that we fund under our rehab programs that I mentioned earlier we don't fund defensive driving programs. So I want to concur with those comments. The research does show that the kids who take part in the advanced driving courses have a higher crash involvement than those who didn't because it's because they're overconfident. They think they're invincible. So yeah we're big roads TSE against against all of that. For a lot of drivers there's two main deficits. One is skill deficit. One is attitude deficit. Okay and a lot of this advanced training course focus primary on the skills and if you improve the skills too high they are overconfident and then they get into trouble. I think today a lot of this driver education system is slowly moving towards addressing the more important issue of the attitude deficit. Yes and so when you sign up your kit for advanced training course make sure that the program is covering the risk management and attitude management more than the skills. As a nurse who does community assessments I guess my question is if we've been out and seen someone who we think has got an impaired cognition who the family have got concerns about driving our general rule of thumb at the moment is to handball to the GP so you'll put a note to the GP. Is that enough for us or I've never seen these forms that the OTs and the geriatricians and GPs are filling out so is it something that we should be doing as well if we have concerns in saying that that's not our area of expertise. So if the family are giving us concerns and the evidence we've collected highlights and issues for us where do we go is highlighting to the GP enough. The human rights element everybody has the right to be able to drive if they're able to and I believe that if you've got family because let's face it our family are probably the most honest people in our lives. If they're saying that we're having a difficulty carrying out a skill I think that that's probably that position you need to be listening and then the human rights element well that person does have a right to drive. So you've got to make a professional judgment in regard to where you think that fits. I don't believe that there's a right or a wrong answer in any of this. It comes down to each case should be judged on its merit and you take it from there. You take on board everything or the evidence that's presented to you at the time and you make the best professional judgment that you think that you're able to do and let it go on to the other areas that will make that judgment on that person's behalf that have the power to. First of all I think that it's interesting to note that overconfidence in a young person is called lack of insight in an old in a sorry well overconfidence in a younger person is described as lack of insight in an older person and I think we need to be very careful about how ageist we are in the way we approach the language around driving capability. I think while the vast majority of older drivers make appropriate choices about when they should stop driving and dementia is a very common condition in older age we should also allow that possibility without undue bureaucratic restrictions and finally until the older driver especially the rural older driver older drivers are given guaranteed real options that maintain their community engagement this will continue to be a problem for us as a community. Personally I'd just like to thank everybody for including me in today I wish that I could have been here all day because I think it could have been quite beneficial to my professional role. In regard to the older driver I concur with Mark and that's pretty much all I have to say so thank you very much for including me in today. I don't envy for one moment the work that you have to do in the conflicts that you face in this in this area in terms of your the confidentiality and the privacy obligations you have to your patients as opposed to the public safety issues that we've raised as well and the independence and the autonomy that patients like Mark has have out in the rural communities but I see every day of the week the consequences of what happens after someone's had a road accident and I think anything that any of us can do to try and prevent an accident from prevent people from being injured we should do that so thank you. Thank you I'd just like to echo those sentiments about how pleased I am to be invited along to a session like this because I think that raising awareness of medical fitness to drive is always very important I think there are conflicting requirements or conflicting aims in in in this whole situation one is to preserve people's mobility as much as possible now the one is to preserve public health and safety as much as possible in most cases those two aims are completely well-defined and distinct and it's relatively easy to make the decisions in the grey area in between when when you've got to try and compromise one or the other is where organisation like VicRoads Medical Review and ourselves get involved and hopefully we can help make those decisions in the right direction. From VicRoads perspective we're not trying to take people off the road we want people to be able to drive for as long as they're safe to do so so I want to make that point and the people that we want off the road are the medically impaired people so this this issue isn't about older drivers it's about medically impaired drivers and they can be medically impaired at any age so as health professionals we want you to help get those medically impaired people into our system so that we can assess them and determine whether they're safe to drive or not. Thanks. I think we have heard frequently enough that driving is actually a very important to the well-being of people and it's also a very major engine for the economy and so my view is that driving should not be restricted without good reason and we are here most of you are health professionals and your job is to assess somebody's fitness to drive and I just want to point out one fact if a health professional make a mistake you kill them one at a time if an engineer make a mistake you kill people by hundreds and thousands when the building collapsed so let's take some comfort in there. As you know I've already told you I had a stroke and this means my hand doesn't work and my leg doesn't work real well the officer came to and told me you have to give up your license for six months which the neurologist explained and my doctor explained I didn't have anyone explain that from the TAC no the big roads and now I'm waiting seven months and I still don't have my license back so good luck with all of you and what you do because I think you're doing a wonderful job yourself to put other people on off the road as they need be. I guess I just wanted to make two points one was to recognise that I think for health professionals our anxiety is that whilst thick roads is making the ultimate licensing decision they're not the people that are sitting in front of the patient so I think our concern comes when we are the ones that have to explain the process and explain what's going to happen and we take the brunt of that face-to-face contact whilst we can say oh look it wasn't me it was Vic Rose but you told him so that's the reality that we deal with and I think that's where we get this real disquiet between our rapport with our patient and the difficulty in the reality of explaining what is for them a bureaucratic system not a face-to-face personal system for them and I think that when it is something as meaningful as and is as important as driving that's where a lot of the anxiety lies. Second point was just that just to kind of reiterate that the OT driving assessment is for a small proportion of patients so sometimes I get worried when we're in a room this big that I'm gonna suddenly get 500 referrals next week for driving assessments because it's on everybody's brain but the OT assessment is not always the most appropriate route for people to travel those conditions should be reported to Vic Roads and then they'll make a determination about whether or not that assessments actually possible so we cannot assess everybody that you have a concern about and it's not our role so just wanted to reiterate. I think no matter how hard it is I'd rather hear that I couldn't drive or having trouble driving from my doctor or therapist or the nursing staff rather than have to go to Vic Roads and have someone told me I can't drive and we're better trained better equipped to do that and I think as I said as hard as it is it's better that we do it than leave it to someone that the patient doesn't know or understand so with that I'd say thank you to everyone the fruit baskets are for the speakers although there's a wealth of them it's not for everyone and thank you very much drive safely.