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Swedish Road Administration Sven Hultman Stina Stenback Brussels 25 Nov 2005 Swedish Road Administration Sven Hultman Stina Stenback Brussels 25 Nov 2005

The obligatory medical testing for category B drivers in Sweden contains • a self The obligatory medical testing for category B drivers in Sweden contains • a self declaration of health, and • an eyesight test • When there is need for it, a doctor´s certificate will be ordered by the county administration

Content of the medical test: • Self declaration regarding all the different diseases in Content of the medical test: • Self declaration regarding all the different diseases in our regulations with the medical requirements for driving licence holders • Visual acuity • Field of vision

The obligatory eyesight test is carried out by • a general practitioner, • an The obligatory eyesight test is carried out by • a general practitioner, • an optician, or • a trained person at a driving school with special equipment

Doctors do not make any formal decisions regarding possession of driving licences Their certificates Doctors do not make any formal decisions regarding possession of driving licences Their certificates should however be considered by the responsible official at the county administration

Those who apply for a learner´s driving permit will get a decision with • Those who apply for a learner´s driving permit will get a decision with • refusal if the medical requirements are not met, • approval if the medical requirements are met, or • approval with conditions to give in new certificates within a certain period if the medical conditions are met but there is a need to follow-up the medical status

Those who already possess a learner´s driving permit or a driving licence that has Those who already possess a learner´s driving permit or a driving licence that has been questioned will get a decision with • revocation (withdrawal), or • requirement to submit new certificates within a certain period

Appeal County decisions to refuse or revoke a learner´s driving permit and to revoke Appeal County decisions to refuse or revoke a learner´s driving permit and to revoke a driving licence may be appealed in an administrative court

Reports from doctors to the county administration Reports from the police Reports from the Reports from doctors to the county administration Reports from the police Reports from the criminal courts

In 1982 the mandatory doctor´s certificate was abolished for those who apply for a In 1982 the mandatory doctor´s certificate was abolished for those who apply for a learner´s driving permit or a driving licence category B The reason was that an official study had found that those check-ups did not provide any new information that was not mentioned in the applicants´ health declarations, and that the medical profession should be used for better purposes.

In 1953 the Swedish doctors were recommended to provide the county administration with relevant In 1953 the Swedish doctors were recommended to provide the county administration with relevant information when their patients did not fulfil the medical requirements for driving licences – but it was still voluntary In 1972 they were told that they ought to do so Since 1981 the law says that they shall do so

How to identify drivers and associated medical problems How to identify drivers and associated medical problems

Since 1981: • All medical doctors are responsible for INFORMING THE ADMINISTRATION AUTHORITY of Since 1981: • All medical doctors are responsible for INFORMING THE ADMINISTRATION AUTHORITY of any medical impairment concerning driving capability • It is also possible to reach a doctor – patient agreement (as long as the doctor trusts the patient) that the patient shall abstain from driving

+ • The physician who is duty bound to report usually knows his patient + • The physician who is duty bound to report usually knows his patient well • It´s cheap. Medical check-ups every 10 years, drivers aged 45 years or more, will be expensive. More than 3 milion drivers should need a medical examination during the next 10 years • Quick medical examinations do not always identify medical impairment. In our country since 1998 C and D drivers aged 45 years or more undergo medical tests every 10 years and thereafter. Reports indicate that only very few medical problems are identified in these tests.

+ • Check-ups do not seem to increase skills of the doctors. 1998 comparing + • Check-ups do not seem to increase skills of the doctors. 1998 comparing 3000 GP in Finland Sweden, physicians in Finland did not show more activity or knowledge with regard to fitness-to-drive. • Drivers sometimes have to wait a long time before they can see a doctor which might cause problems related to work. • Better information and education encouraged doctors to inform the authorities.

_ • Reporting to the authorities will obstruct patient – doctor relations • Physicians _ • Reporting to the authorities will obstruct patient – doctor relations • Physicians do not know when to report • If there are no apparent medical impairments – what to do when the doctors need to make sure that driving capacity is still good enough? Maybe the patient refuses further examination. Mild dementia, post stroke etc… • Some drivers will never see a doctor

The Swedish Road Administration suggests: 1. Physicians are obliged to report medical impairment 2. The Swedish Road Administration suggests: 1. Physicians are obliged to report medical impairment 2. Guidelines will make it easier to understand the regulations 3. Traffic Medical Centres to which doctors can refer patients to see neuropsychologists, work therapists, doctors, driving examiners etc. Research, simulator, computers

The Swedish Road Administration suggests: 4. Traffic Medical Units at existing units like Geriatric The Swedish Road Administration suggests: 4. Traffic Medical Units at existing units like Geriatric wards 5. Education in medical schools, postgraduate information 6. Mandatory self health declaration when renewing the driving license every 10 years