Text adapted in 2021 from The Fundamentals of Addiction in The Primary Care Addiction Toolkit (online only). A complete list of Toolkit authors, editors and contributors is available here.
When to report a patient
Physicians have a responsibility to report patients who they believe have a condition that may make it dangerous to operate a motor vehicle.
Provinces are responsible for legislation that sets out reporting requirements. Seven provinces and all three territories mandate reporting of conditions which physicians feel may make it unsafe to drive. In Quebec, reporting is mandatory when a physician believes that a person's medical condition makes them a threat to public safety and they continue to drive despite warnings. In Alberta and Nova Scotia, reporting is discretionary.
Quick Takes Podcast: Ontario Ministry of Transportation reporting requirements
Dr. David Gratzer, Dr. Brittany Poynter and Dr. Travis Barron run through a few real-world scenarios as they discuss when to report a patient under Ontario's mandatory reporting guidelines.
Where to Report
- Ministry of Justice: Driver medical fitness information for medical professionals
- Alberta Transportation: Driver fitness and monitoring
- College of Physicians and Surgeons of Alberta: Reporting unfit drivers (Legislated Reporting & Release of Medical Information)
- Saskatchewan Society of Occupational Therapists: Mandatory reporting to SGI
- Doctors Manitoba: Reporting medically unfit drivers
- Manitoba Public Insurance: Medical conditions and driving – Information for health care professionals
The Ministry of Transportation changed mandatory reporting requirements for healthcare practitioners (physicians, optometrists and nurse practitioners) in July, 2018. Details and forms are on the ministry website.
Physicians, optometrists, nurse practitioners and occupational therapists also have the discretionary authority to report conditions that, in the opinion of the healthcare practitioner, make it dangerous for a person to drive.
Prince Edward Island
- Department of Transportation, Infrastructure and Energy – Highway Safety Division: Medical fitness to drive
- Collège des médecins du Québec: L'evaluation medicale de l'aptitude a conduire un vehicule automobile
- Société de l’assurance automobile Québec: Unfitness to drive declaration
- Registrar of Motor Vehicles: Mandatory reporting
Treating a Patient who is Intoxicated
The first step is to assess the patient for clinical signs of intoxication. The smell of alcohol is not enough, because even small amounts of alcohol have a detectable odour. Clinical signs of intoxication include:
- slurred speech
- emotional lability
- ataxia and inco-ordination (which can be elicited through walking heel to toe, rapid alternating movements, finger to nose).
When a patient is intoxicated, and especially when they intend to drive while intoxicated, you need to take immediate steps to prevent harm to the patient and others:
- Advise the patient to have a friend or family member drive them home, or to wait and be reassessed after several hours.
- Before releasing the patient, you must be sure that the only reason for the patient's presentation is intoxication and that no other factors are involved. A subdural hematoma due to a fall, for example, may have fatal consequences if undetected.
- Contact the police if the patient leaves the clinic against medical advice.
Informing the Patient of a Decision to Report
Although you are not required to inform patients that you have decided to report their condition to the provincial ministry of transportation, telling them about your decision ahead of time may help to allay their concerns or anger and preserve a positive relationship with them.
- Explain to the patient that you have a legal obligation to report.
- Explain that any decision to suspend the patient's driver's licence is made by the ministry, and the patient has the right to appeal that decision.
- Explain that the report does not have legal implications as it does not involve the justice system. Use the opportunity to talk to patients about the need for reduced drinking, abstinence or counselling and treatment.
In Fundamentals of Addiction
- Defining Addiction
- Key Concepts in Addiction
- Implications for Clinical Practice
- DSM Criteria for Substance Use Disorders
- Identifying Concurrent Disorders (Co-occurring Substance Use and Mental Health Problems)
- Intoxication & Driving
- Motivation and change