12th August 2019, Dr Chee L Khoo
A truck driver with type 2 diabetes (T2D) comes in for a “driving medical”. He’s had the forms for at least 6 weeks and he hands you the blue form. “It’s due today, doc”. You are in a bit of a bind. If you don’t sign off the form today, his commercial driver’s licence will lapse tomorrow. One, you don’t have enough to pass him for the licence. Second, Are you even allow to sign his licence as a GP? What do you do? Do you know which category of commercial drivers with diabetes you can sign off?
When we talk about commercial drivers, we are referring to truck drivers, bus drivers, taxi drivers and now UBER drivers. I see at least one commercial driver a month in my practice whose licence have been signed off wrongly by a GP when they should not have been.
Diet/Exercise only
There are strict rules as to who can sign off on their drivers’ licence. They are stated clearly in the “Assessing Fitness to Drive for commercial and private vehicle drivers – guide 2016” on Page 63. This is a summary of the rules pertaining to commercial drivers.
Commercial driver on diet and exercise only
Oral Therapy only
Driving licensing authority (DLA) need not be notified. There are no restrictions and there is no review necessary.
Commercial driver on metformin only
Patient need to notify the driving licensing authority (DLA). Patient must be refered to a specialist endocrinologist for an assessment of control. If glycaemic control is adequate on metformin alone, then annual review of the licence by the GP is sufficient but the initial assessment MUST be by an endocrinologist.
Commercial driver on other oral therapy
If the patient is on more than just metformin, the driver definitely needs to be referred to an endocrinologist for initial and ALL subsequent review annually. The GP CANNOT sign off on the driver’s licence. See Fig 2.
Commercial driver on insulin
You can imagine that if the driver who is on oral medications other than metformin need to see an endocrinologist, a driver who is on insulin therapy MUST be seen by the specialist for the initial and ALL subsequent annual reviews. We, as GPs cannot sign off on the licence.
Insulin requiring
In summary, we can only sign off on commercial drivers licence if the patient is on diet and exercise only. All other commercial drivers need to be seen by the endocrinologist. If the driver is on metformin alone and glycaemic control is adequate on metformin alone, then we can sign off on subsequent reviews. But the first assessment must still be with the endocrinologist.
The fact that the driver may have his or her licence temporarily suspended because the appointment with the endocrinologist is not for another 3 months is never an excuse for you, as a GP, to sign off the licence. Often, I will write a letter to the DLA explaining the delay in getting in to see the endocrinologist. Please keep in mind that your name is on that form when you sign off and you are potentially liable if there is a misadventure related to the driver’s diabetes care.
Download the Assessing Fitness to Drive for commercial and private vehicle drivers – guide 2016 here.