By DR MILTON LUM
PETALING JAYA: Driving is a complex task which involves skill and simultaneous interaction with the vehicle and the external environment.
Information about the latter, which is provided by the eyes and ears, is acted upon by several cognitive processes, which include concentration, memory and judgment, to make decisions.
These decisions are performed by the musculoskeletal system to perform the task of driving. The process is coordinated by interactions that involve the driver’s personality, behaviour, strategic and adaptive abilities, and the ability to self-monitor.
The whole cycle is repeated rapidly with some variation depending on the traffic conditions.
Disease and/or injury affects the body systems required for safe driving.
Assessing a driver’s fitness
Doctors have a professional duty to advise an individual on the impact of their medical condition for safe driving ability, advise the affected individual to notify the Road Transport Department (JPJ) of any such condition, and treat, manage and monitor the individual’s condition with ongoing consideration of their fitness to drive.
Whether the doctor is under an obligation to notify JPJ if an unfit individual continues to drive is unclear.
This is of particular importance in the case of commercial vehicle drivers as the public may be endangered by such unfit drivers.
Like most countries, Malaysia has standards for the medical examination of drivers of commercial vehicles like lorries, buses and taxis.
The Medical Examination Standards for Vocational Driver’s Licensing developed by the Health Ministry and JPJ were published in 2011.
Apart from assessment of general health, there are specific standards for assessments of:
> visual impairment, visual field defects, double vision (diplopia), colour vision defect, night blindness
> hearing loss, vestibular disorders
> fits (epilepsy), loss of consciousness, tendency to fall asleep in relaxed conditions (narcolepsy), laughter or emotions causing sudden collapse (cataplexy), other sleep disorders, chronic neurological disorders, liability to sudden giddiness and fainting, stroke, central nervous system infection, disorders of the spinal cord and peripheral nervous system, nervous system tumour, serious craniospinal injuries, hydrocephalus. complicated migraine, cerebral palsy
> heart conditions like high blood pressure, angina, acute myocardial infection, heart failure, congenital heart disease, cardiomyopathy, fainting due to high blood pressure, previous angioplasty and/or cardiac bypass operation, arrhythmia, deep vein thrombosis, pacemaker
> poor diabetic control
> chronic lung diseases, respiratory related sleep disorders, respiratory failure
> kidney failure
> amputation or congenital absence of a limb, both thumbs missing, restriction of movement of the cervical spine, chronic pain, restriction or loss of movement of peripheral joint
psychiatric disorders like psychosis, use or dependence on psychotropic drugs, affection of judgement or perception, cognitive or motor function, likelihood of relapse of previous psychotic condition
> abuse and/or dependency on illicit drugs and/or alcohol.
Inability to comply with the standards would render the individual unfit to drive with a vocational licence, to drive a commercial vehicle.
Compliance with the standards change with time as disease and injuries may occur that will affect an individual’s fitness.
As such, regular assessments are necessary.
In short, the medical assessment is comprehensive, requiring time and effort from the general practitioners, who usually perform such assessments; and in some instances, referral to specialist(s) for more detailed assessment(s). The JPJ form L8A, which was agreed to by the JPJ and medical associations, summarises the requirements.
Doctors who perform cursory assessments and certify unfit applicants as fit expose themselves to disciplinary action by the Malaysian Medical Council.
The general practitioners usually charge a professional fee of RM80-RM120 for this assessment and certification although the Private Health Care Facilities and Services Act and its Regulations permit them to charge RM200.
The fee for a similar examination and certification by a Health Ministry doctor is RM100 under the Fees Order of the Fees Act 1951.
U-turn endangers
The JPJ issued a circular on Aug 20,2019 stating that the revised format L8A would apply to all applications for vocational drivers’ licence and that the fee would be RM80.
This did not sit well with a group of e-hailing drivers who are subjected to regulations introduced recently, effective Oct 12,2019.
They also claimed that 135 clinics have agreed to a RM20 fee.
The Transport Minister and JPJ then did a u-turn stating that the revised format L8A would apply to new applications and that the old single page format would apply to renewals.
The Transport Minister was also reported to have said that general practitioners are taking advantage of the situation, an unwarranted comment.
Readers can decide for themselves on the Health Ministry’s silence on this issue and whether the u-turn is in tandem with its vision and mission.
Is the safety of millions of road users being traded just because there are grouses about the doctors’ professional fee of RM80 by a group of e-hailing drivers?
The Transport Minister and JPJ have to ask themselves what can be expected from RM20, which could be the amount that is charged for valet parking.
Is it in the public interest to condone and/or accept sub-standard assessments?
Who would be liable if injury, disability or death result from this policy of the Transport Minister and JPJ?
Would it be the drivers; owners of the vehicles; doctors who certified unfit drivers fit; or the Transport Minister and JPJ?
Is it not the Government’s duty to protect the road safety of the public and not the interests of a small group of e-hailing drivers?
> This article first appeared in The Star newspaper. Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
