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To this day, Dr. John Crosby, a family physician in Cambridge, Ont., remembers the scene perfectly: “She chased me around my waiting room with a walker, screaming and yelling.” The doctor dodged in and out of chairs to avoid getting beaten. “She” was one of his patients. Months later, when she was admitted to hospital and Dr. Crosby went to visit her, she greeted him with: “Oh! If it isn’t Big John Crosby.” She’d never forgive him, she said, not even on her deathbed.

The offense? Dr. Crosby had reported her to the Registrar of Motor Vehicles because she had dementia, and by his calculation, was a potential hazard behind the wheel. In Ontario, according to the Highway Traffic Act, physicians are legally required to report patients who are suffering from a condition that may impair their ability to drive. This is part of their role as guardians in our society, alongside other unpleasant duties like filing reports about gunshot wounds or suspected child abuse. But just because it’s a legal and professional obligation doesn’t make the task any less painful. “It’s one of the hardest things,” said Dr. Crosby. “Patients are always furious with you, no matter what.”

This is why doctors dread telling patients they may be unfit to drive, and it’s why, in 2006, Ontario introduced a financial incentive—$36.25 that doctors could bill the province—for each time they tell on a patient.

Six years later, a New England Journal of Medicine study released today, finds that the rate of reporting by doctors has increased since 2006 and patients who’d received a formal RMV warning were 40 to 45 per cent less likely to be involved in a serious car crash. “In our study, the baseline risk in this cohort of patients was 4.7 serious crashes per 1,000 drivers per year,” said Dr. Donald Redelmeier, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and lead author of the report. After the warning, the risk came down to 2.7 serious crashes per 1,000 drivers per year.

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