Press release

Who's fit to drive?

p. 1701  Saskatchewan physicians' attitudes and knowledge regarding assessment of medical fitness to drive — Shawn Marshall, MD; Nathalie Gilbert, MN [full text]

Patients who are no longer medically fit to drive can create a thorny issue for physicians. The advent of legislation that makes it mandatory for physicians to report patients who are unfit to drive puts doctors in the uncomfortable position of representing government interests, which may be contrary to those of their patients.

Shawn Marshall and Nathalie Gilbert discovered that more than half of Saskatchewan physicians (58.6%) fear that reporting a patient who is medically unfit to drive will adversely affect the patient­physician relationship. The 523 Saskatchewan physicians they surveyed were willing to do what was needed to protect public safety, but almost all (97%) said they would benefit from some form of ongoing program to help them assess a patient's fitness to drive.

p. 1738  Canadian Consensus Conference on Dementia: a physician's guide to using the recommendations — C.J.S. Patterson, MD; et al [full text]

Dementia affects 8% of Canadians over age 65, but as the population ages the growing number of people with the condition will pose an increasing burden for patients, their caregivers and the health care system. In response, the Canadian Consensus Conference on Dementia was created in 1998, when 34 experts helped develop a series of consensus statements to serve as a basis for clinical practice guidelines for recognizing, assessing and managing dementing disorders.

On June 15, the results of this rigorous process will be revealed to 55 000 Canadian physicians as a special supplement to the Canadian Medical Association Journal. The goal is to help primary care physicians better recognize the many forms of dementing disorders. The 48 recommendations represent the best available evidence. In an accompanying article in CMAJ, Dr. Christopher Patterson and colleagues explain why doctors should read the guidelines closely: by 2031 the number of Canadians experiencing dementia will surpass 750 000 — that's roughly the population of Calgary, and three times the current number.

p. 1719  Fetal exposure to oral isotretinoin: failure to comply with the Pregnancy Prevention Program — Gordana Atanackovic, MD; Gideon Koren, MD [full text]

p. 1723  Oral isotretinoin: prescribers beware — Neil Shear, MD [full text]

Oral isotretinoin (Accutane) is well known as a first-line treatment for severe acne. Although physicians know that fetuses must never be exposed to the drug, patients are less aware of the risk of birth defects and may not take proper contraceptive safeguards. Gordana Atanackovic and Gideon Koren report on 4 cases involving patients who became pregnant while taking the medication. They suggest that young women taking the drug, particularly adolescents, should be referred for professional contraceptive counselling. In an accompanying editorial, dermatologist Neil Shear offers a blunt warning. "If physicians do not fulfil their responsibilities, patients will lose a good treatment."

p. 1705  Decision-making for long-term tube- feeding in cognitively impaired elderly people — Susan Mitchell, MD, MPH; Fiona Lawson, MB, ChB [abstract]

p. 1721  Substitute decision-making for cognitively impaired older people — Margaret Brockett, EdD [full text]

Approximately 10% of elderly residents in chronic care facilities are fed via a tube. However, there is little evidence proving the claimed benefits — preventing aspiration of food and prolonged life — of this procedure. The decision to start long-term tube-feeding is complex and the process by which such decisions are made is not well understood. This makes it doubly difficult for substitute decision-makers who must decide for cognitively impaired patients.

In their study, Susan Mitchell and Fiona Lawson found that just over half of substitute decision-makers were confident that the patient would want to be tube-fed (56.5%) and felt that they had received adequate support from the health care team in making the decision (52.2%). Although most felt that they understood the benefits of tube-feeding (84.8%), less than half (45.7%) felt they understood the risks. In an accompanying editorial, Margaret Brockett explores the ethics and misconceptions surrounding tube-feeding, and the challenges of substitute-decision making in a technological age.