What this report is for
Every Australian driver licensing authority assesses medical fitness to drive against the same document: Austroads' Assessing Fitness to Drive, which has a dedicated section on psychiatric conditions and separate standards for private and commercial vehicle drivers. The report you write is an opinion against that standard. Its reader is an officer at the licensing authority who will grant, condition, suspend or refuse a licence on the strength of it, and who is not a clinician.
That gives the report a shape unlike a clinical letter. It has to say which standard was applied and which licence class, address the criteria the standard actually sets for the condition in question, give the opinion in the standard's categories (meets the standard, meets the criteria for a conditional licence, does not meet the standard), and set a review period. And it has to record that the patient was told of their own legal duty to report a condition that may affect their driving, which exists in every jurisdiction.
The standard, and what it asks about
For psychiatric conditions the standard is concerned with the effect on the task of driving rather than with diagnosis as such: insight and judgement, attention and concentration, the risk of an acute episode at the wheel, behaviour during episodes, adherence to treatment, substance use, and the effects of medication, sedation in particular. It treats an acute episode of psychosis, mania or severe depression as incompatible with driving while it lasts, and it sets out when a person whose condition is stable and treated may meet the criteria for a conditional licence with periodic review. The commercial standard is stricter throughout.
Read the current edition before writing. The criteria are specific, they are what the licensing authority will check your opinion against, and they change between editions. The standard is linked under Sources.
What it must contain
- The standard and the edition. That the assessment was made against Assessing Fitness to Drive, the edition, and the section applied.
- The licence class. Private or commercial, and the vehicle type where relevant. This determines which standard applies and must be stated before the opinion.
- Your standing. Treating psychiatrist since when, or single assessment on referral from the authority, and what records were reviewed.
- Diagnosis and current status. The condition, its course, the date of the last acute episode, and current symptoms.
- Treatment and stability. What the person is taking or receiving, for how long the condition has been stable, adherence, and insight.
- Medication effects. Sedation, reaction time, attention, and any recent change in dose, addressed specifically because the standard asks about them.
- Substance use. Current use, history, and its relevance to driving.
- Cognition and behaviour relevant to driving. Attention, judgement, impulsivity, any behaviour during episodes that bears on driving.
- The opinion, in the standard's terms. Meets the standard; meets the criteria for a conditional licence subject to stated conditions and review at a stated interval; or does not meet the standard. With the reasoning tied to the criteria.
- The review period. The interval at which the condition should be reassessed for licensing purposes, and what would prompt earlier review.
- Advice to the patient. That they were told of their duty to report to the licensing authority and, where relevant, advised not to drive, with the date.
Where reports fall short
- "Fit to drive" with no reference to the standard, its edition or its criteria, which the authority cannot act on.
- The licence class is not stated, so the authority cannot tell which standard was applied.
- Medication effects are not addressed, when the standard asks about them directly.
- Clinical stability is offered as the conclusion, without the criteria the standard actually sets.
- No review period, so a conditional licence cannot be set up.
- The patient's duty to report, and the advice given, are not recorded.
- The authority's form exists and was not used, so the opinion arrives in the wrong shape.
A skeleton that works
Related documents
The same discipline, an opinion against a named standard for a non-clinical decision-maker, applies to fitness for other licences and registrations, from firearms to professional registration, each with its own standard and its own preset in the library. A patient who has been advised not to drive may also need a medical certificate for work or leave, which is a separate document.
How PsychDispatch drafts this
The Fitness for Licence / Registration preset drafts the report in the structure above, with the standard named and the opinion in its categories. Patient Intelligence supplies the parts a licensing authority checks most closely: the date of the last acute episode, the medication history with dose changes and dates, the record of stability across consultations, and the note that the patient was advised of their duty to report. Every statement is verified against the source before you sign, and the report goes out on your letterhead.