Thousands of patients are allowed to drive again

Anyone who is ill and still gets into the car can be a danger on the road. An epileptic seizure in the car, for example, can cause a lot of lumps. That is why the Ministry of Transport, Public Works and Water Management has Regulation Requirements Suitability 2000 We have established which diseases and under which conditions we may or may not continue to drive. These rules have been refined over the years, advice from the Health Council.

After all, science does not stand still: some diseases can be better treated or controlled. For example, the negative consequences of sleep disorders can now be almost completely controlled. There is also talk of ‘advancing insight’: what used to seem serious, turns out to be not that bad in practice. For example, the consequences of a TIA or stroke are not disastrous in all cases.

mild dementia
Due to the relaxation of the rules, thousands of people who until recently had to leave their car behind are allowed to get back behind the wheel. This concerns the small driving license for motorcycles and passenger cars for private use. An important change concerns dementia patients. They were never allowed to drive, regardless of the stage of their illness. Since February, it has been allowed to drive in the case of mild dementia, provided the patient can show that he has good control of the car.

Due to medical advances, dementia can now also be detected at a very early stage and then safe driving is still possible. The new standard: patients with mild dementia who pass the mandatory driving test of the CBR (Central Bureau for Driving Proofs) are ‘fit to drive’ for a year.

After a TIA
The assessment of medical fitness to drive is increasingly subject to customization. Where in the past people used to talk about fitness to drive — someone has dementia and is not allowed to drive, period — there is now an increasing focus on a specialist report and a driving test.

The biggest breakthrough concerns the procedure for TIA and stroke. Previously, a driving ban was for six months, now this period has been drastically reduced to two weeks. If there are no problems in the first two weeks after the TIA or stroke, you may continue to drive. Anyone who has physical problems, for example reduced strength in the arm, may not drive for three months. After that, a specialist report is required and a driving test at the CBR. If the result is positive, a fitness to drive will be issued for a maximum of five years.

It makes sense if you know the latest scientific insights about the consequences of a TIA or stroke: many people recover quickly and hardly suffer from residual symptoms. Often because a TIA and stroke are recognized more quickly and can therefore be treated more quickly, which significantly reduces the risk of harmful consequences.

Pass out
The criteria for fitness to drive have also changed considerably in the field of consciousness disorders. It concerns people who temporarily lose consciousness; fainting is part of that. It is estimated that half of all people will faint at some point in their lives.

Intense emotions, stress, pain, standing still for a long time or heat can trigger fainting. In the past, anyone who passed out once had to leave the car immediately. The new rule: a driving ban only applies if you pass out three or more times a year. The criteria have been stretched, because scientific research has shown that the chance of recurrence of fainting while driving is minimal.

Also good news for patients with chronic heart failure. People with minor complaints were always allowed to stay
to drive. A new feature is that those with moderate complaints are also fit to drive, for a maximum period of three years. Research has shown that it is not the disease itself, but mainly the stability of the disease that determines whether someone can safely drive a car. People with moderate complaints are stable enough to participate in traffic. However, people with chronic heart failure should be careful if their medication changes. Certain medications that affect blood pressure prevent them from getting in a car for a week.

Bad sleeping
Those who suffer from sleep disorders, such as sleep apnea and narcolepsy, are allowed to drive again under certain conditions. In those who suffer from sleep apnea, breathing stops while sleeping; many sleep interruptions make them chronically tired. Chances are that they are so tired during the day that they doze off behind the wheel. Sleep apnea is most common in old age.

Narcolepsy patients can spontaneously fall asleep during the day, even while driving. There are now adequate treatments for both conditions. If they catch on, people with these disorders can still be fit to drive.

A small group of eye patients also benefits from the new rules: anyone who has a so-called bioptic telescope (a type of binoculars on the spectacle lenses) can still enter the car. However, this is only possible after extensive training and a successful driving test. In addition, driving is only allowed during the day in a car with an automatic transmission.

For all other illnesses and conditions for which there were restrictions on fitness to drive, the old rules remain in force. People with epilepsy, for example, still have to meet the same requirements as before, just like diabetics and people who have had a heart attack.

When are you punishable?
Suppose you develop an illness for which a driving ban applies, do you have to surrender your driving license immediately? There is no legal obligation to report to the CBR that you are ill. The temptation is therefore great for many to keep driving. Nobody likes to give up the freedom and independence that a car brings. In addition, it is not checked.

But you can get into trouble if you keep driving against your better judgement and get involved in an accident. You will not go free then. You can be punished for irresponsible driving, just like someone who is drunk behind the wheel is punishable. The insurance company can also be difficult and refuse to pay for the damage.

Medically fit to drive?
The relaxation of the rules applies to driving with a ‘small’ driving license for motorcycles and passenger cars. Do you think the new rules apply to you? Then collect the ‘Own declaration with medical report’ form from the municipality (costs: €22.90) and fill in ten questions. The medical report must be completed by a doctor.

Sometimes you also need a medical report from a specialist. The costs of this vary, but count on about € 150. You send all this to the CBR (Central Bureau for Driving Proofs), which then assesses whether you are fit to drive, and if so for how long. In some cases, a driving test is required. This is not a driving test. The driving test is purely intended to see whether someone can drive a car in a safe and responsible manner. You take the driving test in your own car and it is free.

The entire procedure may take some time. The CBR applies a maximum term of four months. By the way: from the age of seventy, every motorist is obliged to request a medical certificate when renewing the driver’s license.

For detailed information about the new scheme, visit the website of the Central Bureau for Driving Licenses: www.cbr.nl

Pill up? Let you drive!
In addition to a disease or condition, medicines can also make you unfit to drive a car. Pills can make you drowsy and reduce your ability to react. You are less fast and alert, which is very important in traffic. The effect of some medicines is at least as strong as that of a few glasses of alcohol. Many people tend to underestimate this.

Drugs that are dangerous to drive can be recognized by the yellow sticker on the box. These can be sleeping pills and sedatives, but also certain antidepressants, eye drops, morphine and antitussives. It is quite difficult to determine to what extent a drug has an influence on driving behaviour. One reacts differently to one

medicine than the other. Age also plays a part. Medicines have a greater effect on the elderly: they are more sensitive to them and their bodies break down the medicine less quickly. Furthermore, the dosage and the time at which the drug is taken has an influence. It also matters how long you have been taking a medicine. People who take morphine, for example, can often safely get behind the wheel after a habituation period of two weeks.

on www.rijveiligmetmedicijnen.nl There is an extensive list of medicines with which you may or may not drive. You can also take a virtual test drive on the website to see how medicines affect your driving skills.

Thanks to Jan van der Vlist, senior policy officer and project leader for medical fitness to drive at the Ministry of Transport, Public Works and Water Management.