Physician Sex Is a Predictor of Reporting Drivers With MCI
Physician Sex Is a Predictor of Reporting Drivers With MCI
To the Editor: Most individuals with dementia continue to drive at the onset of their illness and keep driving even as their cognitive impairment progresses. Ontario is one of nine Canadian jurisdictions with mandatory reporting of potentially medically unfit drivers, but compliance with this is low, and approximately one-third of physicians are hesitant to report medically unsafe drivers. A modified Delphi study was conducted with 38 Ontario physicians with expertise in dementia to determine which patient- and physician-related factors best predicted reporting to transportation authorities (manuscript in revision). The purpose of this letter is to examine physician-related predictors of reporting individuals with mild cognitive impairment (MCI) and mild dementia to transportation authorities.
Detailed methodology is outlined in the manuscript in revision, but briefly, 26 case scenarios describing individuals with MCI and mild dementia were constructed, each presenting variations of clinical details. Geriatric psychiatrists, geriatricians, cognitive neurologists, and family physicians with expertise in dementia or care of elderly adults were randomly selected and electronically reviewed the scenarios over five iterations. They indicated whether they would report the individuals to transportation authorities and whether they would recommend a specialized on-road driving test. The outcome variable for the present study was the percentage of cases that each physician recommended to report to the transportation authorities across all five iterations. Predictor variables included physician sex, years in practice, specialty, rural versus urban community of practice, and scores on the Risk-Taking Scale (RTS), which assesses physician participants' risk-taking and risk-aversion, the Stress from Medical Uncertainty Scale (SUS), and the Fear of Malpractice Scale (FMS). A five-point Likert scale was used for RTS and SUS and a six-point scale for FMS, in error, instead of five points for FMS and six points for RTS and SUS.
Descriptive analyses were completed for the predictor and outcome variables. Analysis of variance, Spearman correlations, and linear regression with tolerance statistics for multicollinearity were used after normality confirmation using Shapiro Wilk tests.
The 38 individual physicians varied in the percentage of case scenarios that they indicated they would report to the transportation authorities (1.6–78.3%, mean 45.6 ± 19.2%). Male physicians indicated that they would report 53.8 ± 19% of all cases, compared with 39.0 ± 17% for female physicians (F1,37 = 6.413, P = .02). Cognitive neurologists indicated that they would report more cases than other specialties and urban physicians more than rural, but these differences were not statistically significant (Table 1). Similarly, those with 8 years or less in practice showed a nonsignificant tendency to report more individuals than more-experienced physicians. There were also no significant correlations between percentage of cases reported and years in practice, RTS, SUS, or FMS.
Sex was the only significant physician-related predictor of reporting to emerge. Only the RTS and SUS changed the sex parameter estimate in the linear regression model by more than 10%. Sex alone predicted 15.1% of the variance in reporting, but sex together with RTS and SUS predicted a cumulative 27.7% of the variance in reporting (F1,34 = 10.65, P = .003).
Female physicians were substantially less likely than male physicians to recommend reporting individuals with MCI or mild dementia to transportation authorities. Contrary to expectation, years in practice, rural status, and specialty were not associated with reporting, although lack of power may have been a limitation in this regard. The reason for the sex difference is unclear. Earlier studies of physician–patient communication have shown that observers of clinical encounters rated female physicians as being more empathic, having longer appointments, and engaging in more positive talk than male physicians.
The limitations of the study include the small number of participants (particularly cognitive neurologists and junior and rural physicians), the hypothetical nature of the cases with limited clinical variability, the restriction of participants to dementia experts in one Canadian province, and the self-described reporting behavior and personality characteristics, as well as the erroneous scale for the RTS, SUS, and FMS measures.
Nonetheless, although opinions of Canadian physicians may differ from those in other countries, this is the first study to systematically examine physician factors underlying reporting decisions. The study highlights substantial variability in the reporting behaviors of physicians despite practicing in a jurisdiction where legislation strictly mandates such reporting. Physician factors appear to contribute to the decision to report drivers with cognitive impairment, but the decision to report should be based on patient factors only if the system is to be fair and honest. These findings underline the need for standardized assessment methods to ensure a more-consistent reporting system.
To the Editor: Most individuals with dementia continue to drive at the onset of their illness and keep driving even as their cognitive impairment progresses. Ontario is one of nine Canadian jurisdictions with mandatory reporting of potentially medically unfit drivers, but compliance with this is low, and approximately one-third of physicians are hesitant to report medically unsafe drivers. A modified Delphi study was conducted with 38 Ontario physicians with expertise in dementia to determine which patient- and physician-related factors best predicted reporting to transportation authorities (manuscript in revision). The purpose of this letter is to examine physician-related predictors of reporting individuals with mild cognitive impairment (MCI) and mild dementia to transportation authorities.
Detailed methodology is outlined in the manuscript in revision, but briefly, 26 case scenarios describing individuals with MCI and mild dementia were constructed, each presenting variations of clinical details. Geriatric psychiatrists, geriatricians, cognitive neurologists, and family physicians with expertise in dementia or care of elderly adults were randomly selected and electronically reviewed the scenarios over five iterations. They indicated whether they would report the individuals to transportation authorities and whether they would recommend a specialized on-road driving test. The outcome variable for the present study was the percentage of cases that each physician recommended to report to the transportation authorities across all five iterations. Predictor variables included physician sex, years in practice, specialty, rural versus urban community of practice, and scores on the Risk-Taking Scale (RTS), which assesses physician participants' risk-taking and risk-aversion, the Stress from Medical Uncertainty Scale (SUS), and the Fear of Malpractice Scale (FMS). A five-point Likert scale was used for RTS and SUS and a six-point scale for FMS, in error, instead of five points for FMS and six points for RTS and SUS.
Descriptive analyses were completed for the predictor and outcome variables. Analysis of variance, Spearman correlations, and linear regression with tolerance statistics for multicollinearity were used after normality confirmation using Shapiro Wilk tests.
The 38 individual physicians varied in the percentage of case scenarios that they indicated they would report to the transportation authorities (1.6–78.3%, mean 45.6 ± 19.2%). Male physicians indicated that they would report 53.8 ± 19% of all cases, compared with 39.0 ± 17% for female physicians (F1,37 = 6.413, P = .02). Cognitive neurologists indicated that they would report more cases than other specialties and urban physicians more than rural, but these differences were not statistically significant (Table 1). Similarly, those with 8 years or less in practice showed a nonsignificant tendency to report more individuals than more-experienced physicians. There were also no significant correlations between percentage of cases reported and years in practice, RTS, SUS, or FMS.
Sex was the only significant physician-related predictor of reporting to emerge. Only the RTS and SUS changed the sex parameter estimate in the linear regression model by more than 10%. Sex alone predicted 15.1% of the variance in reporting, but sex together with RTS and SUS predicted a cumulative 27.7% of the variance in reporting (F1,34 = 10.65, P = .003).
Female physicians were substantially less likely than male physicians to recommend reporting individuals with MCI or mild dementia to transportation authorities. Contrary to expectation, years in practice, rural status, and specialty were not associated with reporting, although lack of power may have been a limitation in this regard. The reason for the sex difference is unclear. Earlier studies of physician–patient communication have shown that observers of clinical encounters rated female physicians as being more empathic, having longer appointments, and engaging in more positive talk than male physicians.
The limitations of the study include the small number of participants (particularly cognitive neurologists and junior and rural physicians), the hypothetical nature of the cases with limited clinical variability, the restriction of participants to dementia experts in one Canadian province, and the self-described reporting behavior and personality characteristics, as well as the erroneous scale for the RTS, SUS, and FMS measures.
Nonetheless, although opinions of Canadian physicians may differ from those in other countries, this is the first study to systematically examine physician factors underlying reporting decisions. The study highlights substantial variability in the reporting behaviors of physicians despite practicing in a jurisdiction where legislation strictly mandates such reporting. Physician factors appear to contribute to the decision to report drivers with cognitive impairment, but the decision to report should be based on patient factors only if the system is to be fair and honest. These findings underline the need for standardized assessment methods to ensure a more-consistent reporting system.
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