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Purpose of Physical Examination
The general purpose of the history and physical examination is to detect the presence
of physical, mental, or organic conditions of such character and extent as to affect
the ability of the driver to operate a commercial motor vehicle (CMV) safely. This
examination is for public safety determination and is considered by the Federal
Motor Carrier Safety Administration (FMCSA) to be a “medical fitness for duty"
examination.
Issue Is Risk
As a medical examiner, your fundamental obligation during the physical assessment
is to establish whether a driver has a disease or disorder that interferes with
the ability to safely operate a CMV, increases the risk for sudden death, or increases
the risk for the onset of gradual or sudden incapacitation, thus endangering public
safety.
Risk is the probability of an event occurring within a certain period of time. Determining
"acceptable risk" is both a medical and societal decision.
Does the Driver Pose a Risk to Public Safety?
As a medical examiner, any time you answer “yes“ to this question, you
should not certify the driver as medically fit for duty.
Consider Safety Implications
As you conduct the physical examination to determine if the driver is medically
fit to perform the job of commercial driving, you must consider:
- Physical condition.
- Symptoms — Does a benign underlying condition with an excellent
prognosis have symptoms that interfere with the ability to drive (e.g., a benign
supraventricular arrhythmia that causes syncope)?
- Incapacitation — Is the onset of incapacitating symptoms so
rapid that symptoms interfere with safe driving, or can the driver stop the vehicle
safely before becoming incapacitated? Is the onset of incapacitating symptoms so
gradual that the driver is unaware of diminished capabilities, thus adversely impacting
safe driving?
- Mental condition.
- Cognitive — Can the driver process environmental cues rapidly
and make appropriate responses, independently solve problems, and function in a
dynamic environment?
- Behavior — Are the driver interactions appropriate, responsible,
and nonviolent?
- Medical treatment.
- Effects — Does treatment allow the driver to perform tasks safer
than without treatment?
- Side effects — Do side effects interfere with safe driving (e.g.,
drowsiness, dizziness, orthostatic hypotension, blurred vision, and changes in mental
status)?
Medical Examiner Do's
As the medical examiner, you are examining for medical fitness for duty, not diagnosing
and treating personal medical conditions. Nonetheless, you have a responsibility
to educate and refer the driver for further evaluation if you suspect an undiagnosed
or worsening medical problem. Keep the following in mind—
DO:
- Comply with FMCSA regulations.
- Seek further testing/evaluations for those medical conditions of which
you are unsure.
- Refer the driver to his/her personal health-care provider for diagnosis
and treatment of potential medical conditions discovered during your examination.
- Promote public safety by educating the driver about:
- Side effects caused by the use of prescription and/or over-the-counter
medications.
- Medication warning labels and how to read them.
- The importance of seeking appropriate intervention for non-disqualifying
conditions, especially those that, if neglected, could result in serious illness
and possible future disqualification.
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