Prescribing benzodiazepines - a critical incident study of a physician dilemma

Use of benzodiazepines has been discussed extensively both among the public and within the medical society. The aim of this study was to explore the q uality of dilemmas experienced by physicians when prescribing benzodiazepin es. A questionnaire was sent to 213 Swedish General Practitioners. The crit ical incident technique was chosen as an appropriate method for surveying p rofessional experiences. Concern for the patient and threats to the integri ty of the physician were common dilemmas. The physicians did not believe th at the patients were telling the truth or did not trust the patients' abili ty to handle the medicine. The most frequent consequences of the dilemmas w ere worry about a disturbed relationship with patients indicating an uncert ainty as to how to create a good relationship with them. The participants i n the study were aware of the national guidelines for prescribing benzodiaz epines, but due to insufficient time a prescription was often chosen as a w ay to handle the dilemmas. Improvement in the rational use of benzodiazepin es is not achieved by the medical board making new rules but rather by offe ring physicians education in communication and negotiating skills as well a s more time with the individual patient who is requesting benzodiazepines. (C) 1999 Elsevier Science Ltd. All rights reserved.