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 quality of dilemmas experienced by physicians when prescribing benzodiazepines. A questionnaire was sent to 213 Swedish General Practitioners. The critical incident technique was chosen as an appropriate method for surveying professional experiences. Concern for the patient and threats to the integrity of the physician were common dilemmas. The physicians did not believe that the patients were telling the truth or did not trust the patients' ability to handle the medicine. The most frequent consequences of the dilemmas were worry about a disturbed relationship with patients indicating an uncertainty as to how to create a good relationship with them. The participants in the study were aware of the national guidelines for prescribing benzodiazepines, but due to insufficient time a prescription was often chosen as a way to handle the dilemmas. Improvement in the rational use of benzodiazepines is not achieved by the medical board making new rules but rather by offering physicians education in communication and negotiating skills as well as more time with the individual patient who is requesting benzodiazepines.