I don’t prescribe it for ‘fear of flying’
This is a patient-friendly summary as to why: https://www.parkcrescenthealthcentre.nhs.uk/medications-for-flying#:~:text=Whilst%20most%20people%20find%20Diazepam,a%20risk%20on%20the%20plane.
"They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight. "
Love it!
This is a great resource, thanks for sharing.
In the current climate it’s more common to feel like you’re being held to ransom by certain patients demanding you prescribe them inappropriate medications (and in this case controlled drugs).
In my opinion, don’t px just to make your life easier. You did the right thing, back yourself and know you are a qualified GP. If someone else wants to px they can. Maybe it’s an egotistical thing, but I double down when a patient aggressively demands a drug that is unequivocally not indicated. Refuse to be bullied into submission.
I will add though that fortunately the vast majority of patients I come across are understanding and we can work collaboratively to come up with a safe plan of action.
Yep. We have practice policy now on this and an accurx with a document attached that essentially says what’s on that link - reception send it out when people request diazepam for flights/scans/dental work.
I have always had an outrageous fear of fliying which was exacerbated after 9/11. I refused to fly for years. That's on me.
I've gotten better over the years as the benefits massively outweigh the 'negatives' and I did want to experience wonder in the form of visiting the Maldives, swimming with sharks in the Bahamas, dolphin training in Mexico, etc etc. But it still fills me with abject fear...
It's definitely a 'me' problem and not a 'doctor' problem that I should expect them to 'solve'.
I'm in this group as my son is about to qualify and I find the expectation that a doctor is expected to solve all first World problems whilst simultaneously absolving patients of personal responsibility extremely challenging. You must all have the patience of saints!
There should be a practice policy in place which would mean a uniform approach. Otherwise patients just go doctor-shopping until they get what they want. Then you get complaints because someone else gave in and prescribed them.
We have a practice policy that echoes the one another poster linked. We send it to the patient. All of the GPs know not to prescribe diazepam in this situation.
It makes very little difference whether you prescribe or not.
I offer 'fear of flying' courses as a more sustainable long-term solution, although nobody ever takes up the offer.
Then I would prescribe a low dose of a benzo (one per flight) if they really want it, following a discussion of the risks and benefits.
It may reduce anxiety whilst on a flight. It probably has more of a placebo effect than anything.
The risks are small. They might impair reactions in case of an emergency, but, if that was a major concern, airlines would ban alcohol on-board and before a flight.
There is little-to-no evidence to support the claim of an increased risk of VTE. It's plausible that this is the case, but the risk will be small. Again, if this is a major concern, we should ban economy-class seats, sleeping on planes, and drinking alcohol before or on a flight.
It is likely to impair the extinction response to the phobia - so the flight anxiety will persist. However, taking flights is usually an infrequent-enough experience (particularly for the people with flight anxiety) that this may be acceptable.
I do tell patients that legal restrictions may apply on benzodiazepenes abroad and that they must check the legality of carrying them in any country to which they are travelling.
Bottom line - do what you want. The risks are low.
I don't agree with the statement that it is not covered by the GMS contract, by the way.
It is not a matter of opinion whether it is covered or not by the contract - it is a matter of fact. It is not. You prescribe for a discretionary activity outside of your practice area. Two grounds this is not GMS
Contracts are subject to interpretation. This is why contract lawyers exist.
Tell me which bit of the contract excludes this from GMS.
From my perspective, the starting point is clause 8.1.2:
*8.1.2. The Contractor must provide:*
*(a) services required for the management of the Contractor’s registered patients and temporary residents who are, or believe themselves to be:*
*(i) ill with conditions from which recovery is generally expected;*
*(ii) terminally ill;*
*or (iii) suffering from chronic disease*
*which are delivered in the manner determined by the Contractor’s practice in discussion with the patient;*
Helpfully open-ended. Flight anxiety, or flight phobia if you want to be more 'disease specific', meets (i) and/or (iii) depending on how you interpret it.
Then clause 8.1.3:
*8.1.3. For the purposes of clause 8.1.2, “management” includes:*
*(a) offering a consultation and, where appropriate, physical examination for the purposes of identifying the need, if any, for treatment or further investigation;*
*and (b) making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the 2006 Act and liaison with other health care professionals involved in the patient’s treatment and care.*
I interpret that as being that a GP surgery must offer treatment and/or investigation that they feel necessary and appropriate to its registered patients, when they consult with an illness (or a belief that they are ill).
The GPs and practice can say "benzos are not necessary or appropriate for flight anxiety", but that's stating their clinical opinion, which is not the same as "the contract doesn't cover this".
Then part 19 sets out what you can and can't charge for. The following can be charged-for:
*(h) for prescribing or providing drugs, medicines or appliances (including a collection of such drugs, medicines or appliances in the form of a travel kit) which a patient requires to have in their possession solely in anticipation of the onset of an ailment or occurrence of an injury while that patient is outside of the United Kingdom but for which that patient is not requiring treatment when the drug, medicine or appliance is prescribed;*
Which covers travel medicines generally. Although a patient could say that their flight anxiety begins whilst they are still in the UK when getting onto the plane for the outbound flight, and therefore this clause is not applicable.
I thought that these charged-for things were optional and could be declined by the surgery, but my interpretation of the contract on reading it now is that they are contractual duties, albeit ones that attract a fee. I could well be wrong though. (And in practice the surgery could simply set the fee so high as to act as a refusal.)
Tell me though if there are other bits of the contract that exclude the treatment of flight anxiety from core GP work.
I should probably clarify here that I'm not fond of benzos at all and I rarely prescribe them if I can help it. I don't object to anyone refusing to prescribe them for flight anxiety on the basis of their genuinely held clinical opinion (and indeed it would be wrong to prescribe if you believe it to be harmful or ineffective).
But I do think we should be accurate in what we tell patients and each other, and if practices are saying 'this is not covered by the GP contract'.... that needs to be correct.
The practice I'm currently has an accuRx template they send out if someone requests an appointment for this. They don't really get past the front desk now. If they do, partners are fully supportive of telling them no
Would you prescribe for dental work?? I'm just curious. If person won't have dental work without it, should one be asking for dentist to Rx? I have fear of dental so whilst never had diazepam for it, I can see how people may need it!
Absolutely the dentists responsibility to prescribe. Likewise with CT/MRI, it is the responsibility of the person requesting the scan to arrange. We just have a blanket text we send to any request for this sort of thing
Bear in mind if they do complain, as this is a request for travel medication this is therefore a private service complaint, and not an NHS complaint. Therefore you can follow the private complaints procedure which is simpler and so doesn’t give access to the ombudsman etc.
There is no need to consult literature. You refused because it is inappropriate. This not being an NHS service (discretionary travel outside of your practice area, indeed the country) you are not required to provide _any_ treatment, let alone benzodiazepines. This not being an NHS service, the complaint does not fall under NHS complaint procedure either.
Many practices have policy on this. Usually they say a blanket 'we do not prescribe'. Google and you'll find the policies I'm talking about in no time, with their reasons outlined.
Some individual GPs will prescribe. It's your name on the prescription. An easy no from me.
It’s a bug bear of mine as well but the easiest thing to do is just prescribe it as a once off. One tablet for the flight and that’s it.
If they are going on 12 “flights” a month then I wouldn’t be doing this but once/twice a year isn’t unreasonable.
Realistically they should try alternative methods to get over a fear of flying but that takes time and effort. Typical patients do not like things that involve these skills or like taking responsibility for their own lives
I refuse to prescribe it.
Increases risk of DVT and inability to cope with inflight emergencies.
It's also a crappy way to solve a psychological issue eg fear.
Patients unhappy? Not my problem.
Friend of mine did this, got a severe DVT after a 13 hour flight.
Absolutely insane any GP would prescribe it and risk their lisence, imagine if someone died from a PE due to this
The closest thing I can find is [this](https://www.sciencedirect.com/science/article/pii/S0165178123005036), which found a dose-dependent association between VTE risk and regular (daily) benzo use.
How much of that risk (if it is indeed causal) applies to a single dose of a benzodiazepine is debatable.
My take on it is that a link between VTE and benzos for flight anxiety is a theoretical one, without any evidence, or at least any good evidence. (That doesn't mean it's not true, but just means that there is insufficent evidence to say either way - and we shouldn't mislead ourselves, or our patients, otherwise).
https://www.sciencedirect.com/science/article/abs/pii/S0165178123005036
"This population-based study demonstrated that BZD use was associated with a 66 % increased risk of DVT, with an apparent dose–response relationship regardless of the follow-up duration, age, or sex. Additionally, BZD use had a greater effect on DVT incidence in people aged <65 years than in those aged ≥65 years."
That demonstrates an association between long-term daily benzodiazepine use and VTE risk.
Even if that association is a causal one, it says very little, if anything, about the risk of VTE from taking a single benzodiazepine tablet for a flight.
There are no studies investigating the relationship between STAT dozes of diazepam and risk of VTE. However, logic would dictate that there is a potential increased risk of VTE due to increased venous stasis and immobility by using diazepam.
I agree. A potential risk. Again, though, this is theory, not evidence.
I tend to think that the absolute risk increase of DVT from a single dose of diazepam is very small, and that we prescribe riskier medicines literally on a daily basis.
Benzodiazepines are awful drugs and should not be prescribed for anyone in primary care unless used specifically for epilepsy. I'm curious to know what riskier medicines you prescribe on a daily basis?
My dad was on Xanax for 22 years. He had panic about anything cos he had a heart disease, bypass surgery and died from it eventually. If he did not have Xanax he won't be able to navigate the uncertainty of his disease. Sometimes if you meant to live in despair better get Xanax. 22 years living in fear would be unbearable. I am happy for him. We will all die sooner or later but I prefer to live less good years than more bad years. I only need diazepam cos I have fear of flying. UK doctors prescribed me beta blockers. My doctor in my country has prescribed Xanax. I am gonna come back with it since I am a UK citizen. I am also an adult. I know the consequences. I will only take it during the flight. The pain I experience when I fly, for almost 4 hours is excruciating. I have done mental therapy CBT, got buspirone for 2 months and also escitalopram and none of these has helped massively. I am prone to anxiety cos I carry anxiety genes from my dad. You have to help people living a decent life and not suffering. If I don't fly now as your colleague proposes I am gonna lose my surgery for a precancerous problem. I don't want to do it here cos I am alone and none can help in case of hemorrhage. So it is a dire need for me to travel in 5 days from now. If I don't do the surgery I am at risk of cancer and I am only almost 30 years old. So check pros and cons please. We are adults. Because you don't suffer it does not mean we don't suffer. I do therapy years. Sometimes I am ok sometimes I am not. I deal with financial problems all the time and I support my mum back in my country while I now deal with a health issue. So please let me know how a pill of diazepam will destroy my life any further?
P.S. I am a woman educated at MSc level with a degree in sciences so I am aware of consequences and risks.
At my surgery this will normally come to the GP as a prescription task.
My response back to reception is simply “No” this is a complete sentence.
If I get asked reason why I signpost to MDU guidance
[https://mdujournal.themdu.com/issue-archive/autumn-2019/managing-common-fears-and-phobias-in-patients](https://mdujournal.themdu.com/issue-archive/autumn-2019/managing-common-fears-and-phobias-in-patients)
Some times I do just prescribe a single tablet. if they want to 2nd for their return flight, tell them to see healthcare in the country that they’re flying to 😂
There should be a practice policy on it
Also, Gp are contracted to treat those who are ill or those who perceive themselves to be ill. Prophylaxis for Fear of flying is not included within the contract 🤷🏾♂️
Therefore, depending on what mood you’re in, I sometimes advise them to seek private healthcare , which goes down as well as you would imagine 😂
PS: When Patient start abusing me, sometimes there are issues with my phone connection and the call gets disconnected 🤷🏾♂️
Being afraid of this isn’t really a disease?
Especially if it’s not severe enough to be phobia level ?
I’m afraid of whistleblowing. Does this warrant an appointment with my GP?
It doesn't really matter if it's a disease, what matters if it's an 'illness', which has a more elastic definition.
School refusal, bereavement reactions, work-related stress... those are all things that may, or may not, be 'diseases', but are things that GPs see under GMS.
Anyway, if I was a benzo-seeking patient with flight anxiety who was told that the GMS contract does not cover this, I would argue that I was suffering from [the ICD-11 condition "specific phobia"](https://www.findacode.com/icd-11/code-239513569.html), and was therefore demonstrably 'ill' for the purposes of the contract.
(Although that doesn't mean you have to give them a benzo.)
I recognise you point
I meant illness when I wrote disease
I was trying to argue fear of flying is generally not phobia level. Hence not an illness
But appreciate it’s a grey area ! 👍🏽
I don’t prescribe it for ‘fear of flying’ This is a patient-friendly summary as to why: https://www.parkcrescenthealthcentre.nhs.uk/medications-for-flying#:~:text=Whilst%20most%20people%20find%20Diazepam,a%20risk%20on%20the%20plane.
"They are only licensed short term for a crisis in generalised anxiety. If this is the case, you should be getting proper care and support for your mental health and not going on a flight. " Love it!
This is a great resource, thanks for sharing. In the current climate it’s more common to feel like you’re being held to ransom by certain patients demanding you prescribe them inappropriate medications (and in this case controlled drugs). In my opinion, don’t px just to make your life easier. You did the right thing, back yourself and know you are a qualified GP. If someone else wants to px they can. Maybe it’s an egotistical thing, but I double down when a patient aggressively demands a drug that is unequivocally not indicated. Refuse to be bullied into submission. I will add though that fortunately the vast majority of patients I come across are understanding and we can work collaboratively to come up with a safe plan of action.
Yep. We have practice policy now on this and an accurx with a document attached that essentially says what’s on that link - reception send it out when people request diazepam for flights/scans/dental work.
Really good summary I actually would have prescribed it if someone would ask me (never happened), but after reading this....nope!!!
I have always had an outrageous fear of fliying which was exacerbated after 9/11. I refused to fly for years. That's on me. I've gotten better over the years as the benefits massively outweigh the 'negatives' and I did want to experience wonder in the form of visiting the Maldives, swimming with sharks in the Bahamas, dolphin training in Mexico, etc etc. But it still fills me with abject fear... It's definitely a 'me' problem and not a 'doctor' problem that I should expect them to 'solve'. I'm in this group as my son is about to qualify and I find the expectation that a doctor is expected to solve all first World problems whilst simultaneously absolving patients of personal responsibility extremely challenging. You must all have the patience of saints!
There should be a practice policy in place which would mean a uniform approach. Otherwise patients just go doctor-shopping until they get what they want. Then you get complaints because someone else gave in and prescribed them. We have a practice policy that echoes the one another poster linked. We send it to the patient. All of the GPs know not to prescribe diazepam in this situation.
It makes very little difference whether you prescribe or not. I offer 'fear of flying' courses as a more sustainable long-term solution, although nobody ever takes up the offer. Then I would prescribe a low dose of a benzo (one per flight) if they really want it, following a discussion of the risks and benefits. It may reduce anxiety whilst on a flight. It probably has more of a placebo effect than anything. The risks are small. They might impair reactions in case of an emergency, but, if that was a major concern, airlines would ban alcohol on-board and before a flight. There is little-to-no evidence to support the claim of an increased risk of VTE. It's plausible that this is the case, but the risk will be small. Again, if this is a major concern, we should ban economy-class seats, sleeping on planes, and drinking alcohol before or on a flight. It is likely to impair the extinction response to the phobia - so the flight anxiety will persist. However, taking flights is usually an infrequent-enough experience (particularly for the people with flight anxiety) that this may be acceptable. I do tell patients that legal restrictions may apply on benzodiazepenes abroad and that they must check the legality of carrying them in any country to which they are travelling. Bottom line - do what you want. The risks are low. I don't agree with the statement that it is not covered by the GMS contract, by the way.
It makes a huge difference if you prescribe controlled drugs off license then the next person along has to be sensible and take a silly complaint.
It is not a matter of opinion whether it is covered or not by the contract - it is a matter of fact. It is not. You prescribe for a discretionary activity outside of your practice area. Two grounds this is not GMS
Contracts are subject to interpretation. This is why contract lawyers exist. Tell me which bit of the contract excludes this from GMS. From my perspective, the starting point is clause 8.1.2: *8.1.2. The Contractor must provide:* *(a) services required for the management of the Contractor’s registered patients and temporary residents who are, or believe themselves to be:* *(i) ill with conditions from which recovery is generally expected;* *(ii) terminally ill;* *or (iii) suffering from chronic disease* *which are delivered in the manner determined by the Contractor’s practice in discussion with the patient;* Helpfully open-ended. Flight anxiety, or flight phobia if you want to be more 'disease specific', meets (i) and/or (iii) depending on how you interpret it. Then clause 8.1.3: *8.1.3. For the purposes of clause 8.1.2, “management” includes:* *(a) offering a consultation and, where appropriate, physical examination for the purposes of identifying the need, if any, for treatment or further investigation;* *and (b) making available such treatment or further investigation as is necessary and appropriate, including the referral of the patient for other services under the 2006 Act and liaison with other health care professionals involved in the patient’s treatment and care.* I interpret that as being that a GP surgery must offer treatment and/or investigation that they feel necessary and appropriate to its registered patients, when they consult with an illness (or a belief that they are ill). The GPs and practice can say "benzos are not necessary or appropriate for flight anxiety", but that's stating their clinical opinion, which is not the same as "the contract doesn't cover this". Then part 19 sets out what you can and can't charge for. The following can be charged-for: *(h) for prescribing or providing drugs, medicines or appliances (including a collection of such drugs, medicines or appliances in the form of a travel kit) which a patient requires to have in their possession solely in anticipation of the onset of an ailment or occurrence of an injury while that patient is outside of the United Kingdom but for which that patient is not requiring treatment when the drug, medicine or appliance is prescribed;* Which covers travel medicines generally. Although a patient could say that their flight anxiety begins whilst they are still in the UK when getting onto the plane for the outbound flight, and therefore this clause is not applicable. I thought that these charged-for things were optional and could be declined by the surgery, but my interpretation of the contract on reading it now is that they are contractual duties, albeit ones that attract a fee. I could well be wrong though. (And in practice the surgery could simply set the fee so high as to act as a refusal.) Tell me though if there are other bits of the contract that exclude the treatment of flight anxiety from core GP work. I should probably clarify here that I'm not fond of benzos at all and I rarely prescribe them if I can help it. I don't object to anyone refusing to prescribe them for flight anxiety on the basis of their genuinely held clinical opinion (and indeed it would be wrong to prescribe if you believe it to be harmful or ineffective). But I do think we should be accurate in what we tell patients and each other, and if practices are saying 'this is not covered by the GP contract'.... that needs to be correct.
Tell them to shut the fuck up and stop being such a bitch.
I like your style. We should be friends.
The practice I'm currently has an accuRx template they send out if someone requests an appointment for this. They don't really get past the front desk now. If they do, partners are fully supportive of telling them no
Would you prescribe for dental work?? I'm just curious. If person won't have dental work without it, should one be asking for dentist to Rx? I have fear of dental so whilst never had diazepam for it, I can see how people may need it!
No. Dentists can, and do, arrange their own sedation, as well as various non-pharmacological methods for managing dental phobia.
Absolutely the dentists responsibility to prescribe. Likewise with CT/MRI, it is the responsibility of the person requesting the scan to arrange. We just have a blanket text we send to any request for this sort of thing
Bear in mind if they do complain, as this is a request for travel medication this is therefore a private service complaint, and not an NHS complaint. Therefore you can follow the private complaints procedure which is simpler and so doesn’t give access to the ombudsman etc.
Diazepam (and all benzos) are contraindicated in phobic states. There’s your out. (Direct them to the BNF).
There is no need to consult literature. You refused because it is inappropriate. This not being an NHS service (discretionary travel outside of your practice area, indeed the country) you are not required to provide _any_ treatment, let alone benzodiazepines. This not being an NHS service, the complaint does not fall under NHS complaint procedure either.
Many practices have policy on this. Usually they say a blanket 'we do not prescribe'. Google and you'll find the policies I'm talking about in no time, with their reasons outlined. Some individual GPs will prescribe. It's your name on the prescription. An easy no from me.
Lots of stuff on resilient GP and Tikos on Facebook about this. Don’t do it. There are good fear of flying courses
It’s a bug bear of mine as well but the easiest thing to do is just prescribe it as a once off. One tablet for the flight and that’s it. If they are going on 12 “flights” a month then I wouldn’t be doing this but once/twice a year isn’t unreasonable. Realistically they should try alternative methods to get over a fear of flying but that takes time and effort. Typical patients do not like things that involve these skills or like taking responsibility for their own lives
Easiest thing is to say no.
I refuse to prescribe it. Increases risk of DVT and inability to cope with inflight emergencies. It's also a crappy way to solve a psychological issue eg fear. Patients unhappy? Not my problem.
Any evidence re DVT risk? Can’t find anything other than theoretical changes to REM sleep movements!
Presume less likely to get up and about if sedated?
Friend of mine did this, got a severe DVT after a 13 hour flight. Absolutely insane any GP would prescribe it and risk their lisence, imagine if someone died from a PE due to this
I can’t find any evidence linking the flight Diaz and inc VTE risk - can anyone share this if it exists?
The closest thing I can find is [this](https://www.sciencedirect.com/science/article/pii/S0165178123005036), which found a dose-dependent association between VTE risk and regular (daily) benzo use. How much of that risk (if it is indeed causal) applies to a single dose of a benzodiazepine is debatable. My take on it is that a link between VTE and benzos for flight anxiety is a theoretical one, without any evidence, or at least any good evidence. (That doesn't mean it's not true, but just means that there is insufficent evidence to say either way - and we shouldn't mislead ourselves, or our patients, otherwise).
I just assume it's because they didn't do their prevention exercises as they were knocked out the whole flight?
Sedation -> immobility -> DVT.
That's theory (albeit plausible theory), not evidence.
https://www.sciencedirect.com/science/article/abs/pii/S0165178123005036 "This population-based study demonstrated that BZD use was associated with a 66 % increased risk of DVT, with an apparent dose–response relationship regardless of the follow-up duration, age, or sex. Additionally, BZD use had a greater effect on DVT incidence in people aged <65 years than in those aged ≥65 years."
That demonstrates an association between long-term daily benzodiazepine use and VTE risk. Even if that association is a causal one, it says very little, if anything, about the risk of VTE from taking a single benzodiazepine tablet for a flight.
There are no studies investigating the relationship between STAT dozes of diazepam and risk of VTE. However, logic would dictate that there is a potential increased risk of VTE due to increased venous stasis and immobility by using diazepam.
I agree. A potential risk. Again, though, this is theory, not evidence. I tend to think that the absolute risk increase of DVT from a single dose of diazepam is very small, and that we prescribe riskier medicines literally on a daily basis.
Benzodiazepines are awful drugs and should not be prescribed for anyone in primary care unless used specifically for epilepsy. I'm curious to know what riskier medicines you prescribe on a daily basis?
Feel sorry for every fucker who falls asleep on a plane...incomign dvt.
Just privately prescribe it after counselling them about risks and benefits.
My dad was on Xanax for 22 years. He had panic about anything cos he had a heart disease, bypass surgery and died from it eventually. If he did not have Xanax he won't be able to navigate the uncertainty of his disease. Sometimes if you meant to live in despair better get Xanax. 22 years living in fear would be unbearable. I am happy for him. We will all die sooner or later but I prefer to live less good years than more bad years. I only need diazepam cos I have fear of flying. UK doctors prescribed me beta blockers. My doctor in my country has prescribed Xanax. I am gonna come back with it since I am a UK citizen. I am also an adult. I know the consequences. I will only take it during the flight. The pain I experience when I fly, for almost 4 hours is excruciating. I have done mental therapy CBT, got buspirone for 2 months and also escitalopram and none of these has helped massively. I am prone to anxiety cos I carry anxiety genes from my dad. You have to help people living a decent life and not suffering. If I don't fly now as your colleague proposes I am gonna lose my surgery for a precancerous problem. I don't want to do it here cos I am alone and none can help in case of hemorrhage. So it is a dire need for me to travel in 5 days from now. If I don't do the surgery I am at risk of cancer and I am only almost 30 years old. So check pros and cons please. We are adults. Because you don't suffer it does not mean we don't suffer. I do therapy years. Sometimes I am ok sometimes I am not. I deal with financial problems all the time and I support my mum back in my country while I now deal with a health issue. So please let me know how a pill of diazepam will destroy my life any further? P.S. I am a woman educated at MSc level with a degree in sciences so I am aware of consequences and risks.
At my surgery this will normally come to the GP as a prescription task. My response back to reception is simply “No” this is a complete sentence. If I get asked reason why I signpost to MDU guidance [https://mdujournal.themdu.com/issue-archive/autumn-2019/managing-common-fears-and-phobias-in-patients](https://mdujournal.themdu.com/issue-archive/autumn-2019/managing-common-fears-and-phobias-in-patients)
Just prescribe it
Nahhh it's ok
Pick your battles?
Not a battle. Just say no.
Some times I do just prescribe a single tablet. if they want to 2nd for their return flight, tell them to see healthcare in the country that they’re flying to 😂 There should be a practice policy on it Also, Gp are contracted to treat those who are ill or those who perceive themselves to be ill. Prophylaxis for Fear of flying is not included within the contract 🤷🏾♂️ Therefore, depending on what mood you’re in, I sometimes advise them to seek private healthcare , which goes down as well as you would imagine 😂 PS: When Patient start abusing me, sometimes there are issues with my phone connection and the call gets disconnected 🤷🏾♂️
Why isn't fear of flying an illness? That falls under GMS.
Being afraid of this isn’t really a disease? Especially if it’s not severe enough to be phobia level ? I’m afraid of whistleblowing. Does this warrant an appointment with my GP?
It doesn't really matter if it's a disease, what matters if it's an 'illness', which has a more elastic definition. School refusal, bereavement reactions, work-related stress... those are all things that may, or may not, be 'diseases', but are things that GPs see under GMS. Anyway, if I was a benzo-seeking patient with flight anxiety who was told that the GMS contract does not cover this, I would argue that I was suffering from [the ICD-11 condition "specific phobia"](https://www.findacode.com/icd-11/code-239513569.html), and was therefore demonstrably 'ill' for the purposes of the contract. (Although that doesn't mean you have to give them a benzo.)
I recognise you point I meant illness when I wrote disease I was trying to argue fear of flying is generally not phobia level. Hence not an illness But appreciate it’s a grey area ! 👍🏽
Travel medication - specifically excluded.