One of the more unusual aspects of my career is that I began training in aviation medicine over 20 years ago. Since then, I have also trained and worked as a GP, practising in both military and NHS settings.
Perhaps because of this background, I often find myself reflecting on a question that recurs on UK GP forums: should diazepam be prescribed to patients who experience anxiety about flying and are due to travel in the next few days?
My perspective on these requests is shaped by experience in both aviation medicine and primary care. I recognise that many GPs will not have had formal training in aviation medicine, and some potential safety implications may not be immediately apparent. As a result, requests for medication to facilitate flying have always prompted me to pause and consider the wider picture.
Over the past decade, I have compiled a list of issues to consider before deciding whether prescribing is appropriate. These considerations extend beyond the immediate symptoms of anxiety and include factors such as safety, fitness to travel, medication effects, and the broader context of the patient’s journey.
What can make these consultations particularly challenging is that patients often arrive with clear expectations. These expectations may have been shaped by advice from friends, information found online, or previous experiences in which a similar medication was prescribed without difficulty. Declining such requests, or even exploring them in greater depth, can therefore be met with surprise or frustration.
Nevertheless, these conversations offer an important opportunity to balance compassion with clinical and safety judgment. While the distress associated with a fear of flying is very real, it is equally important to consider the potential risks of prescribing sedative medication in the aviation environment.
In the attached document, I illustrate some of the key factors that I believe clinicians should consider when faced with requests for diazepam or similar medications to manage flight-related anxiety.
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