Key Feature 4: In appropriate patients with insomnia, use hypnotic medication judiciously (ex: prescribe it when there is a severe impact on function, but do not prescribe it without a clear indication).
Skill: Clinical Reasoning
So many patients have difficulty with sleep, and understandably, so many of them want a prescription for a quick fix. This makes sense: by the time they've come to see the doctor they are typically run-down, exhausted, and the idea of putting extra energy into working at sleep hygiene is utterly heinous. But it's the only thing that fixes the problem and is far better at improving outcomes in the long-term. The risk of harm is also astronomically in favour of nonpharmocological therapy.
That being said, there are times when a short-term course of pharmacotherapy may be appropriate. A patient may be having an acutely difficult moment in their life and need a sleep aid to get through a time-limited stressor. Generally no more than a week's worth of sleeping pills would be warranted for this. What should one prescribe to balance the risk of benefit and harm in such a circumstance?
Choices (with some general reasons for or against) include: