Physical Exam Can Sort Out - And Treat - Common Type of Vertigo
Some older patients with dizziness undergo thousands of dollars of tests that often turn up nothing. Others are told it’s just a part of aging. But with the most common kind of vertigo, there’s actually an easy fix. “You don’t even have to put on a gown,” says one patient in a New York Times article from 2016.
Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV), as highlighted by the vignettes in the New York Times piece, is both simple and effective. And it highlights something important: for all the technology available to us, the physical exam is still extremely effective.
According to the article, BPPV “occurs when the tiny calcium carbonate crystals of your inner ear loosen and migrate into one of the semicircular canals, where their presence signals the brain that you’re moving when you’re not." Trained providers can diagnose and treat the symptoms of BPPV simply by repositioning the patient’s head. BPPV is confirmed by presence of nystagmus, a characteristic eye movement when the patient turns his/her head side to side.
The symptoms of BPPV can be treated by a 5-minute procedure called the Epley maneuver. Otolaryngologist John Oghalai tells the NYT, “When you tell patients that all you have to do is move your head in a few different directions, they think you’re crazy.” But “they love it” when they “find their vertigo gone with a simple test and a non-pharmacological treatment. Leaving it untreated can lead to falls that cause serious injury,” says the NYT.
Yet another reason that we here at Stanford 25 emphasize the bedside: you never know what you might discover.
Humility is an underappreciated skill in a time of global budgets, evidenced based approaches, and cost-containment. The bright, well-read, talented medical students who may lack humility are not uncommon.
Patient-centered care is an important aspect of the National Strategy for Quality Improvement on Health Care. As such, healthcare institutions are strongly focusing on the patient-physician relationship and the patient experience.
The editor-in-chief of Medscape, Dr. Eric Topol, visited Stanford to sit down and do an interview with our Dr. Vergese for the Medscape One-on-One online video series.
Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles. With the internet becoming the “elephant in the doctor’s office,” the dynamic of medical authority has certainly changed…