Hopefully, I have provided some insight as to why there are so few vestibular specialty clinics. Let’s move on to some suggestions for improving the situation.
First, from the patient’s perspective, the days of leaving all your health care decisions to your family doctor probably are, and probably should be, over. You need to do a little research on your own. The internet has opened the doors to make basic medical information available. Make sure you use a trusted site. I would recommend (www.dizzinesandbalance.com) , a site maintained by Dr. Tim Hain, a neurologist at Northwestern university. The Vestibular Disorders Association (www.vestibular.org) not only has useful brief articles about many vestibular disorders, but has a list of providers that have an interest in managing vestibular disorders. Micromedical Technologies (www.micromedical.com) offers the Dizziness Reference Guide, which is a symptom based guide offering descriptions of the most common causes of dizziness along with management suggestions. Full disclosure, I wrote this and make a few dollars of each sale.
From the practitioner’s perspective, it is important that Audiologists, ENT Physicians and Neurologists recognize and are honest about their limitations. Many patients can be successfully diagnosed and treated without a full battery of vestibular tests. For example, BPPV, the most common cause of dizziness, generally does not require any specialized equipment, but it does require an experienced, knowledgeable practitioner. Some patients require the expertise and equipment found only in a vestibular specialty clinic, so all practices seeing dizzy patients should have a protocol for referring on patients that are not easily diagnosed and treated.
From the vestibular specialist’s perspective, there needs to be a recognition by both the practitioner and the patient that Medicare won’t cover the costs of some tests that are very important for patients with chronic dizziness. The practitioner has to decide whether to offer the services at a loss, or ask the patient to pay for things Medicare won’t cover. If the patient is unwilling to cover these costs, the practitioner may be forced to develop a treatment plan without some critical information.
