“Good morning Mrs. Butterworth, Tell me what you brings you here today?”
Mrs. Butterworth: “I’m dizzy.”
What have I learned? Nothing.
The term “dizziness” serves as a catch-all phrase for a wide range of sensations, making it an inadequate descriptor. It encompasses experiences such as vertigo, lightheadedness, faintness, disorientation, and gait instability. These diverse complaints can arise from various underlying causes. Lumping such a broad array of symptoms under the single category of “dizziness” can impede accurate diagnosis and hinder effective treatment.
In a recent study, it was found that over 80% of audiologists made efforts to obtain a more detailed description of patients’ dizziness symptoms. However, the same study revealed that only 33% of geriatricians did so. Consequently, patients with chronic vestibular symptoms often report that a comprehensive history was never taken. As a result, they may visit multiple physicians without receiving a conclusive diagnosis or finding resolution to their complaints. In many cases, these individuals are treated symptomatically with vestibular suppressant medications like Antivert (Meclizine), despite not having a confirmed diagnosis of vestibular dysfunction.
Broad Descriptions Can Hinder Accurate Diagnosis and Treatment
Taking a directed case history and conducting a brief physical examination can offer a more focused, logical, and cost-effective approach to diagnosis and treatment. After providing patients with an opportunity to describe their symptoms in their own words, specific questions should be asked to gain a better understanding of their experiences. As Dr. Joel Goebel from Washington University of St. Louis emphasizes, the accuracy and quality of the history depend on the examiner’s patience and skill.
It is crucial to dedicate sufficient time to individual patients, allowing for a thorough understanding of their histories and complaints before attempting to make a diagnosis. This comprehensive approach increases the chances of arriving at an accurate assessment and tailoring the treatment accordingly. By taking the time to listen to patients’ experiences, healthcare professionals can uncover important details and nuances that may help identify the underlying causes of their symptoms.
The accuracy and quality of the history is directly related to the patience and skill of the examiner.
By moving away from the generic term “dizziness” and adopting a more nuanced approach, healthcare practitioners can enhance the quality of care provided to patients. A deeper understanding of the specific symptoms experienced by each individual enables a targeted and personalized treatment plan, addressing the root causes and improving patient outcomes.
It is therefore important to spend sufficient time with individual patients to understand their history and complaints thoroughly before attempting to make a diagnosis.
Next week, we will discuss the finer points of taking a history from a patient complaining of “dizziness.”
