A recent study out of Switzerland essentially posed the question “How much impact does a specialty vestibular clinic have on the correct diagnosis and effective management of patients complaining of dizziness or vertigo?” They attempted to answer this question by looking at the suspected diagnosis made by the referring Primary Care Physician (PCP), and comparing it to the final diagnosis made after undergoing specialty examination. As the director of a specialty vestibular clinic, the results did not surprise me, but I think some health care management types might want to pay attention to this study.
The first group addresses those referred with “unclear dizziness.” Close to 70% of patients entering the specialty clinic were classified as “unclear dizziness.” After specialty examination, only about 10 to 12% remained unclear. I will help with the math. That means 88% to 90% of patients referred to the specialty clinic left with a firm diagnosis. I think we all agree that treatment is more effective when you know what you are treating. This might be a good time to mention that studies reviewing the effectiveness of performing cranial CT Scans or cranial MRI’s on dizzy patients report that they help provide a firm diagnosis somewhere between less than 1% and almost 4%, respectively.
The authors make the valid point that the 70% classified as “unclear dizziness” most likely do not represent the general population, as those with clear diagnosis at the PCP level are less likely to be referred for specialty examination. This author (me) makes the equally valid point (I think) that the take home message is that the specialty clinic could provide a firm diagnosis in about 90% of patients seen.
Next week, let’s see what else they found.