Last week, I reviewed some studies that found that patients with BPPV have historically been managed quite ineffectively. I am pasting a reader (Audiologist) comment I received shortly after the blog was posted:
“Sadly, I’m not shocked at all by these stats. However, I will say there seems to be more awareness amongst physicians the past few years.
“Inevitably, though, we get referrals from the MDs for all vertigo patients as “BPPV” or “BPV.” Of course, lots of these are not BPPV…which is fine; at least the MDs are more often referring patients in the right direction to help narrow down the possible diagnosis. Our local ER has finally caught on though and seems to be very competent in this regard, so that is encouraging.”
These types of comments are encouraging because I do think there are two sides to every story. On the one hand, just like politics, health care is local. Practice patterns differ geographically, but not necessarily based on geography. There are a number of factors that influence this. A local medical school or residency program may have a more comprehensive approach to the dizzy patient. Reimbursement might be better because of a different socio-economic population or insurance coverage. A local individual might take a particular interest in vestibular disorders and make it a mission to educate the local primary care doctors. I do not lose sight or hope that things will continue to improve, but it is a slow process.
There is a quote by Dr. Max Planck, who won the Nobel Prize for Medicine in 1918.
“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that are familiar with it.”
A few years ago, I was involved in writing the multi-specialty Clinical Practice Guideline for BPPV sponsored by the American Academy of Otolaryngology – Head and Neck Surgery. We had representatives from each and every specialty that might come in contact with a patient suffering from BPPV. We scoured the literature, considered all perspectives, made some compromises, and published a solid (I think) guideline to make the path of the BPPV patient shorter and more efficient. There were clear recommendations regarding the use of imaging, vestibular suppressant medication and Canalith Repositioning. Yet, I still see at least one patient every day referred for possible BPPV, but they arrive with a copy of the cranial MRI or CT scan in hand, and are a week or two into a prescription of meclizine, both of which are contrary to the guidelines’ recommendations.
I am sure that many readers of this post will think, “That’s not the way we do it here.” I know and I think that’s great. There are many well-trained and caring specialists out there, but there are more people with simple-to-treat BPPV who are not getting optimal care. Things are gradually improving, but I post summaries and statistics in the hopes thet we might speed up the process. Next week, we will look at some studies regarding treatments used for patients diagnosed with BPPV.