VERTIGO/DIZZINESS: STILL A BEDSIDE MANNER

Abstract

Current trends in Neurotology have a significant tendency towards administration of diagnostic tools and treating the results obtained from machine rather than patient Medical science has advanced a great deal and this has led to tendency for over investigation, ordering a raft of investigations instead of confirmatory test. Investigation is must, but proper history and clinical examination will help to request for appropriate test.

Good clinician must understand that ten patients with same results in vestibular test may have ten different disorders. Even a perfectly normal finding in VNG does not mean that there is no disorder in balance system. Normal person without any vestibular problem may have abnormal vestibular finding in VNG or other vestibular test.

Medical practice has a abstracts quality that heals the patient and technology cannot be a substitute for clinical examination or bond that a patient shares with his/her doctor. It is bond that takes away distress or anxiety and healing begins before any medicine. Each patient is different and their reaction to a disease is different. No machine can analyze such a difference.

Technology cannot be a substitute for clinical examination or doctor patient relationship. We should not forget that medicine is learnt best at bedside /spending more time with patient; listening to their problems and physically examining them. Development in technology in recent past has led many of us to depend heavily on machines and diagnostic tools instead

of going by what we see, hear or feel. But a good practitioner is the one, who spend time with his/her patients, can take out the relevant information and knows in which direction to head. Good clinical judgement is hall mark of good clinician. Good clinician should be able to hear an unspoken nuance of the disease which no machine can detect.

In the field of neurotology, investigation have very little /or no meaning without proper detailed history and clinical examination. Machine is useless without the man behind the machine. Man behind the machine and who interpret the report should have through knowledge of vestibular physiology and nuances of vestibular Test. He/she should be well versed with how the finding changes in different pathologies in different individual.

Taking proper history and clinical examination and linking/analyzing it with finding obtained from different vestibular test is the base of neurotology practice.

Instead of depending heavily on diagnostic tool/ test, clinician should fall back on old favorites, time tested bedside manner of proper history taking and clinical examination.

Investing more time familiarizing with symptoms, sign and scientific facts around various pathologies and by taking a comprehensive history and clinical examination prior to administration of sophisticated test can contribute to better approach to diagnosis and treatment of dizzy patient.