I’m currently staying at a ridiculously luxurious hotel in the centre of Boston, USA (I booked too late and couldn’t find anything cheaper!). It’s the second morning of the American Neurological Association meeting with the Association of British Neurologists. Having just realised I left my shirts with some friends, I’m off to shop for some more. However, there’s a bit of time to review one of the sessions from yesterday.
I like these sorts of general conferences because there are sessions I wouldn’t normally have any interest in. Yesterday’s session on healthcare research was one. There were about 7 short presentations, mainly focused on how to deal with inequality in the US healthcare system. Obviously there were quite a few issues which could be solved in an instant by a tax-based financed healthcare system, but rather than rant about those, one issue that came up was CT scans for dizziness.
Why is scanning dizzy people in healthcare services research atl all? Well, firstly it’s bad for people. A CT scan is not a trivial dose of radiation and you’re more likely to find something benign and unrelated to the presenting symptoms than you are to find anything that might cause the dizziness. And that results in anxiety and worry. Many people would request a scan to practice ‘defensive medicine’, ie the worry you ‘might have missed something’, even if that ‘something’ is unspecified. Insurance company provider and gender among other factors dictated whether you were more or less likely to be scanned.
The speaker talked about the T-form, a checklist style clerking proforma filled in by the Emergency Department doctor. This included a box for CT results. The argument was that removing this may help decrease the number of CTs requested.
What wasn’t discussed was actually making a positive diagnosis in dizziness. Most cases will be due to Benign Paroxysmal Position Vertigo, or another peripheral cause such as labyrnthitis. There are some nice easy tests to make this diagnosis, such as the fun-to-perform-scary-to-have-done-to-you Hallpike test . The related Epley manouver often cures BPPV (if you’re dizzy, just look it up on Youtube).
So, my recommendation? Ditch the CT box and replace it with a box for the Hallpike test. Right, now off to find some breakfast and a shirt….