Difficulties in diagnosing vertigo in primary care

A study by the Jordi Gol Primary Care Research Institute (IdiapJGol) identifies lack of time, clinical insecurity and difficulty interpreting nystagmus (involuntary and rapid eye movements) as “main obstacles” for a family doctor to apply the recommended maneuvers to diagnose the benign paroxysmal positional vertigo in primary care.

The work, published in the magazine BMJ Openanalyzes why these techniques have not yet been routinely incorporated into clinical practice despite being endorsed by the guidelines, IdiapJGol reports in a statement this Thursday.

The work is based on 4 focus groups with 34 family doctors from 4 primary care teams from L’Hospitalet de Llobregat (Barcelona), and collects their experiences and perceptions about addressing vertigo in the consultation.

Patient expectations

The participating doctors explain that Patient expectations also determine the approach to benign vertigo: According to the professionals questioned, many patients prefer medication to relieve symptoms and show “reluctance” to physical maneuvers, particularly if they have had a bad previous experience.

The situation contributes to reinforce the “inertia” of pharmacological treatmentwhich the participants describe as a common practice in the health system, despite the fact that clinical guidelines recommend prioritizing diagnostic and therapeutic maneuvers and avoiding unnecessary medication.

Save time and queries

The IdiapJGol researcher and first signatory of the study, Alicia Rullan-Rabassa, has highlighted that Applying the maneuvers more systematically “could save time and avoid repeated consultations.”

The team considers it necessary to reinforce practical training “with periodic updates”, have reference professionals and have digital tools that facilitate the application of the techniques and the interpretation of nystagmus.