A friend in her 30s recently regaled me with her encounters with the Taiwanese medical system: She suffered from acute onset vertigo, sought help from a hospital-based ear, nose and throat (ENT) specialist, had a battery of tests done and was prescribed medications. Although her symptoms did improve, the vertigo returned with the cessation of medications.
Another ENT specialist suggested a neurological causation. A neurologist’s opinion was sought and my friend had more tests. The results all came back normal. Again, she was placed on medications.
As the neurologist remained skeptical, a third ENT specialist opinion was obtained and benign paroxysmal positional vertigo (BPPV) was confirmed. Maneuvers were administered to good effect with an unremarkable recovery thereafter.
My friend described her journey through the healthcare system as likened to venturing into a labyrinth.
Luckily for her, after eight visits, she succeeded in finding an exit to her problems, but, despite the seemingly successful outcome, my friend remains doubtful after the convoluted lengthy ordeal.
When I consider my friend’s story, her experience would have been drastically different if the first point of contact had been a general practitioner (GP), as would be the case in Australia: The consultation would have entailed a detailed history and a focused neurological and ENT exam. This would have led to a peripheral cause of vertigo rather than a central one.
Funneling down the list of peripheral causes, and knowing that common things happen commonly, the arrival at the diagnosis of BPPV would have been confirmed through the diagnostic Dix-Hallpike maneuver. Investigations would have been bypassed.
The key treatment would have been Epley’s maneuver, and the patient educated on how to continue these maneuvers at home to speed up recovery. Short-term medications would have been used as required, with a limited quantity prescribed.
A single follow-up visit would have been organized to ensure a resolution, with the proviso of a clear safety net in case symptoms took an unexpected turn. One, if not two visits would have been all that was necessary.
Residents of Taiwan are indulged with freedom within the healthcare system. Medical care is affordable and comprehensive. Specialists are accessible and seen promptly.
However, there is a hitch in this approach: the human body is complex. Doctors receive years of training to identify patterns and to practice detective work in solving the medical puzzle.
When medically untrained patients adopt a trial-and-error approach, they fire at will, casting a wide net for a medical solution.
People dive into the myriad of specialists with an assortment of outcomes: Some reach an answer, while others do not. The concern is that those who are less fortunate, less literate or less tech savvy to Google their way through might be sidelined and neglected.
What patients need is a guide in this medical maze — a skilled professional to be the first point of contact for queries and a central coordinator of care when multiple specialists are involved.
GPs are specifically trained to be this person. They are the life specialists holding the beacon of light to lead the lost out of the maze.
Kathleen Shaw is a physician specializing in family medicine and a pharmacist trained in Australia.
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