The word dizzy means one thing to one person and many times something quite different to another. Regrettably that disconnect is often between a doctor and patient. Both can ill afford it though. The reasons relate to the growing emphasis on the cost and quality of health care.
Lightheadedness and vertigo are the two most common symptoms patients mean when they use the term dizzy. Less often, they apply the term to problems with balance or visual disturbances. Despite the fact that all four sensations are vastly different, patients often mean either when they use the term dizzy.
The Importance of Proper Terminology
Use of the vague term dizzy without clear mutual understanding and agreement on what the word means can lead the doctor on a wild goose chase in trying to find out the cause in a patient. It might appear to just be a moot point on the surface but in today’s world this miscommunication between doctor and patient can be at a heavy price for both.
It is costly for patients because health care benefits are no longer a blank check. With increased cost-sharing, deductibles and copayments are much greater than in times past. The bottom line for patients is the number and types of tests they undergo and the amount and type of care they receive.
The miscommunication in the use of the word dizzy can be costly to doctors because of the impact on reimbursement for the services they provide. There are a number of ways that this can play out. One scenario is nonpayment by an insurance carrier due to the use of an incorrect ICD 10 code. As healthcare payment reform evolves, penalties by insurance companies will also be a factor. Those penalties will be in the form of reduced payments. They will be the result of a doctor’s failure to control spending and/or meet specific quality standards.
A precise description of the word dizzy not only promotes a more cost-effective pursuit of the cause. It also helps to lower costs if it prevents needless treatment based on an incorrect symptom. The treatment might be of the symptom itself or a change in existing treatment.
The Different Meanings of Dizziness and Their Implications
Lightheadedness usually implies dysfunction of the cardiovascular system leading to a drop in blood flow to the brain. It might be a result of hypovolemia or other pathophysiology that causes syncope, but which is just short of it.
Vertigo is usually the result of a problem involving the peripheral or central nervous system. When the problem is peripheral it involves the labyrinth – a complex system of interconnecting cavities in the inner ear which is involved in hearing and equilibrium. Adjoining the respective parts of it are fibers of the vestibular nerve and cochlear nerve that send signals for balance and hearing respectively to the brain. When the problem is central, it is usually due to disease or injury to the vestibular nuclei, cerebellum and/or the nerve tracts that connect those areas in the brain stem. Lesions of the eighth cranial nerve are also included as a cause of central vertigo.
The most common visual symptom that patients report as dizziness is floaters. They are the black or grey wavy lines, specs, streaks or cobwebs that appear in the vision. They are usually due to changes in the jelly-like substance within the eye that occur with aging.
Dysequilibrium almost always points to a problem in the function of the nervous system. The problem might be in the peripheral nerves, spinal cord tracts, or the brain itself. Two of the most important areas of the brain that govern balance are the cerebellum and basal ganglia. Since they send and receive signals to and from the cerebrum, the tracts connecting them are also important.
It is not necessary for patients to be medical students. But in reporting dizziness it is important for doctors and patients to be on the same page. This involves an accurate description by patients and a mutual understanding on the part of the patient and the doctor as to what dizzy means. Notes taken by a patient and reviewed with the doctor might be helpful to this end.
The following quote sums up the importance of the accurate use of the word dizzy:
”If you take care of the small things, the big things take care of themselves. You can gain more control over your life by paying closer attention to the little things.” ~ Emily Dickinson, 1830 – 1886
This is true of not just dizziness. It also applies to communication in health care in general.