The Illusion of Healthcare Progress

Wellcome Film based in London has transferred numerous films dating from the early 20th century related to healthcare and medicine that anybody can view for free. Aside from the historical value, it is amazing that much of what we know and do now is not all that different than what was done in the 1920s. It makes me wonder sometimes what "progress" in healthcare actually has happened over the past century. In some things, tremendous change has occurred whereas in other areas of medicine, time might as well have stood still.

It also perhaps explains why in spite of all our "high-tech" medical equipment and sophisticated tests available in the United States that our health as a nation is still not as good as other nations without these benefits.

Take for example dizziness evaluation and understanding. Here are 3 films from 1925 that goes over dizziness evaluation and physiologic basis for it.

At its essence, nothing has really changed between 1925 and 2011. Sad really... Given this lack of progress, I would so far as to venture (with a straight face and all kidding aside) to say that American rates of dizziness is comparable to ANY other nation in the world with treatment protocols no better or worse too.

The King's Speech and Those With Spasmodic Dysphonia

The film "The King's Speech," nominated for Oscars in 12 categories for the 83rd Annual Academy Awards hits home for many who suffer from stuttering. However, I am sure this story also has empathetically affected those patients who suffer from spasmodic dysphonia.

What is spasmodic dysphonia?

Think of it as stuttering of the voicebox where the words get stuck in the throat level rather than the mouth level.

Both conditions result in patients severely limiting their social engagements and cause tremendous stress when communicating with others.

Many people know what stuttering sounds like... Now listen to what spasmodic dysphonia sounds like here in this video. This video also shows how spasmodic dysphonia is treated with botox injections to the vocal cord. Such injections calm the spasms down so that the person is able to speak almost completely normally for at least 3 months until the botox wears off and it needs to be repeated.



Botox injections for spasmodic dysphonia as well as other conditions are performed by Dr. Chang every week.

How is Love Like Dizziness? Medically Speaking...

I watched this touching video of what it is like to fall in love... that very moment when you see the love of your life for the first time... and the world falls away. Time slows down. That feeling of elation, passion, love overwhelms. Time stands still. Everything else blurs out except for him/her...

Nuit Blanche from Spy Films on Vimeo.

Now from a medical perspective, how can we test this? If "love" is considered a disease, how can we positively "diagnose" this? How can a doctor touch, see, feel, measure "love" and the severity of this affliction when all the symptoms are felt on the inside?

The simple answer is you can't. Similarly, dizziness is a problem that like love, can't be seen, touched, measured by the doctor very easily. Unlike tonsillitis where all a doctor has to do is look in the mouth and "see" the infection, we can't do the same for dizziness.

The way a physician approaches a sensation that is only felt by the patient, but no other is via several steps.

A good history. That's why when a patient with dizziness comes to a doctor's office, we ask a lot of really picky questions as it helps narrow down the possibilities. This step is just like when a friend asks exactly what you felt when you first saw the love of your life.

- What does the dizziness exactly feel like? Spinning, fainting, rocking, drunk, etc???
- Exactly how long does an episode last for? Seconds, minutes, hours, days, weeks, months???
- Can it be triggered? Turning, bending, walking, etc???

Click here for a dizziness flowchart based on answers to these and other similar questions.

Based on the history, additional testing may or may not be required. If a doctor was trying to decide if a patient was afflicted with "love", a good history may be all that is required. However, if the doctor is not quite sure, he/she may want to get an EKG to measure the pulse to ensure no supraventricular tachycardia arrhythmia ("When I see John, my heart races"), MRI scan to ensure no brain tumor (causing symptom of time standing still), ophthalmology exam ("Everything else seems to blur out except for John"), etc.

Just like for "love", a similar type workup needs to be pursued for dizziness depending on how the dizziness exactly felt like and may include audiogram, EKG, bloodwork, ENG, cardiac ECHO, 24 hour holter, 30 day cardiac event monitoring, pulmonary function tests, carotid ultrasounds, MRI/CT scans, EEG, chest-x-rays, allergy testing, tilt-table test, etc. As such, one may need to have an evaluation by a neurologist, cardiologist, ENT, pulmonologist, endocrinologist, etc to uncover the cause of your specific dizziness.

Once the cause is determined, treatment is based on addressing that specific diagnosis. As one can see, the human body's sense of balance is actually extremely complex making dizziness one of the most difficult symptom to diagnose and treat.

"Love" would be similarly difficult to diagnose with absolutely certainty if it was considered a disease as well. Based on symptoms alone (without history), love could potentially be confused with fear, anger, hate, etc.