Obviously, the answer is one that is successful at treating patients with balance and dizziness type disorders.  Our office has been sub-specialized in seeing patients with balance problems and fall risk, in particular vertigo and dizziness for some time now.  It is well known that the simplest treatments for vertigo are the most useful, yet we continue to see patients inappropriately medicated with vestibular suppressant therapy, anti-anxiety drugs, and on and on.  The history of these patients typically includes that of a small fortune spent on diagnostic testing, which could have been avoided with appropriate clinical examination and management early on.  The last statistic I read in the medical literature estimated that almost 99% of the MRI’s performed on patients referred with vertigo are normal.  That’s a heck of a lot of money spent for a very small return, certainly not what I would consider an ideal use of the diagnostic dollar.  One of the main problems that I see everyday is that patients are first seen by their primary care provider, which is now the way with insurance HMO’s.  Being generalists, patients are managed such to rule out more threatening diagnostic entity’s, typically by imaging, (MRI).  Since treatment for patients with vertigo and dizziness typically responds very quickly in our office, it would seem this course of action to be a much more sensible initial management plan in the multitude of cases where no life threatening problems are suspected.  If no resolve is evident via this course, or, if on examination suspicion of more threatening diagnostic entities exists, then imaging can be performed.  This plan only delays potential imaging by maybe one week, certainly not enough to have missed the boat, especially, in light of the statistic of 99% of these tests returning as normal.  The one most important factor related to all of this is the initial examination.  The examiner should be so trained that it becomes readily apparent during the examination as to the urgency of specialized studies such as MRI, or not. In the latter, it should not be the next thing done.  Further, all patients need to be evaluated for fall risk.  Those with established fall risk should be managed with fall prevention and rehabilitative therapies congruent with their needs.  We see this as being overlooked more often than not. Our office currently is compliant with JCAHO goal and requirement re: falls-risk identification, assessment and prevention, effective 2005.   Simply put, everyone who walks through our office gets a balance screening test, which we perform free of charge as a community service.  If you or someone you know is suffering with balance loss or dizziness, we would strongly recommend going to our What Patients Had To Say page.  Or, simply call our office directly at (732) 229-5250.