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International Primary Care Association

Clinical Focus Volume 5 N2

Volume 5 Issue 2 - 2011


Whilst dizziness, vertigo and imbalance may be due to systemic disease, they commonly originate from the vestibular system. The presence of vertigo, in particular, implies vestibular involvement. This article will address the diagnosis and management of vestibular dysfunction in adults, highlighting the three commonest causes which can be diagnosed and treated in a primary care setting, and stressing the “red flags” that should trigger referral to more specialist services.


This paper represents personal reflections on the evolution of urology service provision over the past 30 years and offers a possible scenario for such provision in the future. I qualified forty years ago; those were the days when consultants were revered and their senior registrars worked hard to ensure that their masters were never disturbed out of hours; now it seems to be the consultants who work hard so that the ‘juniors’ can stay in bed! There were plenty of ‘Sir Lancelot Spratt’ (the senior surgeon in Richard Gordon’s film ‘Doctor in the House’1) characters about; one of whom undertook an open prostatectomy on my father. A few days later, when he found out that I was due to start at medical school later that year, I was summoned to watch him operate. After removing a kidney and leaving his senior registrar to ‘make good and close’, he took me into the senior surgeon’s sitting room and gave me a few pointers for the future. The most memorable ‘tip’ was that as soon as I had a consultant job I should buy a Rolls Royce car. “Borrow the money if you have to” he said but remember you are in the only job in which you will be respected more for it… and you can double your fees straight away!


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