I am a specialist in otolaryngology, head and neck surgery, in Barrie, Ontario. I also work in Collingwood, Ontario, Orillia, Ontario, and two days a month I travel five hours each way north to work in Kirkland Lake, Ontario. My patients know me as their ear, nose, and throat specialist.
As a surgeon in one of the fastest growing parts of our great country, I was really delighted to be invited by the Standing Committee on Health to address this hearing.
Since my arrival in the community of Barrie almost 20 years ago, I have been involved in innovation in the health care system's delivery model at almost every level. An interest in teaching young doctors led me to volunteer my time to the rural Ontario medical program to bring medical learners, medical students and residents-in-training, to Barrie to be partnered with experienced, hard-working, front-line physicians and surgeons for what for many turn out to be life-changing learning experiences. Many of these young doctors have chosen, upon completion of their training, to return to underserviced communities like Barrie to practise their craft.
I am now an assistant clinical professor of surgery at McMaster University and an adjunct professor of otolaryngology, head and neck surgery, at the University of Western Ontario.
As a continual innovator in medical education, I am most proud of the association I forged in the past decade with the Health Services Training Centre at Canadian Forces Base Borden, where I am a preceptor and lecturer in their physician assistants training program. Working and teaching these highly professional, skilled soldiers has allowed me to indirectly impact the lives and health of many in our military, and indeed many civilians treated by our military doctors and physician assistants around the world.
I completed my medical school and residency training at the University of Western Ontario in 1993. Thereafter, I spent an extra year of training at Cambridge University, in England, where I studied and became an expert in diseases and disorders of the ear, including disorders that cause dizziness and imbalance. In my specialty, and in my community, I am known to the doctors as the “Dizzy Doctor”.
The diagnosis of a patient with a dizziness disorder is one of the toughest jobs in clinical medicine. I remember nights when my father, a small town family doctor, would come home exhausted, telling us how he'd been discussing dizziness problems with only two or three patients that day. The differential diagnosis, the list of possibilities of the causes of dizziness, can seem endless at the beginning of a patient interview.
Vestibular disorders, or disorders of the organ of balance of the inner ear, are some of the most fascinating dizziness conditions, but also some of the most elusive to diagnose. You have all heard, I am sure, of labyrinthitis, a severe dizziness disorder that is caused by a viral infection of the inner ear. You might be surprised, however, to learn that very few doctors have seen and correctly recognized this disorder, which is actually the commonest inner ear disorder causing acute vertigo. Patients with inner ear disorders can be very ill one day and very well the next day. Indeed, some are very dizzy for a few seconds every night when they go to bed and they are symptom-free every other minute of the day.
In medicine, we're taught to take look at the history of a problem and then to do a physical examination of the patient to look for findings. The problem with most inner ear disorders is that when the patient is not dizzy, which is most of the time, they haven't got any findings. When vertiginous, with a disorder like labyrinthitis, a patient will have several findings—they'll get sweaty, their heart will race, they'll complain of nausea—but these are all findings that are non-specific. They're findings that are shared with other disorders. They're findings that I’m feeling right now in this committee room—