That question came to me, again, at the end of a community webinar I gave recently for individuals living with vestibular disorders. It is the most common question I am asked when I speak to community audiences. It is asked without anger. It is asked the way someone asks a question they have lived with for years.

“Why don’t more health care providers know more about dizziness?”

I owe that question an honest answer. And I think the honest answer matters for clinicians too.

Dizziness is one of the most common reasons individuals seek medical care. It is also one of the most poorly recognized, not because clinicians lack the intelligence or the will to recognize it, but because the skill at the center of recognition is targeted clinical questioning, and the system has been engineered in ways that make targeted questioning increasingly difficult to perform.

Some of this conversation is already underway on this platform. John Corsino, a physical therapist, made the case last year for skilled physical examination from the inpatient side, drawing on the TiTrATE framework (Timing, Triggers, And Targeted Examination) developed by neurologists David Newman-Toker and Jonathan Edlow. He is not the first physical therapist working in this space. Dana Thomas published with Newman-Toker in 2016 on PT integration into structured dizziness assessment. What I want to add is what the same recognition problem looks like from the outpatient long arc, across years, not hours.

The data tell that story now in a way they could not before. A 2026 study by Rafati and colleagues in Annals of Clinical and Translational Neurology documented, for the first time, the full vestibular care journey using real registry data. Individuals with vestibular disorders consulted, on average, fifteen providers across that journey. Sixty-six percent carried more than one vestibular diagnosis. One in five reported they were unable to work because of vestibular symptoms.

A 2011 Vestibular Disorders Association (VeDA) Advocacy Survey of over a thousand individuals, published in the organization’s member publication On the Level, cataloged what these individuals were told along the way. The patterns were remarkably consistent. Thirty-two percent had been told they were faking or exaggerating. Twenty-two percent that they were not trying hard enough. Seventeen percent that it was all in their head. These numbers are not failures of individual clinicians. They are what happens, at the population level, when a recognition problem persists.

That same survey also gave us the lever. When the first provider an individual saw recognized possible inner-ear involvement, time to diagnosis was approximately 1 month and 3.8 providers consulted. When the first provider did not, time to diagnosis was approximately 8 months and 5.5 providers consulted. One question, asked early, by anyone: could this be coming from the inner ear?

That finding is what I want clinicians to hold onto. The single most powerful intervention in vestibular care is not advanced equipment, specialist referral, or imaging. It is the right question, asked at the front door. The TiTrATE framework, now recommended by the American Academy of Family Physicians as the preferred approach to dizziness evaluation, is not, at its core, a tool for sorting peripheral from central pathology. It is a discipline of questioning. What is the timing of these symptoms? What triggers them? What pattern do they follow over time? The targeted exam is what the questioning earns you.

That kind of questioning takes time. A 2023 Swiss national survey of primary care physicians documented that assessment of patients with dizziness takes longer than the average primary care visit, a structural mismatch that is not unique to Switzerland. Time is what corporate consolidation of medicine has been compressing out of primary care for two decades. The skill has not left the profession. The system has narrowed the window in which it can be used.

This is where I think my role honestly sits. I am a physical therapist. I have something a primary care physician working under productivity quotas no longer reliably has: time. One of the things I do with that time is treat. Another is teach the people in front of me how to bring better information into their next primary care appointment. How to describe timing. How to describe triggers. How to recognize a pattern in their own symptoms. The goal is not to bypass their physician. The goal is to make them a more useful resource to their physician, so that a 15-minute visit can go somewhere it could not go before.

Vestibular migraine is the most common cause of recurrent dizziness in adults, roughly half of diagnoses in the Rafati cohort. It requires no advanced testing to suspect. It requires the right questions. The neurologist Shin Beh wrote a patient-facing book on vestibular migraine because, in his words, his colleagues were not recognizing or addressing it. The recognition problem is being named from inside medicine, too.

So when individuals at my webinars ask why more providers don’t know more about dizziness, my honest answer is this: the providers are not the problem, and neither are the people in front of them. The system has compressed the time required to use the skill that recognition demands. We can change that journey. The lever is early recognition. The work is teaching everyone in the room, providers, patients, and the people who see them in between, how to ask and how to answer the questions that lead there.

Bridgett Wallace is a vestibular physical therapist.