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I have been on a kick lately. You know those kicks that come after you reboot at a stimulating conference? Perhaps, they come when you have an encounter with a special patient. Well, this dysphagia kick has me singing a new song. It’s called: “Let’s Rehabilitate and Not Compensate.” Perhaps this is not a new headline for many clinicians, but I have had this concept in my head for a long time. I may sing its praises to colleagues, but rarely do I ever tell patients, RNs and MDs about it, until now.

This concept requires significant buy-in. It starts from the minute I enter the patient’s room and meet him for the first time. I have two minutes to win over her trust. No longer do I lead-in with “My name is John Doe and I am a Speech-Language Pathologist and we are going to see if you can swallow.” We know where that gets us:

1) “I can swallow fine”

2) “My Speech is fine”

I have learned to adapt to my audience. Such adjustments may include, “I am your swallowing trainer for the next 3-4 weeks and if you train really hard, I am confident you will be able to achieve your goals.” I want her to know:

1) Therapy is mandatory if they want to get better

2) Therapy is going to be hard work

3) When I visit , I am not coming to “check” to see if you “pass”

4) I am the go-to person if they have any questions about how they are swallowing

5) We will establish goals together and work hard towards achieving them

Sound too flowery?

Now, that I have patient buy-in, it is my job to remind the RN, that when SLPs come to see the patient, we are not checking to see if they “pass” or “fail”, but we have a treatment plan to improve their swallow. In many cases, I ask them not to use the terms “pass” or “fail” around the patient, as this sends the wrong message after every session.

This is achievable, right?

Now, whether I communicate daily results with the MD via conversation or documentation, I am more strategic in my presentation. In my notes, I am focusing on what the patient can do, not necessarily on their deficits. I am focusing on their motivation. If my target audience is a Pulmonologist, I may discuss how their cough is improving and leave the base of tongue discussion for another time. The MD starts to think, “This SLP really knows what he is talking about.”

Small victory???

Now, granted these may be ideal and isolated scenarios, at best, that likely do not apply to most situations. The main point is, I believe there is room for us to change the way we do business. Lets face it, globally, outside of Speech-Language Pathology and a hand full of ENTS, other professions and patients, just do not understand dysphagia.  As Swallowing Pathologists, (sounds catchy, huh?) it is our responsibility to rehabilitate patient, staff, MD misunderstandings, rather than compensate. This may require new ways of establishing rapport with patients, new ways of branding ourselves and our services to staff, and new ways to reach our various target audiences. We all know this deep down inside, some may have it figured out, but now it’s time to start talking about it.

6 COMMENTS

  1. This seems like an excellent breakdown of bedside manner for a dysphagic population and the author is right on the necessity of ‘rehabilitate’.

    One treatment available (or way of rehabilitating dysphagic patients) is called DPNS. It has been a successful treatment used in hospitals, SNFs, and acute care facilities for twenty years.

    Here’s a link to a testimonial on Dysphagia.com from 1997:

    http://dysphagia.com/maillist/1998-September/msg00100.html

    The Speech Team, Inc. has been certifying SLPs in Deep Pharyngeal Neuromuscular Stimulation (DPNS) which is used in Finland, Hong Kong, (listed with both governments as ‘Best Practices’), Ireland, Sweden, and many other nations around the world.

    It was developed by Ms. Karlene Stefanakos, M.A. CCC-SLP. Over 8000 SLPs worldwide have been certified in DPNS since 1993. I hope this helps any SLP out there who is tired of ‘compensating’.

    • Would you want your Doctor prescribing you medication that hasn’t been proven to work? Then why encourage DPNS? Zero peer reviewed evidence that it works. And 9000 folks use it just because it sounds like it works or its just another tool in the toolbox. Hey i hope when you get ill, the Doctor uses another tool in his toolbox to see if you get better lol or prescribe you a drug that hasn’t been through clinical trials with no documentation of efficacy LOL

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