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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 who may be interested in hearing, 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.” That usually gets me

  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. I want the patient to know that when I visit , I am not coming to “check” to see if they “pass”
  4. I inform the patient that I am there go-to person if they have any questions, misunderstandings, concerns about how they are swallowing.
  5. We will establish together and work hard towards attaining the desired goals

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 safety with PO. 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 writing. 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 that, 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. The ways in which we do that may require a new way 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 out loud.

 

7 COMMENTS

    • In the proper setting, I prefer any exercise that taxes the system…like effortful swallows and lingual exercises with resistance. Huge fan of making each rep end in an actual swallow attempt rather than isolate. Will always try to use with a Nokia when appropriate of course.

  1. Out of curiosity, in what setting do you practice? I like your standpoint on this, but it is challenging in acute care where the object is to move the patient to a lower level of care (NH, inpatient rehab, home with HH) as soon as possible.

    • Good point. I will clarify. Acute care definitely for moving them along, keeping safe, minimizing risk, no time for “real therapy” in acute setting. This is more meant for your rehab and OP setting. Not a fan of chin tuck for life 🙂 I’m in acute and OP.

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