Dear Class of 2022,
Congratulations! You made it! You’ve proven your adaptability and resilience as we’ve all sought to navigate the ongoing challenges of the past 2 years. We applaud you, and we welcome you as colleagues. As you begin your careers in this exciting and rewarding profession of speech-language pathology, I would like to offer you a few words of advice.
- Every patient you see is an individual with a life that existed before you entered their world and a life that will exist after you leave their world.
“If to be human is to be limited, then the role of caring professions….ought to be aiding people in their struggle with those limits…Whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric” (Gawande, Being Mortal, p. 160).
The recommendations you make will have a significant impact on your patients’ and their caregivers’ quality of life. Eating and drinking are so much more than nutrition and hydration. Often these simple acts are at the center of our daily lives, our social gatherings, our rituals, and our celebrations. Rarely do we spend time focusing on the physical act of swallowing. Swallowing is something we do hundreds of times per day, typically without a second thought. When someone has dysphagia, we ask them to alter the way they eat and drink, we take away the automaticity of that act, we ask them to learn to navigate life with a new set of rules, and we introduce stressors to a situation that was previously a source of satisfaction. Imagine being told you must hold your breath, swallow, cough, and swallow again each time you take a sip of liquid, or else you’re going to get sick and possibly die. Or, imagine being asked to drink liquids that are the thickness of pudding because you aspirated one time on a swallow study. Think about the impact these recommendations have on your patient’s emotional well-being. What if your patient can’t afford to purchase thickener? What if no one is available to help them prepare their foods in the way you’ve recommended? We need to consider all aspects of our patients’ lives when advising them. It is imperative that we consider the setting in which they live, the relationships they have and the dynamics of those relationships, the stressors in their lives, the things that bring them joy, the culture that informs their existence. Once considered, we need to act in a way that is respectful of the whole person in front of us and not just in the interest of their impaired swallow.
- Listen to your patients. Talk to your patients and try to understand what their goals are. Your goal of preventing someone from developing adverse medical consequences of aspiration or dysphagia, such as development of pneumonia, may not be your patient’s goal. Or, they may not want to take the steps you’ve recommended, such as modifying their diets or refraining from taking anything by mouth, to mitigate the risks of ongoing aspiration. When a patient chooses an option that differs from your recommendation, do not take it personally. Remember your patients are autonomous individuals who have the right to make decisions for themselves. Work with your patients to help them to meet their goals. Involve them in setting goals. Help them navigate a realistic expectation for treatment outcomes. Remember we are there to facilitate their recovery, not to be the food police.
- Be a lifelong learner. As a field, we’ve been working with individuals with dysphagia for less than 50 years. There is a lot we still don’t know about normal swallowing and how to treat disordered swallowing. What you learned in school is very likely to change as advances in research and medicine occur. Be a critical consumer of information, and be willing to change your practice when new evidence indicates that a change is needed.
- Get involved. Seek out opportunities to get involved outside of your day-to-day work. There are a myriad of organizations, such as local, state, national, and international groups, that welcome new volunteers. Don’t be afraid to reach out to these groups and ask how you can get involved. Working with others who share your passion for advancing and protecting the integrity of our profession can prove rewarding and result in developing lifelong professional friendships.
- It’s okay to advocate for what you need, and it’s okay to advocate for what your patients need. If you find yourself working somewhere without access to the resources you need to best serve your patients, advocate to get those resources. Remember that you are there to help those who might not be able to advocate for themselves.
- Realize not everything is fixable. Your job is to navigate the risks and benefits of any intervention we recommend. Patients look to us to offer them a way to return to some sense of normalcy when it comes to how they eat and drink, and most of us got into this profession because we want to help people. It’s hard when we find ourselves in situations where we can’t help, either because of the underlying disease that has resulted in our patient’s swallowing difficulty or because of the effects of the medical interventions that they’ve undergone. Be thoughtful and honest with patients when we’ve exhausted all of our treatment options.
- Love what you do. If you don’t love your career, be willing to move on.
- Be kind…to your colleagues, to your patients, to others in your profession, and to yourself. We are all learning and striving to do the very best for our patients. If a colleague asks for help or if you recognize a colleague could use some help, offer it. None of us is perfect, and none of us knows everything.
- Learn when to turn it off. Find interests outside of speech pathology that excite you. Compassion fatigue is real, and it can lead to burnout. Take care of yourself so you can take care of your patients. (See above about being kind, especially to yourself).
- Question everything. I contend this is the single best piece of advice I was given in graduate school. When new treatments are introduced, question them. When a new publication comes out, read it with a healthy dose of skepticism. Remember what you learned in school, and critically appraise what you read. Question what you hear at conferences and through other continuing education venues. There are very few concrete answers in healthcare.
On behalf of your new colleagues, we welcome you and we congratulate you as you get ready to embark on your new careers! Go forth and do great things!