Open letter to SLPs that work with patients with dysphagia

Open letter to SLPs (sorry this is long, but didn’t I mention that I was an SLP??):

As I was getting ready this morning, my mind was participating in an exchange (with the mirror) about an event that occurred last night on one of the social network sites dedicated to SLPs that work with patients with dysphagia. Unfortunately, one of the site members left the group due to what she perceived as unprofessional behavior by other group members on the site. While I do find it a shame that someone felt this way, I thought it was an opportunity for learning. However, before we dive in, I do firmly believe and assert that all of us should have respect for our fellow (wo)man and demonstrate professionalism within our field – whether it be in the workplace, at a conference, or when representing our profession online. And this open letter is not for the purposes of supporting unprofessional and disrespectful behavior that has been demonstrated; again, I do not condone that behavior. Ah, but here it comes...that dreaded conjunctive adverb...However...

Dysphagia is still relatively new to our field. This makes it both exciting and terrifying at the same time (which personally keeps me jumping out of bed every morning to do this amazing work we do!). It is exciting because we are constantly learning as new information comes to light (we are lucky enough to be one of those professions where we participate in life-long learning!). It is frustrating because a lot of answers we seek, unfortunately, have not yet been answered. It is exciting because advances in medicine allow us to participate longer in a patient’s plan of care. It is frustrating because our patients are becoming more and more medically complex. Personally, as a clinician and a researcher (yes, I am still an active clinician who still sees patients as well as a clinical researcher – so, no, not all of us have not seen a patient in “many years” as was pointed out in another social network discussion implying that all researchers are out of touch with what clinicians are going through – end sidebar), it is exciting that there are so many unanswered clinical research questions that I would love to delve right into helping find the answer. It is frustrating as a researcher that it takes a lot of time (years) and a lot of resources (sometimes millions of dollars and thousands of hours of manpower) to help find the answer (so, maybe give us a little break?).

If you have been lucky enough in your career to have never come across someone that you may have considered abrasive, rude, or even unprofessional, then, you should totally play the lottery – ‘cause you are one lucky human! But, without sounding too cliché, when I have across those circumstances, you know what it did for me? It made me a better clinician – particularly, in the circumstances where someone was questioning my clinical management of a patient. And if I were a betting woman, I would imagine that most (dare I say all?) of us have had at least one instance where our impressions/recommendations/plan of care was called into question by a patient, caregiver, nurse, physician, or even a fellow SLP. And perhaps they even did it an unprofessional manner. Instead of running, I pulled my evidence together and stated my case. Now, does this work every time? No, some colleagues will end up continuing to disagree (see previous comment that there is still a lot of unknown left in our field!). But, I go to sleep at night just fine as long as I know I put my best clinical “foot” forward.

When I was in graduate school in (mumbles years under her breath), dysphagia was still not a required course. And I would bet, that at least half of us SLPs currently practicing experienced the same. But, our passion for bettering patient care has instilled in us an internal drive to pursue knowledge about how to best manage these patients. And this crazy internet thing has allowed us to seek out information more quickly. This is exciting because we can find an answer in just mere seconds. It is terrifying because the answer provided is not always correct! Unfortunately, some answers are provided based on tradition or authority. Let me explain – too often, clinicians rely on what’s always been done (side bar – Dr. Lefton-Greif at DRS had a beautiful opening to her presentation by stating to those clinicians that begin with the statement, “I have been practicing as an SLP for 10 years...” – Have they actually been practicing for 10 or did they only practice for 1 and then kept repeating this practice for another 9 years?) or by doing what was told to them by a professor, clinical supervisor or other person in an authoritative position. The point is that if we continue this practice, we are not clinicians implementing evidence-based practice. So, yes, sometimes, it is frustrating when we see a response about a practice that is outdated or has no support, and yet individuals continue to spread it around like truth. And we should be more tactful when trying to approach this falsehood in our responses and when providing an evidence-based approach that would be more beneficial. I admit that when I found out my ALS patient had received 60 sessions of VitalStim, my initial reaction was not tactful (I did this reaction in the privacy of my office with no one around). (For those of you reading this and wondering why VitalStim is not appropriate for a patient with ALS, I am more than happy to further engage in a discussion without judgment and seeking it as an opportunity for learning.) Sometimes passion can be mistaken for arrogance. But, at the same time, ignorance can be bliss. This lack of not knowing what is not known can be very detrimental to not only our patients but also our field. All it takes is one bad apple (clinician) which can drastically change a physician’s practice in referral to SLP. Never be satisfied that you know all – the more you know, the more you know that you don’t know! And if any clinician presents himself/herself in the light that they are all-knowing – I would be very weary! (sidebar - I would also be weary of a clinician that has does not support his/her argument for doing something, whether it be by demonstration of evidence available or by a true understanding of the underlying pathophysiology of the impaired mechanism).

For those that don’t know the story – our name change from therapist to pathologist was not something that was decided upon after a few cocktails on a Friday night during ASHA. It was because we are autonomous clinicians that are allowed to diagnose and treat communication and swallowing disorders. We are not told our therapy plan for our patient by someone else. We develop our own! This is exciting because each patient is unique in his/her presentation, and we can continuously alter our management which keeps us on our toes and helps eliminates redundancy (and boredom!) in our profession. This is frustrating because we may not always know what to do!!!! And sometimes, when the answer is not yet available out there in the world, we must rely on common sense, which unfortunately, is not always used in our profession. If you truly understand normal physiology of a mechanism and pathophysiology of a process, this can guide your management. Sometimes, all you need is to stop and take few seconds to think. I encourage all clinicians to do every day! (See example of above regarding VitalStim on ALS patients.)

This is where opportunities such as conferences, list serves, ASHA SIGs, journal publications, and social networking sites can be so beneficial for us. It may offer us the opportunity to seek out the answer we need. Again, exciting, because our field can be at our fingertips! Frustrating, particularly in a social network forum because tone of voice may not always be perceived accurately through a written format. Or perhaps it was perceived accurately, and the person that posted response was actually being a jerk! But, don’t run. Never stay down or back down if you are talking about concern for a patient and the advancement of our field. It isn’t about you and your ego – it is about your patient and the SLP field. Let it go, pick yourself up, and move on to someone that can offer more constructive advice. And if appropriate, report the “jerk” to administration.

Gosh, do we have the best profession or what? Happy Friday all!

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