Sunday, May 31, 2015

On the trail of evil

Speech-language pathologists don't solve mysteries. They do not unearth lost treasures from obscure places around the world. When wrongs may be righted, there often is no great financial reward at the end of the quest. But we knew that, going into the professions. We knew that making a financial killing in CSD would require our working multiple jobs and sleeping seldom. And - we need our sleep! Instead of financial riches being our reward for a CSD career, many of us have seen the need to "fight evil".

Poor and ineffective communication* is often the source of poor and ineffective human relationships; by extension, the source of a deficit in the individuals'  quality of life. I will often remind students who choose to train with me, at the beginning of each work day: "fight evil!". When our professions keep quality of life - and its implementation through improved function of communication processes -at the forefront, we fulfill our mission to the persons we serve.

May 2015, known as "Better Hearing and Speech Month", is now over. Each May, what have we and our peers done that will keep us remembered? Since 1927, professionals in communication sciences and disorders have used May to promote what they do, and why treating communication disorders by skilled professionals is important. Here is why.

People communicate everywhere. Most caring and observant persons are able to stimulate human communication in others. Speech-language pathologists know which stimulation methods are most effective.  In a world that is more diverse and more dependent upon the sharing of information  than ever, effective communication skills through the lifespan level the playing field for all persons. In making CSD an integral component of the human service system, society helps prevent human illness by sustaining communication wellness. I cannot say enough to support my colleagues in the professions, as well as those persons who have entrusted their care to me, for all the opportunities given us to fight evil.

*please read: communication and swallowing



Sunday, May 24, 2015

Did you write it?

Documentation has often been the near death of my speech therapy career, more times than I can count. I write a blog now so - I must admire something about writing. But until recently, clinical writing threatened to become the black hole where most of my love for the field might be SUCKED! When I was in training, and even following graduate training - good writing was expected but not well taught. You were shown reports in the university clinic, and expected to emulate the style(s) shown in these reports.  That's all!?! That's all good clinical writing is - ?!?!?!?!? Don't you believe it. But, until I had had enough experience in the trenches, writing  many reports and notes - I rarely had more than other notes from which to learn good clinical writing principles.

Good clinical writing is, above all, a record of what you actually do with your patients. The SLP who writes well can tell the patient's story, in ways that not only satisfy the people who pay  the bills. There is also a need to pass along the uniqueness of the person you serve. When you meet this benchmark of telling the person's story, you give your patient more effective treatment that fits these unique needs  The effective clinical record also meets the standards for behavioral applied science, - namely, what you did and what the patient did in response. And, when the effective written record is completed, other professionals who may also serve your patient will give their best informed service.

There are day to day realities to face about good clinical documentation:

1. "If it wasn't documented, the encounter did not happen". The essence of the SLP ''s work then is - the production of the written record. With point of service documentation (performed at the time of the encounter)  being the trend in clinical practice, the record is completed near the time of the encounter. The clinician who can meet these standards is more confident that the record accurately reflects the actions taken in the encounter.

2. "Data-driven" - your documentation provides value for your patient's care, when it contains the discrete measurements you specify to track changes in your patient's behavior. It could be number of correct initial "s" sounds from a word list, or the number of initiations of conversation, or the average duration of a swallow of ice cream. Your data trends drive your treatment. Let your documentation be easily read with data.

3. Writing clinical notes well tells your readers: you are a skilled observer, not only taking good data but telling a good story. It tells your reader how well behavior has been deconstructed to train the core skills, and anticipates how behavior will be reconstructed so your patient can reenter real life. It requires writing with economy to meet reporting pressures, and writing with clarity so that your patient receives appropriate care.