The Rent You Pay

"Service to Others Is the Rent You Pay, for your Room Here on Earth" - Muhammad Ali

I untangle tongues 'cause I like it!
I like the breakdown into parts -
You work on this process and that one;
You strive for more Science than Arts

So when my patient's all better
I go to the data to see:
Does the trend refer just to blind chance
Or is there authenticity?

Authentic is how I would want me;
So much in the moment, that we -
My patient and I - we're sympatico -
We did make a difference; OUI OUI!

We each have served each other,
The helper and the helped;
Some magic was done by the helper
And her humanity was further whelped

When you serve others, you're lightened;
Dross burdens can all fall away
You float, then you sting;
That venom will linger
Someone will stand taller today.

RIP to the Champ.

Like butter

(I hope to high Hades that I can beat back the noise of the staff, who say my patient can't eat. We had known she was picky about her food, from before the time she had gone to the hospital. Now, she still shows little drive to eat. There are things that can be done. Sometimes everyone is a critic, but - that's why they pay you the big buckaroos.)

The patient was asleep at her table in the dining area, during the lunch hour. She was presented with a tray of pureed food, and fed bites of food and cup sips of liquid. The scoops of each item appeared to dry instantly after being served, so pats of margarine were stirred into each colored oval to add flavor, and some viscosity. The patient was instructed to take each bite and "swallow hard".

(Good gravy Gertrude - one, two and now THREE staff are stopping to watch me feed her! Well, that's good....the tsp laden with the food - mashed potato used as glue for little bits of the other, then held for the patient to see what is there - then she is asked "ready?" before each presentation: THERE YOU GO, good good - though I have to wait 1,2,3 or even 4 seconds before she closes her mouth to pull off the food, but THERE - some downward pressure on her tongue elicits that movement much more easily....)

Gradually, there is a rhythm. The patient wakes up and - especially after being given the initial bite of ice cream - opens her mouth more and more demonstrably, until she is responding to the visual cue in real time to take 90% of the bites and sips, without a verbal prompt.

(Now there's the dietician! Yes, it took some warmup to get her participation at this level, but she did it. Now, I hope the staff will see she CAN be fed....keep the viscosity at appropriate levels; assure flavor; keep the patient engaged in the process w/ coaching; move at a speed at which the patient can function; and - be positive! Find a way).

The noon meal flowed like butter, until - it was done.

Secondary prevention products

I like this topic: secondary prevention, known to us rank and file clinicians as "screening", is among our best marketing tools for the field. The places I've been, and the things I've seen while screening people of all ages, for communication and swallowing needs: kindergarten and first grade gymnasiums; senior center meeting rooms; high school study halls; supermarket alcoves; - and a wide variation of other sites and situations that allow meet and greet, Q&A, test and counsel and refer, and sell, sell, sell what we do - so well. Is this what is done in other fields when there is effective secondary prevention?

In the speech, language and hearing clinic of the near future, first described in an 11/28/12 post for this blog, prevention is not solely a few lines in a position statement of a professional group, - it is also an actual product line that has potential to bring in substantial revenue to the clinic. The secondary prevention product line for this clinic will operate along three fronts (Ontario: Institute for Work and Health, 2015):

* detecting and treating disease/injury as early as possible;
* encouraging personal strategies for prevention of recurrence of the condition;
* implementing programs to return people to return to their original health and function;

As primary prevention encourages SLP professionals to get out of the therapy room, so goes secondary prevention. To help persons in the community come forward when they suspect they may have a communication or swallowing problem, the secondary prevention staff have to promote scheduled screening events: in print and electronic media; through speaking events to social organizations, by distribution of educational material in many forms, and in making the screening venue accessible, attractive, and friendly to the participants.

At screening events, there need be a commitment for proactive time management, efficient scheduling, current science applied to the measurement tools being used, sufficient time spent with the participant who needs education and counseling, an easily followed procedure for accessing other levels of the human service system, and reliable and valid data management systems. Above and beyond all the meticulous care a screening manager will use, - working a screening clinic can be fun! You explain what we do for the general public, in terms they can understand. You encourage buy in for the process of taking care of your skills for communication and swallowing. You liaison with the human service system, as a personal  and system advocate. But, but but beyond that:

You may help identify problems a person may have, and you may help the person identify resources they can access to improve their wellness. Are there services/ interventions you offer,  that will help the participants resume their usual activity, without enrolling in formal 'therapy'? If these services stop short of working with clinical impairments, but address real world needs people have in these areas (e.g. the picky eater, or an accent that seems to limit the person's occupational success)
 - how robust are these services you provide? Your screening services can provide rich data along more than one domain. Getting more invilved in the development of prevention as a product in your line, will help answer these wuestions. Consider secondary prevention as an essential tool for your SLP practice.