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.

We Named the Salad

" We're fortunate that our patients wanted to get these plants started in the dead of winter - relatively speaking. It's now May, and our first crop of salad greens is ready for harvest! OK, now: let's review what is going to happen in the group today. Ellen?"
"John is going to harvest enough Swiss chard for our first salad - but, how much is that?"
"Let's see - we're not cooking it but dressing it, so - there are six of us working, patients and trainers, and we'll probably eat 1 tablespoon each (gotta be realistic!) so - 6 tablespoons!" But, can John see it?"
"Sure! I marked the boundary around the chard bed with red colored duct tape; he can't help but zero in on it."

John's treatment plan for 5/7/16: John will cut 6 Swiss chard plants within his line of vision, with no more than moderate verbal and gestural cueing, and with 83% (accurate-delayed) accuracy. 

"OK - good plan; his field of vision is better but this will help him focus on the job. Becky - will Mary Anne have any difficulty pulling the radishes?"
"If I am not there for the entire time she can pick enough enough radishes, then she may go on a tangent and rip out a red light bulb from the night lights!"

Mary Anne's treatment plan for 5/7/16: Mary Anne will pull 6 radishes from the raised bed, with constant verbal, gestural and tactile cues, and with 60% (repeat prompt) accuracy. 

"OK then! I think you know what to do. And I am working with Celeste today; her job is to follow John and Mary Anne, and check that they have completed their jobs before we all head to the kitchen".

Celeste's treatment plan for 5/7/16: Celeste will record the performance of both John and Mary Anne on their garden assignments, and report to both Ellen and Becky on their execution of the plans - with occasional cues, and with 93% accuracy. 

"But, but - that means we have only chard and radishes for the salad?!?!?! BLecccchhhhhh....; BORING".
"OOPS"
"We'd better then go for more: I don't cook that often. How about, then....after John gets the chard, he can also cut some arugula. Then Mary Anne can....get some shears and cut some butter lettuce. That should be ready, too - right, Becky?"
"Right! And I will keep an eye on Mary Anne using shears; maybe, tell her she has only 15 cuts allotted from these shears today!"
"I agree. There is a head of iceberg lettuce from the grocery in our refrigerator; we can use it to add the "crunch" that many salad eaters tend to crave. Also, can both of your clients swallow nuts without problems?"
"Yes"
"O Yes!"
"Great. The creamy dressing should help hold everything together in a good bite to swallow.  There's crunch, and there's sweetness. There's pepper in the arugula, and there's pepper and crunch in the radish. Anything left?"
"No, Doris".
"Let's go".

The call came in....

I was working the day watch out of swallowing division, and was about to go out on a call when the desk sergeant caught me: "there's a new case up on 2nd floor; go check it out". Just as I thought, as I moved to the electronic medical record and started to skim the material. Don't ever plan ahead. But the flip side of that is: you are NEVER bored here!

Minutes later, I was interviewing the suspect about the alleged swallowing incident. "Just the facts, ma'am", and so she gave me the facts. Then I talked to the persons taking care of her, asking them for the same facts. They gave me different facts. My partner gave me some facts from a book. Those facts kinda said: maybe A, but it could be B as well. Should I call forensics in on this one?

The evidence had to be procured, and so I started to work the crime scene. "Try a bite of this", then "How about a drink of ______?", followed by "Would you like to try this, or THAT??"; and then finally, "Tell me what you would like next". Always, pacing the presentation of the spoon - so the suspect had to exert active control over the material; always, awaiting her subtle bloop of the hyoid up and forward, so then another bite/sip could be offered. Always, keeping that subtle but vital communication flowing throughout the meal, so that the suspect could eat and drink to the best of her ability.

Case closed. There was to be, at least today, no end of the shift with hearing a sentence pronounced: "mechanical soft, nectar thick- THIRTY YEARS TO LIFE". This is the city. I carry an IOPI.

Happy Better Hearing and Speech Month

May has been known as Better Hearing and Speech Month in the United States since 1927. During that year, the Holland Tunnel opened to feed traffic into and out of New York City. The Marines invaded Nicaragua and stayed until 1933. Heisenberg developed a theory of physics, but he was uncertain. The movie "Metropolis" premiered, and it certainly set the screen world on its ear. In the same vein, the American Speech-Language-Hearing Association (ASHA) set out that year, to tell the public about disorders of communication. ASHA also started to tell the story on what speech-language pathologists can do for the individuals afflicted with these disorders. So much has changed since 1927, but Better Hearing and Speech Month has not. This year's theme is titled "Communication Takes Care". Activities, events, and public relations tools are used to spread the word about what SLP's do for the persons we serve.

How do I want to commemorate the month? Above all, I want to say "thanks" to my current and former employers, for giving me the chance to serve persons in need. I have grown tremendously as a professional, from the wise experience and advice I had received from patients, their families, my colleagues and my peers. Following is a list of those employers.

* Kindred Rehabilitation Services, Streamwood IL
* Payne Wellness Center, Schaumburg, IL
* Brookdale Senior Living, Des Plaines IL
* Independence Plus, Inc., Oak Brook IL
* Elmhurst Memorial Hospital, Elmhurst IL
* Michael Reese Hospital, Chicago IL
* Allendale Association, Lake Villa IL
* Exceptional Persons, Inc., Waterloo IA
* University of Northern Iowa, Cedar Falls IA
* Covenant Health System, Waterloo IA
* State of Idaho Dept. Health and Welfare, Rupert ID
* State of Louisiana Dept. Health and Welfare, Thibodaux LA
* Assumption Parish School Board, Napoleonville LA
* University of Iowa Healthcare, Iowa City IA
* St Luke's Methodist Hospital, Cedar Rapids, IA
* University of Iowa, Iowa City IA
* Mississippi Valley State University, Itta Bena MS
* Veterans Administration Medical Center, Gulfport -    Biloxi MS
* University of Mississippi, Oxford MS

Happy Better Hearing and Speech Month, everyone!

Who has the best approach?

With a previous post ("Are You A Technician? A Psychometrician?"), I began to describe two perspectives the SLP might bring to the job, regardless of the customer base or service setting where the SLP might work. With the roles of the technician vs. the psychometrician,  I wanted to call attention to not only how each role is endowed with unique responsibilities, but also how each role can limit the autonomy of the SLP.

To keep it real, the majority of my days and those of most of my peers have significant portions devoted to repetitive,  focused tasks. We all spend time at specialized and circumscribed activities available for our use by our education, training and experience. But if this were the entirety of the workday, I would run, run like the wind from such a job. Growing in this profession means, to me at least, that you should be able to use all your skill set; to challenge yourself to think while you work; to use your good work to indirectly market your profession: I can hear it now....

(Sung to the tune of 'Dark End of the Street') -

"Do you know - what an SLP can do?
She may help you talk, but you hear better too;
He helps you swallow; helps you think on your feet -
She lives in the real world so your life's more a treat.

YOU AND ME - tangled tongue, straightened out by an SLP....

He sees the big picture,
Not just the skill constricture;
She works well with mothers, bosses
And your MDddddddddddddddd

YOU AND ME - tangled tongue, straightened out by an SLP" -

I am calling this perspective on the clinician, the "diagnostician". How do all three perspectives compare in a nutshell??

WHO DOES IT?		HOW DO THEY THINK?		WHAT DO THEY THINK?
SLP as technician		Let’s do this one thing.		I’ll do all the ‘x’ you want to give me.
SLP as psychometrician		Let’s do this exactly right.		I am your lab bench jockey.
SLP as diagnostician		Let’s do it so this person cans communicate/swallow/think better.		I do it all for person ‘Y’.

I see the diagnostician as the apogee of evolution in our field: the diagnostician draws her/his decision making skills from a broad general skill set, in addition to the specialized knowledge required for the CCC. Technician and psychometrician skill sets are folded into what the diagnostician does, but there remains much more. Perspectives #1 and #2 are domain specific, but #3 is more and more a generalist - though knowing how to be specific, for the needs of each of the persons she serves. Where the technician and diagnostician fill a role, the diagnostician embodies an identity.

I hope that these ideas can help fuel more thought and discussion about how the SLP approaches her work.