how much scope is too much scope?

6 Sep

As you may have noticed, I’m in my course on dysphagia this semester. Dysphagia interests me greatly but I have to admit that part of me thinks, “Is this really what I signed up to do?”

I took on speech path as a major because speech and language interest me. I’ve taken a lot of classes on linguistics, communication, the English language, and obviously – communicative disorders. I absolutely adore therapy, especially that of early childhood artic/phono and adult cognition. For the most part I always envisioned myself in a long term acute setting or a SNF, though lately I have more and more considered ECSE as a potential path.

Previously, when I thought of myself working with adults I imagined speech and language therapy with dysarthria, apraxia, aphasia, executive functioning, cognitive-communicative skills, and the like. However, as I’ve gotten further into my graduate school program and talked more with people who work in the settings I always wanted I’ve noticed that they all say the same thing.

“A major part of my caseload is dysphagia.”

As I said before, I find dysphagia fascinating, but sometimes I don’t fully understand why I would be doing it. I get the logic – the aerodigestive tract is also the vocal tract and as SLPs we know about all of those muscles and structures and functions and so on and so forth.

But. I’m a speech. and language. pathologist. Even that name we’ve discussed in class as questionable at best because we aren’t just pathologists, we’re also therapists. So a better title might be speech-language clinician.  Or should we be called Speech-Language-Swallowing Clinicians? (That’s another post for another day. The semantics of our field is enough to make a person crazy.)

Dysphagia is scary. Trachs. Vents. Scary. I know I can do it – it isn’t a matter of possessing the skill set. I can do whatever I need to do, I’m a big girl. I have to wonder though, are there other people in other fields more qualified to deal with something that could be life threatening like a dysphagia? There are nurses, doctors, dieticians, ENTs, dentists, respiratory therapists – the list goes on. Obviously all of these professionals are on a team with us and we’re working towards the same goal but are we the best for the job? Are we stepping on toes? Who had dysphagia before we did?

Why is there not a specialty certificate for SLPs working with dysphagia? I feel this is such a specialized area of our field that there should be more specialized training than just a class. Don’t get me wrong – the clinicians that work with dysphagia know their stuff. They aren’t messing around, but most of their training is experience based rather than classroom or clinic based. We don’t go to externship sites with any REAL dysphagia work. Perhaps this is a case where an elective clinical doctorate might be more practical – it could provide more coursework, more clinical experience, and more specialized training for people wanting to go in the medical direction.

A professor I had once referred to the “tentacles” of ASHA – reaching out and grabbing up things like dysphagia. I don’t know that I agree or disagree with that, but with the seriousness of disorders relating to dyphagia I think it is an important conversation to have with colleagues, and with ourselves. How much is too much? When is it time to demand further education for our expanding medical scope? Can we hold our client’s welfare paramount in the case of dysphagia without more knowledge?

You can read more about the role of the SLP in dysphagia HERE! And share your opinion, I’d love to hear from people who are out there! I’m just a baby-child so my real world experience is limited.


4 Responses to “how much scope is too much scope?”

  1. Lisa S (@sylinca) September 6, 2011 at 5:03 pm #

    In Quebec, part of the things that a SLP do in the States and in the rest of Canada, we can’t do, like inserting the scope, for example. That means SLP working with the said population do a little less of swallowing and a little more of everything else. A little bit. I am in the same course this semester, and wondering the exact same thing.

  2. Lisa S (@sylinca) September 7, 2011 at 7:07 pm #

    I’m not sure either. I’ll ask a couple more questions in my voice course, but the dysphagia course is this winter semester !

    • weathersby September 7, 2011 at 7:33 pm #

      I was doing a little reading today and it seems that in Quebec they count on more specialties – there’s a difference between a registered dietician, a registered nutritionist etc. So maybe there is a certificate to specialize and do FEES. WHO KNOWS?! Scope is a weird, touchy subject.

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