[Dysphagia] MBS issues

[swlslp at yahoo.com (Sandi Lancaster)]

Thanks to everyone for the responses re: MBS exams and inadequate info...I got a lot of helpful responses both on the listserve and off.
 
I'll answer some of the recurring questions I got:  Yes, I did (and always do!) send very specific background info on the patient who was going for the MBS...unfortunately, sometimes the background info just doesn't seem to get incorporated into the ultimate analysis, and sometimes my requests (for specific maneuvers, etc) go unheeded...
 
There are certain hospitals and certain clinicians in my area who I who I would much prefer to have pts go to over others, b/c I know I will get more useful information.  I always find it a bit tricky to explain to a pt or family why I am suggesting that they go to a hospital that is further away from them instead of one that is closer by, without outright saying something critical of the closer hospital/SLP.  Does anyone else encounter this?  Anyone come up with a tactful yet convincing explanation?
 
-Sandi
 
P.S.  I just spoke to the mother of the patient I originally wrote about...she was glad we are continuing dysphagia therapy despite the MBS "conclusions".

"Buckie,Marcia" <mbuckie@dmc.org> wrote:
Unfortunately, there is a lot of variance in the quality of studies done. Sometimes, the radiologist dictates the "culture" of the exam and therefore, it is very brief, while othertimes it is simply done by someone who is not skilled at the therapeutic benefits of an MBSS, not just its diagnostic value.

Do you have multiple sites that you send to, and do you have a choice where the patients go? I would let the clinician know they are not providing the service you are seeking. I would want to know. 

I am an acute therapist and have always appreciated being given info from the primary clinician to help guide the direction of the study. I want to make the exam as useful as possible.

MBuckie

-----Original Message----- 
From: dysphagia-bounces@b9.com on behalf of Sandi Lancaster 
Sent: Mon 8/30/2004 5:56 PM 
To: dysphagia listserve 
Cc: 
Subject: [Dysphagia] MBS issues



Hi all,

I'm looking for feedback on an issue I have encountered occasionally regarding MBS exams. I am an outpatient SLP and I sometimes refer dysphagia pts for an MBS to provide further info re: pharyngeal swallow, for treatment planning. Unfortunately, sometimes what we get back is far from helpful! 

One problem we encounter is when the emphasis of the report is just on the presence or absence of aspiration, with limited or no info on what is happening physiologically with the swallow. I am often looking for info on pharyngeal dysfunction so I can plan pharyngeal exercises accordingly, but when the emphasis is on aspiration alone, I don't get the info I need!

Another issue we encounter sometimes is when no compensatory strategies are trialed during the exam - or, maybe chin tuck will be the one token strategy trialed! 

A third issue we sometimes encounter is when background info is ignored and the clinician performing the MBS assumes that the performance during the MBS is representative of real-life at all times! 

I recently referred a pt for an MBS and provided background info to the SLP performing it, explaining that the pt. has intermittent episodes of distress with thin liquids and has recurrent chest congestion. Well, when I got the report, the report indicated that there was no penetration or aspiration on the MBS, no presence of dysphagia, and no therapy needed at this time. I am planning to continue therapy w/ this pt because he does have episodes of distress, but now I am in the position of having to explain to his family why he still needs dysphagia therapy when the x-ray supposedly "proved" that he did not.

Before I start to sound like a big complainer, I should also say that I have also at times gotten some great info from some MBS exams. Sometimes they can be very helpful. But I am experiencing unhelpful MBS exams often enough that sometimes I am less likely to recommend an MBS at times when they really could be helpful! I am wondering if other SLPs experience these types of situations at times, and I am welcoming any suggestions on how to make it better! I try to collaborate with other SLPs whenever possible and I always provide background info when I can, along with any specific questions I would like answered. But yet these concerns continue at times...any thoughts?

-Sandi


Sandi Lancaster, M.A. CCC-SLP
Speech-Language Pathologist
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Sandi Lancaster, M.A. CCC-SLP
Speech-Language Pathologist
		
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