[Dysphagia] Esophageal dysphagia

[lobsterpam at aol.com (lobsterpam@aol.com)]

 Michel writes: 
 
 [[ What would you say if I improvise myself with a 2 days conference on aphasia and teach my colleagues RD here that works in NH (here it's the contrary, we have RD in most NH but no SLP) to do the speech treatments. I would be the first to not feel safe to do that. SLPs take 4 years of university here and I respect your knowledge. I took 4 years to do my bachelor degree and 2 long years of non stop work to do my master. Why wouldn't anyone respect that? I know a lot of RD in the US and they say that SLPs are taking over in esophageal dysphagia. They are pushed away and they have a hard time to find a job. NH have the money to hire RD as well as SLP. Why the SLP that are alone in a NH don't push to hire RD and help the patient to get the best nutrition therapy they could have? ]]
  
 Pam responds: 
 
 I can only speak for the relationships I have had with RDs in the buildings in which I have worked. I hope that someone out there who has more specific experience in either administration or reimbursement can either corroborate or correct what has been my impression. 
 
 Our RDs were employed by the food service contractor, not for the nursing home itself. Their services were not reimbursed by insurances and did not directly contribute to the per diem rate. Economics plays a role. This appeared to be the reason that they were assigned to multiple facilities... cost containment issues on the part of the food service contractor. We have terrific RDs, I've always worked well with them, and never managed a patient without their input. Sometimes that input was reading their evaluation, and in the case of a patient with 'issues,' direct consultation.
 
 If my impressions about administration and reimbursement are in fact true, then it isn't so much that 'SLPs are taking over in esophageal dysphagia,' but that SLPs are attempting to best meet their patients' needs in the context of availability of staff. Nutritional status is an item on the MDS, and every patient is seen by the RD by the due date for the MDS. But if the patient is having difficulty TODAY, someone must see them TODAY (not just review their chart), and this cannot not wait till next Monday when the RD is assigned to be in the building. Next Monday will meet the MDS requirement but not the patient's needs. Perhaps US RDs need to advocate for their services in the same way that SLP has for many years, and continue to do. I am certainly not in a position to evaluate any nation's health care system, but one must work within the system wherein one finds onself, and/or advocate for change.
 
 It is also, IMO, incorrect to assume that SLPs believe they can "replace" a dietician. There is a great difference between RECOGNIZING nutritional issues and believing one can MANAGE them. I teach my students to RECOGNIZE esophageal issues, to RECOGNIZE nutritional issues, to be aware of the impact of what they might recommend ON those issues, and know when to refer. You cannot recognize issues if you have no background/training in them, but that's not the same thing as thinking you can manage them. I would hope that if you evaluated a patient who had a communication problem that you would recognize it and be sure the SLP knew about it.
 
 There is NO excuse for ignorance of the multiple issues that impact our patient's overall health. My students unfortunately have to hear my soapbox on a weekly basis about how much SLPs as a profession often may not know about physiology and the complex issues that contribute to dysphagia. I hope and think as a field we are doing better with that, but time will tell. I try to teach them to use their knowledge of anatomy and physiology and the concept of the patient as being more than a trachea.... this necessitates at least an appreciation of the complex systems involved and multidisciplinary involvement in care. There is no expectation that any one profession can have that breadth of knowledge. The lesson to hopefully be taken from that is that we do NOT manage this alone. 
 
 Pam Smith, Ph.D.
 Bloomsburg University
 Bloomsburg, PA
  
  
   
________________________________________________________________________
Check out the new AOL.  Most comprehensive set of free safety and security tools, free access to millions of high-quality videos from across the web, free AOL Mail and more.