At TCU on Thursday the 13th

Just a heads-up: On Thursday, we will be treating our patients on TCU. Think about some of the patients you know, and decide who you'd like to treat vs. who you'd prefer to observe.

T.E.E.

Transesophageal Echocardiogram What is a Transesophageal Echocardiogram? A transesophageal echocardiogram is a special ultrasound test that uses sound waves to take pictures of the heart. This type of echo can take clearer pictures of the heart than regular ultrasound especially in older children and adults. It is also used during heart operations to help guide the surgeon. There is no known risk from ultrasound exposure and no radiation exposure is involved. How is it done? The study is done by passing a special tube down the throat into the esophagus or food pipe. The end of this tube is placed near the heart which allows very clear, detailed pictures to be taken. So, can you think of any reason this procedure might lead to swallowing dysfunction?

Remember that Old Adage...

Remember that old adage "you can't please all of the people all of the time..."? Who is ultimately responsible for decisions made regarding the care of a patient? That is the question of the evening.

Is it the patient?
The patient's nurse?
The attending physician?
The surgeon?
The registered dietician?
The speech pathologist?
The physical or occupational therapists?
The medical student? or the physician's assistant?

Or, is it the team? And who is on that team? Is there a leader of that team? And who is that leader?

The patient?
The doctor?

Ultimately someone has to make the final decisions. How does that person make the right decision given a variety of recommendations? Do a JPEG. Don't do a JPEG. Downsize a trach. Don't downsize a trach. How does that person know that the entire team will agree or disagree? Does that person have the time needed to find out? Why? or why not?

Does it do any good to entrust to someone else communication of your recommendations and your rationale for them? And, are your recommendations always to be followed? Or, are they just recommendations?

And, is your recommendation the same as an "order?" Would suggestion be a more appropriate term? Why? Why not? If so, always or only sometimes?

And, why would someone ever say that a nurse does not "have the whole picture" of her/his patient? Why would someone ever imply that an attending physician did not have "time to know patients" entrusted to him or her?

These are my probing questions this evening. Aspects of being a therapist to consider and reflect upon.

Verbal Feedback

During treatment (not evaluation), verbal feedback of some kind needs to come after each response elicited.

This verbal feedback can be "that's right" vs. "that's wrong" or "that's not right" followed by a cue of some sort. Most semantic cues can be drawn from semantic feature analysis with questions such as:

"where is this found?"
"what do you do with this?"
"what does this item do?"
"to which group does this item belong"
"what does this look like, feel like, taste like, smell like...etc?"

If the question does not elicit a correct response, then providing the information in statement form, such as "you use this to open cans" may assist the person. If not, the first letter of the target word sometimes triggers word retrieval. Finally, the phonemic cue may be given. Often it helps to remind the person to attend to your face with "watch me, listen to me, do what I do."

The verbal feedback that you gave today re: sustaining attention via eye contact, etc. was very appropriate.

Keep up the good work.

Time Zone

Time stamps should be correct now. The time zone was set at "Pacific."

Good News!

Found my misplaced bag on TCU...

Comments

Don't forget: You may find it easier to answer my questions via "comments." This way, we won't forget to discuss these during the practicum. Thanks!

ALS Clinic

I recommend you page me on Friday morning to check my schedule as I am not certain when I am going to be at ALS Clinic.

Thought Organization

What is thought organization anyway? What's semantic feature analysis?

Look It Up

What is an empyema? Can you think of any impact this condition might have for speech pathology?