When I worked in acute care, I was a strong advocate for the idea that everyone deserves a chance to get therapy. I still believe that strongly, but having now worked in both home health and outpatient settings (in addition to previous placements also in skilled nursing facilities during my clinical fellowship), I've come to a new realization:

Not everyone is a good candidate for therapy.

As a new clinician, and working in such an intense setting, it didn't occur to me that not everyone responds well to therapy, and more than that, not everyone even wants therapy.

Many folks want to tell clinicians what they think they want to hear. Keep an eye on body language, and consistency with attending appointments, and motivation (or lack thereof) will become readily apparent.

See enough people do the same, and you'll get better at recognizing motivation in the moment. Part of patient-centered care is respecting when patients don't want our help.

★ Aiming to Please

Though many people don’t think about it, there are plenty of similarities between working with adults and working with children. Just as pediatric SLPs note the periodic need for incentives in order to make progress in therapy, there are plenty of adults who do as well. I frequently work with patients who are very confused and, as a result, can be less than inclined to work with a guy like me. “Speech pathologist?”, I often hear, “I can talk just fine, what are you doing here?”

In addition to the often-seen challenge of helping someone acknowledge that they’re having difficulty swallowing, an added bonus is that such difficulty is often coupled with poor appetite. It’s the ultimate paradox: when you feel bad, you don’t feel hungry; but, the best way to heal is to get some good nutrition.

Recently, I worked with a patient who had a poor appetite and wasn’t eating enough as a result. She was refusing most food and was not inclined to drink liquid supplements, citing that they were never cold enough to properly enjoy them. I excused myself, ran to the nutrition room on the floor, and returned with a cup of ice. Ensure on the rocks, then?”, I asked as I began to pour. She had a good chuckle and agreed.

Though it lacked the punch of a good mixed drink, it did the trick to make her day just a little bit brighter.

★ Pancakes!!!

One thing I love about medical speech pathology is the sheer variety of people I get to work with. Recently I've gotten to work with a number of patients with a variety of psych histories. Yesterday was a gem:

Phil: Would you like a snack? Patient: Pancakes!!! Phil: Yum! But I don't have pancakes. How about applesauce? Patient: Ok. Patient: I'm ready for supper! Phil: It's 10:30 in the morning, but I'll bite. What do you want? Patient: Pancakes!!! Phil: What about for lunch today? Patient: Pancakes!!!

The humor wasn't even in the words themselves, but the uninhibited enthusiasm with which they were spoken. It's moments like these that really make me love what I do.