speech pathology

★ In Retrospect

Every once in a while, I find myself writing in new places. Yesterday was one such day. I wrote my first ever article for ASHAsphere, the official ASHA blog. I wrote a piece I called A Handful of Post-Graduate Retrospection. It was a lot of fun.

One of the hardest things about any new endeavor is getting started. Everyone has to start somewhere, and much as we would prefer to think otherwise, the best place to start is at the beginning. Much as I don’t want to admit it, I hated starting at the beginning. But I did it (and I’m glad I did it), and here’s a handful of things I’ve learned so far.

I would be honored if you go read it. If you already have, I hope you enjoyed reading it as much as I enjoyed writing it.

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★ Some Words About Performance

I had my first annual performance evaluation at work a few weeks ago. In nearly every way, it was good. It was very constructive, and I got ideas for what I can do, and genuine goals to work toward, from people who care about my professional growth. It’s a foreign feeling, previously coming from a place that valued only the ‘product’ (service) I provided and cared little about the quality. Still, the perfectionist in me struggles. And I just have to smack that guy down, because he’s anything but helpful.

  • The perfectionist sees suggestions and critiques as flaws, rather than seeing the potential.
  • The perfectionist gets down on himself for not knowing more, rather than acknowledging that everything takes time.
  • The perfectionist wants to be awesome now, rather than accepting that the only way to get awesome is to start at the beginning and work hard to reach new heights.
  • The perfectionist wants to be good at everything right away, instead of focusing on 1-2 things at a time and really honing those skills before moving on.

I have to remind myself that I’m still only just beginning. I have to tell myself that, in time, things will truly ‘click’ and I will come into my own. In the meantime, I have to keep myself from being my own worst critic, embrace the journey, and cherish the little victories.

★ On Making Strides

One of the great things about the field of speech-language pathology, and incidentally one of its biggest challenges, is that you never really stop learning. Just when you think you've gotten the hang of something, a new idea or presentation comes along that turns your understanding on its head and makes you rethink just about everything. This is always a good thing, but that doesn't mean it isn't frustrating. I've been following my own learning path with video swallow studies. I had minimal exposure during my CF, and at that they weren't even proper fluoro, so when I took this position I asked that I be retrained so I could learn "from the ground up" to do them well. My learning curve has gone roughly as follows:

  • Observe the process and work with supervisor to interpret results.
  • Learn procedure and setup, as well as progression of studies.
  • Start to perform studies with supervision, and notice that they're agonizingly slow when you do them.
  • Notice that you gradually start to get the hang of things.
  • Feel comfortable going through the motions, and starting to also catch more instances of penetration and aspiration.
  • Realize that there's more to swallowing than those two favorite things.
  • As you start to observe the "bigger picture" of swallowing, realize that you're slipping in terms of efficiency.
  • Work to integrate knowledge of swallowing function into study to make for more complete evaluation.

I have had to remind myself in recent weeks that this is perfectly normal. It helps to lay it out as I have above, to really see the trajectory and remind myself that I am, indeed, making progress. I had found I was getting down on myself for things that, when I look at them this way, are not actually issues. As my supervisor said very well, "We've all been there".

When she said that, it made me think back to my days learning ASL and on the road to becoming an interpreter. I've been an interpreter for going on six years now, and realize now just how far I've come.

I was thinking about learning my second language. It dawned on me that as I was learning, I would take things in, acknowledge them, and try to incorporate it into my use of the language. I could go through the motions, but I didn't really *get it*. After some time (days, week, or even months later), it would suddenly click, and I would find myself actually *over*using it. Eventually, I would tone it down as it fully sank in and use it appropriately.

With regard to my clinical skills as an SLP, and to video swallow studies in this case, I'm still in the middle of this process. Nothing happens overnight. I think back to nearly one year ago, at the ASHA Convention in San Diego last year, and conversations I had with Tiffani Wallace from Dysphagia Ramblings. She helped me rethink my perspective, encouraged me to keep going out and doing and re-learning. Nearly one year later, I realize that I *have* made progress. I'm on the right track. I keep challenging what I think I know, and when I don't, a new patient puts me in check to keep thinking critically.

It's a process. A difficult one with an enormous learning curve, but one that is very much worth the time and effort. I can only imagine where I'll be in another year.

★ This article prepositions the following...

I spent much of my day today catching up on paperwork, and specifically was working on reports for some outpatient clients I had seen for video swallow studies. The challenge of this task? Not writing in telegraphic speech.

It would appear that my time spent in inpatient acute care has done horrible things to my grammar.

★ Writing About Writing

Back in graduate school, I used to think I did a lot of writing. Writing notes for class, working on short essays and term papers here and there, writing lesson plans for clinic (and then, of course, rewriting them) and then writing SOAP notes after sessions. I remember hearing at some point that I should get used to all the paperwork, because it would become a big part of my life, but like any good graduate student, I laughed it off and instead imagined a glamorous, paperwork-free career ahead of me. It's now pushing two years since I graduated with my Master's degree, and I've discovered that writing is not only a big part of what I do, it's a really huge part. Everything we do, it seems, requires documention.

Can this be overwhelming? Absolutely. Is it necessary for us to do all this writing? I've come to believe that, yes, it is vital to what we do. I also believe that good writing applies to any setting we find ourselves.

So who benefits from all this writing?

  • We do.

    As an acute care SLP, my caseload varies significantly from day to day. I do a lot of assessments, and sometimes only work with patients one or two times before they get discharged. Other times, I work with a patient one day, then won't be able to see that same patient for another day or two. Having good notes about each encounter re-orients me to each patient, and serves to assist a memory that is greatly overwhelmed with memories of sessions and evaluations.

    My fellow SLPs who work in outpatient and skilled settings can use notes to track session objectives and activities, and maintain progress. The same goes for private practice and educational clinicians.

  • Our patients/clients do.

    They may never read them, but should services need to be transferred to another clinician or location for any reason, good documentation can help that new clinician pick up therapy where they left off. It's a win for both the client and clinician.

  • Other professionals.

    In my case, I work regularly with doctors, and they rely on my notes for monitoring patient status and discharge planning.

The list goes on.

Over the last few months, I grew curious about just how much I actually write on a daily basis. I've taken to writing my notes in Microsoft Word (not my first choice for word processing software, but the only one available on my work PC, unfortunately), and have taken note at the end of each day of the total word count.

On an average day in February, I wrote somewhere in the vicinity of 1,000 words. In March, I noticed that that number had risen to closer to 1,500 words. Doing some rough calculations, that breaks down as follows.

  • Words per day: 1,500
  • Words per week: 7,500
  • Words per month: 30,000

This means that, in the space of less than two months, I have written enough words to fit a novel that satisfies the constraints of National Novel Writing Month.

All this writing is tiring, certainly, and sometimes when I try to write a blog post here, I find I'm worn out and unable to do so. It's the nature of the beast, however as I have gotten more accustomed to New Job, I have found that writing is slowly getting easier.

I have embraced clinical writing, and with time have noticed that it steadily improves along with my clinical skills.

This is a good thing, and gives me hope, because there is much still that I want to do. I just have to remember to be patient and let things happen in good time.