[Dysphagia] swallowing and dementia

[DEmke at acmedctr.org (Emke, Donna ACMC)]

Dear Candace,

I am a swallowing therapist in acute care at a large county hospital in the
San Francisco Bay Area.  We are a trauma center, and we have many different
types of patients with many different needs.  We are also a teaching
hospital, so we are working with interns, residents as well as attendings.
To answer your question regarding has the medical community lost it's common
sense; yes, it has.  My colleague, who is also a swallowing therapist and I
see it every day, unfortunately with many different issues- not just this
one, as well as poor medical management regarding the placement of NGT/GT in
the elderly who are in need of palliative care instead.  We try our best to
educate the residents/interns on a 1:1 basis, patient by patient.  Sometimes
we get lucky and they can see our point when a patient is in need of
palliative care.  Attendings we have tried and continue to try on a more
formal basis.  You did not mention who may be on your team, however another
discipline you may try to enlist assistance with this issue is your Social
Worker.  Sometimes I have gotten through to Doc's who are too heady this
way.  Do you or other professionals make recommendations for discharge?
Speak with OT and PT - if more than one discipline, including social work is
documenting/telling the Dr. the same Rec's, i.e., D/C to SNF for palliative
care, they may listen a little more closely.  Speak with family members -
ask them how they feel about PEG's - sometimes when you speak with family
members about the problems they cause - if they are aware of these issues
they may not feel so prompted to go in that direction.  All you can do is
keep pointing to EVIDENCE, as Irene has taught us to do (thank you,
Irene!!).  I feel for you and hope you have support in your workplace- if
not, educate some of the allied professionals involved- they may be new
support for you.  Good Luck!

Donna Emke, OTR/L- SWC



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