[Dysphagia] I am fed up

[lhgrall at hotmail.com (Lawrence Grall)]

As someone who has followed the list serve for several years I have 
witnessed several seasons of turbulence and controversey, often culminating 
in perceived and often overt disrespect and hostility. I suspect this will 
not be the last time and as always, we will learn from this and go on. Irene 
has often been accused of "talking down" or appearing condescending to those 
on the listserve (especially new participants who are not familiar with her 
direct responses) and I really appreciated Pam's perspective of her 
interactions with Irene.  Perhaps some of Irene's tone is simply based on 
sheer frustration, and the passion she possesses for this insidious field of 
dysphagia....having to convey and address over and over the basic principles 
and foundations necessary to even broach this field...and despite the 
redundancy of questions from new listservers, she continues to do it.  I 
submit that it is Irene who has led the way in illuminating what information 
is really out there and most importantlly what is not...and in essence 
played a (if not "the") leading role in changing the whole paradigm of 
clinical assessment and perspective; pulling many of us out of a micro 
focused "MBS" view and into a comprehensive multidisciplinary approach where 
encompassing all approriate areas of medical knowledge is paramount. I have 
often emailed Irene personally for specific information and I can testify 
there has not been one instance where she has not provided me her complete 
attention and service to locating the information I request and may need in 
support of my patient's welfare.

And although I have witnessed many attacks on Irene's character, it is not 
very often where I witness any correspondence on the listserve directly 
thanking her for the time, effort, and dedication to this listserve.  I have 
experienced times where she has been insulted to the point of withdrawing; 
and trust me her insight and experience has been overtly and greatly missed. 
  Fortunately she has always come back.

So with that, I (and I know there are a great many others) want to publicly 
and personally thank you Irene!...thank you for your dedication, your 
perseverence, and sheer passion to helping those with dysphagia...as well as 
those who treat it.  I myself think you have a very purposeful and rewarding 
life!

Sincerely,

Lawrence Grall



>From: lobsterpam at aol.com
>To: EThompson at mountnittany.org
>CC: dysphagia at b9.com
>Subject: Re: [Dysphagia] I am fed up
>Date: Thu, 08 Mar 2007 11:12:44 -0500
>
>
>  I expect that the example of the graduate student who was woefully 
>prepared for a medically based internship is repeated in many settings 
>across the country. It is a situation we do our best to avoid. I'd be 
>willing to bet that it's a big reason some SLPs don't want to take 
>students. Although in our idealism we like to think that "someone did this 
>for you, so you should be willing to do it for them," the reality is that a 
>less-than-prepared student can be more work than benefit. They can require 
>SO much time and energy that your own productivity suffers more than the 
>department is able to absorb. After all, health care is a business.
>
>  Our second years (they'll graduate in May) started their second half 
>placements this week, a week which always makes me a bit nervous, because 
>it is their medical assignment. I hope I did my job well enough so that our 
>SLP supervisors, whom we need and value SO much, can still do theirs. We 
>want the experience with our students to be a benefit, not a burden. That's 
>the goal... time always will be the best judge of how we did.
>
>  And yes, Elana, I'll be at PSHA. Come to "Scary Videos" on Friday!
>
>  Pam Smith
>  Bloomsburg University
>  Bloomsburg, PA
>
>  -----Original Message-----
>  From: EThompson at mountnittany.org
>  To: lobsterpam at aol.com; dysphagia at b9.com
>  Sent: Thu, 8 Mar 2007 10:43 AM
>  Subject: RE: [Dysphagia] I am fed up
>
>   That is very well said, Pam, and is the culmination of many things I was
>considering writing in my own response.  (Now, I don't need to!!)
>I will say this, though....
>Last fall I had a graduate student, supposedly a semester away from 
>graduation,
>who came to do a 12-week internship with me in an adult acute care 
>hospital.
>She had had NO practical adult eval or therapy experience at her school and 
>was
>expecting to spend just 12 weeks with me and gain independence in the 
>skills
>required of an acute care SLP.  Her grade was based on the level of 
>independence
>she achieved during the internship.  She failed.
>In ALL health care settings, the SLP really should be proficient in ALL 
>areas
>Pam mentioned prior to independently seeing patients and grad schools 
>should be
>teaching it to us just like it is taught to an RN, PA-C, or CRNP.  We are
>involved with patients on that level.  You cannot understand swallowing,
>cognition, and general recovery processes without understanding those lab
>values, etc.  I never really understood all of that until the past 5 years, 
>but
>since then I have been trying very hard to gain proficiency in all those 
>areas.
>
>SLP's might not like to hear it, but in health care settings, we are 
>medical
>professionals, not just rehab professionals.  That is probably why it is
>alarming to some people that an SLP already in those settings would need an
>introductory level course.  However, if you need them, take them and I hope 
>they
>are great!
>
>In Pam's words:  Here's to getting the knowledge base, using your 
>inquisitive
>open mind, accessing information, and thickening your skin!!
>
>Sincerely,
>
>Elana Thompson, MS,CCC-SLP
>
>See you at PSHA, Pam?
>
>-----Original Message-----
>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com]On
>Behalf Of lobsterpam at aol.com
>Sent: Thursday, March 08, 2007 7:33 AM
>To: dysphagia at b9.com
>Subject: Re: [Dysphagia] I am fed up
>
>
>   This isn't directed at the 'introductory course' topic specifically, but 
>is a
>more global comment simply offered for consideration. My thoughts on the
>introductory course is that if someone needs the training, go get it. But
>recognize the larger less personal point that dysphagia education in our
>profession in general needs work. Those of us in universities know that and 
>are
>we working hard to improve it. The ASHA Knowledge and Skills documents 
>speak for
>themselves, and Division 13 has many excellent resources available for 
>members.
>
>  That said, I think it's very unhealthy for professionals - or members of 
>a
>professional discussion lists - to stop questioning the practices of the
>profession. NO profession improves unless it is constantly examining 
>itself. The
>whole concept of evidence based practice requires continual objective 
>evaluation
>of the evidence supposedly supporting what we do. If list serve 
>participants
>only wish to support each other with "atta boy!" comments, no one grows as 
>a
>professional. Would we rather have an attorney ask some of the questions 
>that
>are asked here? How do you feel when a smart and savvy family member 
>questions
>what you are doing? Or when a physician won't order your services? In the
>litigious society in which we find ourselves, it's best we get used to 
>people
>asking us the "why" questions about our field, and be prepared to state
>objectively and from an evidence base - not defensively - why we are doing 
>what
>we are doing.
>
>  The management of patients with dysphagia is a multidisciplinary field, 
>and any
>SLP who believes he or she can do it himself/herself has a lot of reading 
>to do
>and additional academic degrees to obtain. A discussion list that welcomes 
>the
>contributions of other professionals only helps us to appreciate what these
>other professionals know. If we are intimidated by that, nothing is gained 
>by
>telling these people to get out of our sandbox. Have the people who find
>themselves angry ever located and read the information Irene has posted? A
>number of years ago I argued openly on this list with Irene, and her tone 
>was
>directed right at me, and of course I didn't appreciate it. Then I finally 
>read
>the literature that was posted (Irene was the first one who I had ever 
>heard of
>mentioning the contribution of reflux or oral secretions to pneumonia, and 
>I'd
>been practicing for close to 10 years at that point.)
>
>  Individuals have their own manner of conveying their thoughts; some 
>people just
>don't sugarcoat things. The written word doesn't provide the complete 
>pragmatic.
>That's a limitation of email communication and it needs to be accepted if 
>one is
>going to use this medium. Sure, people could be nicer, but I remember a
>colleague who could be nicer, too. It's a shame if people choose not to 
>interact
>because of personality differences. Wasn't it Eleanor Roosevelt who said no 
>one
>can make you feel inferior without your consent? Anyway, eventually I 
>realized
>that my angst wasn't really about Irene. It was easy to blame this person 
>who
>was faceless and only showed up in my email inbox with abstracts that 
>showed she
>had a lot of information at her fingertips that I didn't have, and who 
>wrote
>things in a way that made me realize that I was missing some very basic
>information that I SHOULD know. There are and were choices here - to get 
>angry
>and defensive, or to suck it up and learn thing!
>  s. My issues were that I knew practically nothing about lab values, 
>dietary
>requirements, respiratory physiology or infectious diseases, and yet here I 
>was
>working with patients with these very problems. My issues were coming to 
>terms
>with the fact that some of the interventions I had been doing for years had 
>the
>potential to do as much harm as the underlying problem I was trying to 
>help.
>
>  Whenever students ask me about why practices are so inconsistent, and why 
>they
>must continue to read research and understand evidence when they are 
>finished
>with school, I tell them that not so many hundred years ago, doctors used 
>to
>bleed people to cure them of disease, and that's what killed George 
>Washington.
>Someone questioned the practice, and someone had to be the first to suggest 
>that
>maybe bloodletting wasn't the best way to go.
>
>  Working in health care requires a knowledge base, an inquisitive open 
>mind,
>access to information, and a thick skin.
>
>  Pam Smith, Ph.D.
>  Bloomsburg University
>  Bloomsburg, PA
>
>
>  -----Original Message-----
>  From: cohoe at uci.net
>  To: vickycox at yahoo.ca; dysphagia at b9.com
>  Sent: Wed, 7 Mar 2007 11:52 PM
>  Subject: Re: [Dysphagia] I am fed up
>
>   I vote for a kindler, gentler listserve as well.  Can we stop wit the
>questioning of others and simply be supportive?  If we fear posting for the
>ridicule of one member we allow her to win.  Let's ask those beginner
>questions and let's advertise those courses.  This listserve is for SLP's;
>let's take it back.
>
>-----Original Message-----
>From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On Behalf
>Of Vicky Cox
>Sent: Wednesday, March 07, 2007 7:42 PM
>To: dysphagia at b9.com
>Subject: [Dysphagia] I am fed up
>
>Hello all,
>
>   I am an SLP and proud to say that I am attending "beginner" workshops 
>even
>though I have been practising for a long time. I suppose I never think I am
>a perfect SLP, and guess what, I may even learn something from the new
>grads, who as someone put it, should already know everything form their
>masters program.
>
>   I posted a question a few years back when I was a new grad, and a
>particular person posted a reply and made me look like a total idiot (the
>same person who normally does this). I feel saddened to say that I have 
>been
>afraid of posting since then. But reading all of these replies, I am glad
>that others can see how toxic this list serve can be.
>
>   Its a shame really, because there are some really great SLPs who post 
>here
>(all in fact), and I am sorry I had such a bad experience in the past.
>
>   Thanks,
>   Vicky
>
>
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