[Dysphagia] : Logemann results and MBS

[lschmidt at jamestownhospital.com (Lonna.Schmidt)]

I am fairly new to this list serv and have been introduced to ideas that
not only weren't taught when I went through my undergrad and grad
program back in the day when you could still be an SLP with a bachelor's
degree, but directly contradictory to the workshops I took in the 90's
as well as to the conservative approach that my wonderful mentor in my
first job in rehab.  I love to learn new ideas and this list serv has
definitely brought about new ideas.  I am curious about how often one
would feel doing a VFSS is necessary and what criteria you would have
for doing one?  I hear what is said about it not really representing a
full meal, and I have always whole heartedly concurred with that view
which is why I prefer to do a bedside meal assessment prior to any VFSS.
Though this preferred method is rarely agreed to with the docs I have to
work with in very rural North Dakota.  I often get a referral for a VFSS
with NO background information from the docs even though I have a
protocol/history sheet for my staff to inquire before I see the patient.
Yes I know, an awful practice but I can't rock the boat easily.  You
should see the trouble I got into at the nursing home I am contracted to
when I suggested that a supposedly skilled certified nursing assistant
should be able to check the meal card and see if the tray he/she is
serving matches the diet or even understand there can be different names
for a given diet instead of going through each and every food served and
allowing or disallowing it according to skills.  We won't mention
attitudes about thickening (I still shudder every time I go there. Ah
but that is another story...  They did like it when I used FWP which was
alien to their way of thinking though!)  My own hospital finally just
accepted a screening tool for nursing/doctors to use when they should be
referring patients with possible dysphagia though it hasn't been gone
through the final approval process yet.
Yes, I am in the Stone Age here but love the people I work with and how
I am treated otherwise...no productivity requirements which are so often
the case where I moved from.  I can only go slowly.

Lonna J. Schmidt MST-CCC-SLP
Speech Pathologist
Jamestown Hospital
Jamestown ND