What we didn’t know about our field before we started…

By January 2, 2014 Ethics No Comments

I prompted SLPs on Twitter and Facebook to tell me what they did not know about speech-language pathology before they began their training/jobs. This question definitely tapped a nerve. I had over three pages of single spaced responses that I copied and pasted.  I think the responses are applicable to OTs and PTs also.


Instead of sharing all of the thoughts, here are some areas that seemed thematic in the responses:

  • Dysphagia: Many of us did not fully understand the scope of practice to include dysphagia and working with clients with dysphagia brought of few surprises of its own: “a gentleman with a new tracheotomy who hadn’t learned to cover his stoma instead of his mouth when he coughed (resulting in a spray of phlegm)” and “horribly dirty crusty mouths” due to lack of oral care.

  • Paperwork: The quantity of paperwork was mentioned to be “overwhelming at times” resulting in realizing “How much ‘behind the scenes’ work there is for each hour of therapy”.

  • Counseling: Several people mentioned the lack of training for counseling and “I had no idea how much counseling I would do”.

  • Autonomy and Respect: It is a tough world when nobody understand what you do. People mentioned “the lack of respect/credibility we’d have with teachers in schools and physicians/nurses in healthcare” and “how under educated doctors and nurses are about speech and language issues” In addition, “salary disparity as compared to PT/OT even though at the time I started, we had the most education”

  • Ethics: One person summed it up, “How it all comes down to money”. Other people mentioned, “I didn’t realize how often I would have to stay alert and stand firm”, “How much reimbursement $ effects what we do”, and “How my value as an employee would always be summed up to productivity and billable time”.

  • Emotional: We are working with people, so it can pull at your heartstrings.  People recognized the harsh realities of “it could be emotionally draining and you would cry”, “how to separate your heart from your caseload”, and “that a client could pass away…”

  • Making a difference: Our jobs are full of compassion and gratitude. People responded, “I never knew I would be in a position to make an impact on so many lives”, “even years and years later how often I would stop and think about my past patients and wonder where they were in their current lives…”, and “that all those fun games my ‘speech teacher’ played were actually a well thought out strategy!”


One thing that seemed telling to me was there was an overarching theme of frustration and hostility. Many people had tones indicating they felt they were victims of a system against them. To be honest, I have experienced those same frustrations. I think we have all been there. But the question is what can we do about it? What are we going to do about it? Being an SLP is a noble profession. It should be gratifying. It is not perfect. But it should not stir up this much negative emotion.


So I leave you with questions:

  1. What can we do to educate the public and other healthcare professionals about our scope of practice, especially dysphagia?

  2. What can we do to better manage the paperwork, give ourselves time to complete the paperwork, or change the paperwork requirements all while maintaining integrity and accountability?

  3. What can we do to prepare future SLPs for the counseling component of our jobs? What about the emotional side of working with our populations?

  4. What can we do to improve the respect and credibility we have with teachers, social workers, nurses, doctors, and other healthcare professionals?

  5. How can we change the way we are valued as a therapist (not productivity and billable time)?

  6. Perhaps we cannot change a darn thing on the list above. One thing we can change is the support we provide to each other. How can we support each other in a way that will improve our job satisfaction?


As always, I invite you to comment to join the conversation. To make our patients’ world a better place, we need to start with our own.


Image (cc) Flickr Celestine Chua

***This is a modified version of a blog I posted at Talks Just Fine several months ago. It seems very timely to concerns many people are expressing about their workplaces.

Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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