My profession as a community-based Speech-Language Pathologist bears many joys. The blessing of being able to positively impact the life of a child is the most rewarding aspect. Inevitably, though like any profession, there are moments of frustration, times when the pressure of “getting the job done” overwhelms, and the feeling that the entire task weighs only on my shoulders.
Recognizing Our Role on the Healthcare Team
Speech-Language Pathologists fall into the bucket of healthcare providers known as allied healthcare professionals. The dictionary defines allied as “in combination or working together with”, which in theory seems to be a very fitting description of therapeutic services. Yet as I reflectively consider aspects of everyday practice that could be better, I see this as the one area in need of improvement, since so many times I feel like I am the only one “steering the ship”.
When I complete evaluations for children with feeding or communication difficulties, more often than not parents report that they have only minimally discussed their concerns with their pediatrician. Logically, my question to them is, “Why?” Most typically respond with, “I guess I never thought to discuss it”. Some report that it just “never came up”, since they typically only go to the doctor when their child is sick. Others report that it was their child’s school that alerted them of a potential problem and not the pediatrician, which is why they never brought it up. Many who did think to mention it (but admit to not being completely forthcoming as to the severity of the problem), report that their doctor was not especially alarmed, or was told to wait more time.
Coordination is Key
For the record, I am not blaming pediatricians or primary care physicians in any way at all. You see as healthcare providers we ALL have a duty to communicate regularly with each other as a coordinated team. First and foremost, to get to the bottom of most conditions, practitioners must “connect the dots" to be able to see the big picture. When providers do not do this, it leaves them very shortsighted. A “tunnel vision” approach to treatment is never a good thing. Why? Anecdotal evidence shows us that lack of coordinated care among health care professionals leads to poorer outcomes for those with complex medical conditions. Based on my experience, it results in lost time (which is so crucial during the formative years for better outcomes), contributes to a high amount of patient stress and frustration, and breaks down the “trust factor” that inevitably must be in place in order to forge a productive patient-provider relationship. When only one provider is managing a complex case with many facets, it unfairly distributes the weight of responsibility on that one provider, when ideally multiple providers should be sharing it. When this happens, it sets that one provider up for failure. It is not humanly possible to manage all aspects (especially when many aspects are outside of one’s own scope of practice). Consider a child who comes in for a communication assessment, who is also showing delays behaviorally and cognitively. Without other crucial members of the team assuming their respective roles (i.e., BCBA specialist, a developmental specialist, etc.), the task of resolving the communication problem will be greatly impeded because of all of the other difficulties. Outcomes would consequently be less favorable.
Taking the First Step
I believe that the first step is “hitting the reset button” on the way that we view a child’s therapeutic journey. As a parent consider yourself the “captain” of your team; talk openly with your providers while encouraging communication between all of the members of your child’s team; do not withhold crucial concerns or difficulties that you are experiencing from your primary care physician. He or she has the ability to give you proper direction and guidance. If not, perhaps they may not be the right fit for your little one. Most insurance companies require a documented history in your child’s medical chart to substantiate payment for your therapy services. That being said, you as the patient are well within your right to demand that your concerns are being documented in your child’s record. It is also okay to ask them for a copy of your records. I cannot tell you how many times that our practice must request records from a pediatrician to substantiate the start or continuation of therapy for a health insurance company. Undoubtedly, 1 out of 5 patients will have no detailed information in their medical records referencing communication or feeding concerns. Remember if you do not share what is going on with your doctor, they will not be able to document. Take copies of your evaluation reports with you when you visit your primary care physician to include in his or her records. Most allied health professionals will happily send a copy to your doctor or any other member of your child’s team if that is easier for you, as long as you sign consent. Therapy providers have a role in this shift, too. As a provider, take the time to ask the right questions. Dig deep. More often than not, patients are so overwhelmed that they forget details that are crucial in helping you diagnose with more accuracy so that you can develop a more comprehensive plan of treatment. You are obligated to look at the big picture, and consider all factors that have an impact on the problem. This would include investigating the medical, developmental, and social history. Present status is equally as important. Think critically about what impact these factors are having on the problem. If your little inside voice is telling you that you are missing something, don’t be afraid to refer and consult with other related professionals. Never give up on your quest for as much information as possible, especially when dealing with more complex difficulties. It will be well worth it in the end.
Lisa Jiannetto-Surrusco, MA, CCC-SLP
Director/Owner of Reach for the Stars, LLC
Cranford, New Jersey