“But I talk fine!” They say

While no two patients are the same, it would seem as though much of my caseload has been cohesive in their gross misunderstanding of Speech Therapy.

I have grown accustomed to those outside the therapy discipline having a very narrow concept of Speech-Language Pathology. No, we do not *just* work on lisps. No, we do not *just* “fix” speech.

To this day, some of my closest friends still don’t understand exactly what I do. Which is fine, because, to be honest, I was already a few semesters into my graduate program before I began to truly comprehend the full scope of practice. That’s just it though. The breadth and depth of Speech Therapy is so vast that someone (like me!) can be halfway to completing their Masters degree, still learning of unique sectors SLPs play a key role in.

Unfortunately, this lack of familiarity with my chosen profession would cause me trouble as I began my first year out of school, now gainfully employed in a Skilled Nursing Facility (SNF).

Having never worked in a Skilled Nursing Facility prior to my Clinical Fellowship Year (CFY), I was ill-prepared for the amount of resistance I would receive from patients who were unfamiliar with my profession. I would begin my evaluation of a new admit with an introduction. Subsequently, my innocent attempt to establish rapport was often met with push-back. The conversation would go as follows:

Me: Hi, My Name is X, and I’m a Speech Therapist. I’m going to be taking a look at –

Patient (interrupting, flat affect now quickly transforming to a stern, slightly frightening, look of aggressive disapproval): Speech Therapy? Why would I need that? I talk fine!

Me: Yes, I know you talk fine. I’m actually here to look at your cognition, language, and swallowing.

Patient: But, I talk fine! I don’t need Speech Therapy! I’m here to walk!

Some patients were more open-minded than others when it came to allowing me the time to explain why I was seeing them. Most patients permitted me to progress with the evaluation given a little persuasion and firmness on my behalf.

Despite this; however, the disheartening fact remained that some of my patients were utterly disinterested in the service I offered, solely due to the semantics of my job title. I desperately needed my patients to shift their focus away from my job title and instead focus on the value I could add to their rehabilitation process.

Albeit, admittedly, they might “be here to walk”. Fine. Walking was important to them. But, did they understand I could help them safely consume liquid without aspirating? Did they know I could help them improve their ability to express themselves and understand others? We could work together on their cognitive-communication skills in order to augment their progress in other therapies, where they’d have to accurately sequence and recall functional information during wheel-chair transfers and sit to stands.

I was a resource who could help them with things they likely found important. Did they understand that, though?

I suspected they did not.

After tiring of the same song and dance that perpetually proceeded my (now dreaded) introduction, I set out to establish a shared understanding with patients before receiving resistance. This was no easy feat.

I experimented with a new introduction approach. My goal was to conjure up a miracle recipe powerful enough to elicit consistent, favorable responses.

I collected research, which took the form of case studies. Modifying my introduction execution with each new admit, I’d carefully observe the exchange. I’d then draw conclusions about the effectiveness of a modification based on patient reactions and willingness to participate.

I tried everything. First, I tried avoiding my specific job title and opting for the more general title of “therapist”, but that felt dishonest. I then tried avoiding my introduction entirely, but that felt awkward and rude. I tried switching out “Speech Therapist” for “Speech-Language Pathologist”, but that felt, well, equally unproductive and also proved to be, equally unproductive. My patients still developed less buy-in than I’d hoped to facilitate.

I tried leading with an explanation of what I did and then slyly “‘confessing” my job title. Unsurprisingly, this approach still ended with that same push-back and a baffled look on my patient’s face who’d then gripe, “But I talk fine!”.

Finally, something clicked. My patients could not relate to understanding my discipline, because they never needed to before. They did not understand my role, and as much as I wanted them to, I could not make them understand in a thirty-second introductory time span.

I had to work with what they did understand. And they definitely, absolutely, unquestionably, understood that they talked fine. 

So, I began to introduce myself and then carefully (and quickly) follow my job title by validating their reservations. I’d say, “I know it might seem weird that I’m seeing you, because there’s nothing wrong with your speech. I’m actually here to-”. Or, “You might be wondering why you’re seeing a Speech Therapist, but I actually rarely work on someones speech in this setting. The main things I work on with patients here are-”

My patients responded favorably to having their reservations validated. They moved past their own biases associated with my job title. This way of introducing myself allowed us to waste less time. We were able to efficiently focus our attention on their rehabilitation. This small change in my introduction worked.

It worked like the love child of Van Riper’s Hierarchy and Super Duper articulation cards in remediating a lisp. It worked like my fiscally irresponsible ex boyfriend, after returning from a Vegas with only 7 dollars to his name. It worked like Beyonce at a club.

Ok, I think we’re done here.


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