SLPs vs. Doctors

Last week, I got an interesting phone call.  A doctor from the neuroscience division at Brigham and Women’s (a very well-respected hospital here) called the clinic and wanted to talk to an SLP.  I was the only one there, so after I peed my pants a little and tried to remember everything I learned in grad school, I picked up the phone.  Turns out he had an adult patient he wanted to refer to us, but was so confused about what her problem was, as all of the tests he had run turned out fine.  “So I guess what I’m asking is, can you see a patient who has no clear medical diagnosis…and no certain neurological cause for their speech problems?”  Yes.  It’s called a language disorder/every patient on my caseload who doesn’t have autism.  Long story short, after asking him a series of questions, I concluded that his patient was probably a stutterer and assured him that we could definitely see her.  After I got off the phone, I ran to my coworker, an SLP assistant, and we squealed and promptly looked him up on the internet and talked about how adorable he was.  (Because that’s what ladiez do, AMIRITE?)

No, the real reason we were so excited is because doctors literally NEVER care what we have to say.  Not to make sweeping generalizations here, but usually doctors in hospitals are either too busy or too narcissistic or too unaware to ever want to ask our opinion, and doctors in family medicine often haven’t had enough contact with a speech-language pathologist to even really understand what we do.  Anecdote:  I once evaluated a child whose pediatrician (not a neuro expert) had given him a diagnosis of autism over the phone without ever having him come into the office.  He did not have autism.  And yet SLPs aren’t even allowed to refer a child for an autism evaluation unless the parent brings it up.  But this Brigham and Women’s doctor was so dang interested in hearing what I had to say about the situation and in figuring out the best route for his patient that he spent a good 30 minutes on the phone with me asking questions and answering my questions about the patient.  It restored my faith in the medical profession and in the collaboration that could be possible if we all just listened to each other.

Tonight, I had the pleasure of meeting another doctor, my roommate’s brother, who is in town to attend a medical conference.  He works in a hospital where he wears many hats, and he had a very warm personality and seemed like a great doctor.  He also had very nice things to say about the SLPs he works with.  Then he got to asking me about my job.  “Do you see mostly stroke patients?” he asked.  “No, I actually work mostly with pediatric clients,” I responded.  I never expect much when I tell people my job, since most often they think I play games all day, so I’ve started saying this with an internal grimace while waiting for my conversational partner’s next comment.

But since this guy had already complimented my profession, I figured he’d just say something nice and then I would go back to my hidey-hole, where I had been browsing NPR and Pinterest.  Instead, though – and I have to reiterate that he was not trying to be offensive and was only making conversation – he said, “Oh what a fun job!  So much of that is working with neurotic parents, though, huh?  I meet so many parents where I’m like, ‘Sure you can go see a speech therapist if it’ll make you feel better, but just give it time and they’ll be fine.'”  NO, NO, A THOUSAND TIMES NO.  Maybe they will be fine if you give it time, but it’s not your job to judge.  The SLP will decide that. Although they most likely will not be fine without intervention:  seven percent of preschool and school-age children show significant limitations in language ability, these disorders typically become apparent before the age of four, and early detection and intervention has been proven to be effective in improving children’s speech and language skills.  Not to mention the fact that treatment for speech, language, and hearing (just like any other medical treatment) is less expensive and takes less time when it is started early.  Which means that early detection will save all of us money in the long run.*

But alas, I’m embarrassed of how I handled it.  Instead of gently correcting him or encouraging him to refer to SLPs if parents were concerned, I just laughed a little and then ended the conversation.  Luckily, the American Speech-Language-Hearing Association has just started a new campaign called Identify the Signs, focused on early detection of communication disorders.  I’ll be able to spend the rest of the year blabbing about it to anyone who will listen, and I’ll have ASHA to back me up.  There’s still a lot of work to be done, but I’m lucky to work in a profession full of passionate people who won’t shut up until we’re heard.  Got that, doctors?


*Sources:  ASHA Treatment Efficacy Summary, Communication Disorders: Prevalence and Cost in the United States


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