10 Things I Never Learned in Graduate School

When I finished my clinical fellowship ten years ago, I thought I knew pretty much everything there is to know about medical speech pathology... Boy, was I wrong. I’ve learned a few things since then and thought I’d share them for those who recently graduated, those who are soon retiring, and everyone in between. 

1. Information is learned, and knowledge is earned. Learning and growth are lifelong. They are not completed in graduate school, not in one course, not in one training. Once you stop growing, you are no longer providing value to your patients.

2. Aspiration is normal. Everyone does it. Nobody is immune from it. Preventing aspiration is never the point because setting an impossible goal is not only silly but irresponsible. Aspiration pneumonia from aspirating food or liquid alone is uncommon and typically only impacts the highly compromised. 

3. Communicating effectively with the patient requires trust and relationship building, which is rarely completed in only one visit.

4. Your colleagues will only listen to you if they have a good reason to. A nurse has 1,000 things to think about and remember. How will the information you provide connect to what they feel is essential?

5. Almost everyone dislikes modified diets… But not everyone dislikes modified diets. I once took a patient through six weeks of daily, 45-minute, highly involved therapy sessions to get him off of thickened liquids. After finally advancing him to thin, I discovered he preferred the thickened liquid and would rarely drink anything else. Know your patient. Know what the goal is.

6. Most of what you teach your patients will be forgotten or disregarded when they get home. A patient will only change their behavior if she believes she has a problem that needs to be solved and, more importantly, that your solution is the one for them.

7. Our jobs are to #1, do no harm, and #2, care for the patient in a way that improves their life. Sometimes, doing nothing is the best thing. Sometimes, simply getting an extra blanket is the only thing he needs.

8. We need to be more objective but avoid getting lost in the numbers. We should understand the statistics but treat every person as an individual. 

9. To care for someone else requires a human being with empathy and thoughtful consideration for her wants and needs. A computer will never be able to do our jobs.

10. Progress is not a straight line. Research is often conflicting and constantly evolving. Practice patterns may be outdated... until they aren’t… and until they are again. What we do today may be laughed at (if not cried at) 10 years from now. Don’t be afraid to change your practice. Be afraid not to.

Please comment below to add to this list. I love to learn just like you do.

*Check out my new course offered for ethics credit: Let Us Eat: The ethics of swallowing in older adults at high risk