You Can’t Treat What You Can’t See: Why more imaging is desperately needed

By George Barnes MS CCC-SLP

Look first. Diagnose second. Treat last. But look first. It sounds simple, but as a field, we have made it complicated. You might think, “Of course you have to see what you are treating! How could you do it any other way?” But we DO do it another way MOST of the time. We give undeserved weight to the bedside swallow evaluation which is not effective. We allow administrators to downplay the benefits of instrumental studies. We complain about the terrible reports we get from the hospital MBSS, as well as its expense and scheduling difficulties when FEES is becoming more and more available in many different areas (NY and NJ- FEESible has you covered). We come up with other convenient excuses like, “It won’t give us any new information” or “I know MY patient way better than the SLPs running the studies” or “I haven’t used imaging for years, and my patients are doing FINE.” But are they?

“Ignoring dysphagia won’t make it go away”

Since diagnosing dysphagia and confirming aspiration without visualization is ineffective, in the absence of instrumental studies we are pretending to know more information than we do and subsequently putting our patients at risk. Ignoring dysphagia won’t make it go away. Neglect, like many things in life (e.g. your electric bill, the dentist, or taking your dog for a walk), only makes matters worse. If a tree falls in the forest, does it make a sound? Maybe yes, maybe no. But does it cause destruction to everything around it? Yes. And the destruction is not hypothetical. 

Just because we aren’t seeing the residue and the aspiration, doesn’t mean it’s not happening. And unmanaged aspiration is not a good look. There are many, many, many, many articles that link dysphagia and aspiration to pneumonia; particularly in our most vulnerable patients (which just so happens to be the ones we are seeing in hospitals and nursing homes). And I don’t have to tell you that pneumonia matters. Just the fact that you are reading this blog tells me you know and you care- so I apologize if I’m preaching to the choir here. But if so, send this to a friend (because we all have one): their patients will thank you for it.

Don’t assume, take a look

If I sound bitter it’s because I am. We have come WAY too far as a field to ignore the technologies that we need to treat our patients right. Pulmonologists don’t diagnose pneumonia by listening to their cough. Neurologists don’t diagnose strokes by palpating the skull. And PTs don’t treat a suspected muscle tear by having them walk up the stairs to see if they fall. Before jumping to conclusions and making assumptions, they take a look. They see what they are treating. SLPs shouldn’t diagnose (or treat) dysphagia without seeing it first. Suspect it? Yes. Confirm it? Get a FEES. Because we can’t treat what we can’t see. So why not take a look?

Thank you for reading!

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