As a speech therapy professional, you’ll have tricky patients from time to time. And if you don’t know what to do, it can be stressful and overwhelming.
In this article, we answer frequently asked questions about how to deal with difficult patients, including:
- How do I handle complex patients?
- What if treatment is unethical?
- What if my patient is non-compliant?
If you’re a new clinician, you’re in the right place! And if you’re a veteran, bookmark this article for your next student (or get a few ideas of your own).
This is part 2 of our FAQ series. Read Part 1, Dysphagia For New Clinicians. Then check back next week for more useful tips!
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
1. What If My Patient Is Very Complex And Out Of My Comfort Zone?
What do you do if you’re unfamiliar with your patient’s diagnosis or the treatment modality they need?
If a patient is outside of your comfort zone, it’s best to seek training. This may be mentorship and/or training within or outside your workplace.
Per the American Speech-Language-Hearing Association Code of Ethics, SLPs shall:
“…shall engage in only those aspects of the professions that are within the scope of their professional practice and competence, considering their certification status, education, training, and experience” (2023).
Seek Mentorship
Seek mentorship from another SLP, locally or online, who can guide and support you. Ask for their advice about evidence-based assessment and treatment ideas.
This collaboration is a great way to boost your competence in treating a new diagnosis.
Take Continuing Education
Training, including continuing education, is another way to increase your skills in treating complex patients:
- Search our website for evidence-based treatment guides.
- ASHA and other national speech therapy organizations offer numerous resources, including CEUs.
- The Adult Speech Therapy Roadmap is our step-by-step guide to speech therapy assessment, documentation, and treatment. Eligible for 1.55 CEUs.
- Medbridge offers excellent CEUs in numerous diagnoses and treatment modalities (click for $150 off).
What If I’m The Only SLP?
But what if you’re the only speech therapy professional in a facility and you’re expected to treat all patients who need ST services? Or what if you’re crunched for time and resources?
Bring your concerns to your supervisor or director right away.
Request time and training before working with the patient. Be sure to explain the requirements of your SLP licensure and your scope of practice.
What If They’re Just Too Complex?
If your patient is just too complex for your comfort level despite mentorship and training, it’s appropriate to refer them to another SLP.
If, for example, you work in an outpatient setting and are referred a patient with deficits outside your skill level, seek out other local speech therapy services that can meet their needs.
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2. What If It Seems Unethical To Treat A Patient?
If a patient needs hospice, is too medically fragile, or is end-of-life, there are circumstances when it may feel unethical to treat them. Here are some options of what to do.
Advocate For Your Patient
As a speech therapy professional, you may have insight into the severity of your patient’s deficits and how they contribute to their medical issues that the rest of your team doesn’t. Like in the example of severe dysphagia.
Per the American Speech-Language-Hearing Association Code of Ethics, SLPs shall:
“…use independent and evidence-based clinical judgment, keeping paramount the best interests of those being served” (2023).
This means using your clinical judgment to decide if a patient is inappropriate for therapy services due to medical fragility.
Consult with the patient’s doctor about your concerns and your recommendations for comfort measures.
What If My Employer Pushes Back?
What if your employer pushes back and asks you to treat the patient anyway?
In addition to ASHA’s Code of Ethics, there are clinical ethics that healthcare providers worldwide are expected to abide by: beneficence, nonmaleficence, autonomy, and justice.
Beneficence, specifically, is the responsibility to act in your patient’s best interests.
This includes protecting and defending their rights while protecting them from harm (Varsky, 2021). If speech therapy treatment is ethically inappropriate and could affect your patient negatively, it’s your obligation to say no.
3. What If My Patient Won’t Cooperate?
Although frustrating…it’s ok!
The choice is ultimately up to the patient. Each person has the right to make their own decisions based on their own beliefs and values.
Per the U.S. Patient Self-Determination Act of 1990, patients have the right to direct their health care decisions to the extent permitted by State law (Teoli, D., & Ghassemzadeh, S., 2023).
What If I Don’t Agree?
But what if you disagree with their decision?
What if they refuse to participate or don’t follow your recommendations, putting them at risk for aspiration, pneumonia, or worse?
Again, you can’t ethically control your patients’ decisions or persuade them.
What you can do is:
- Listen carefully to your patient and their caregivers.
- Educate extensively about the benefits of your recommendation and the risks of their choices.
- Answer their questions and give them time to decide.
- Then, document your education, your recommendations, and the patient’s decision.
Remember that your patient’s quality of life is our greatest priority, even if you don’t always agree with them.
More Materials For New SLPs
For step-by-step guidance to all of your frequently asked questions, visit our shop and The Roadmap Course. Now eligible for 1.55 ASHA CEUs!
Adult Speech Therapy Starter Pack
The Starter Pack is 900+ pages of print-and-go adult speech therapy worksheets, handouts, and templates.
Adult Speech Therapy Roadmap Course
The Adult Speech Therapy Roadmap is an online course that teaches you how to assess, treat, and document all major areas of adult speech therapy, from Day 1 to Discharge.
References
- American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. Available from www.asha.org/policy/.
- Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
- H.R.4449 – 101st Congress (1989-1990): Patient Self Determination Act of 1990. (n.d.). Congress.gov. Retrieved November 5, 2024, from https://www.congress.gov/bill/101st-congress/house-bill/4449
- Teoli, D., & Ghassemzadeh, S. (2023). Patient Self-Determination Act – StatPearls. NCBI. Retrieved November, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK538297/
- Varkey B. (2021). Principles of Clinical Ethics and Their Application to Practice. Medical principles and practice : international journal of the Kuwait University, Health Science Centre, 30(1), 17–28. https://doi.org/10.1159/000509119
