September 4, 2025 • 30 mins
What happens when a passionate SLP flies to Hawaii to train a hospital team in FEES—and ends up learning just as much as she teaches?
In this episode, Theresa shares the powerful, behind-the-scenes story of a multi-day FEES training in a hospital system. From the logistics (yes, including rolled up manila folders) to the deeply human moments (like helping a burn patient eat for the first time in months), you’ll hear exactly what it takes to build confident, compassionate FEES providers—without throwing anyone to the wolves.
This isn’t just about technique. It’s about mindset. Mentorship. The language we use. The space we create. And the incredible ripple effect it all has on patient care.
Whether you're a seasoned FEES mentor or considering your very first pass, this story-driven episode will leave you inspired, empowered, and maybe even a little teary-eyed (in the best way).
Listen to the full episode at: https://syppodcast.com/374
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Youtube: https://www.youtube.com/@TheresaRichardMedicalSLP
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The post 374 – Building Confidence in FEES: The Key to Successful Swallowing Assessments appeared first on Swallow Your Pride Podcast.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:12):
Welcome to the Swall Your Pride podcast. I'm
your host, Theresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders,
a mobile thieves business owner, and founder of
the MedSLP Collective.
This podcast is all about delivering the latest
evidence based practice to medical SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
(00:33):
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
(00:54):
that, let's dive right in.
Just a quick
disclaimer that all statements and opinions expressed in
this episode do not reflect on the organizations
associated with the speakers and are their own
opinions solely.
Hello, my friends.
It is me, Teresa Richard. I am back
with another solo episode today. So hope you
don't mind that I'm hogging the mic all
to myself today.
(01:15):
But wanted to get a few of these
solo episodes out before we have some amazing
guests coming up in the next few weeks
that I'm really excited about. But I recently,
took a trip to Hawaii. I was asked
to come out and do fees training for
a hospital group out there, and there are
so many insights, so many lessons that I
learned
from a professional level, from a personal level,
(01:37):
and it was just it was such a
rich learning experience that I have a lot
that I wanna come back and share with
you. So I'll share a little bit of
the logistics first because, you know, that's the
important stuff, and then I'll share some of
the insights that still you know, it's been
a few months since I did this trip
that I think about
so, so, so often. And I think about
this a lot with patients that I work
(01:58):
with, with situations
that I have with my son.
And
yeah. So I'm I'm excited to dive into
this stuff. Let me rewind. I again, as
I said, I was asked to come out
and do fees training for a hospital system
in Hawaii. And the way that they had
set this up was, gosh, I think it
took them I'm I'm not even joking when
I say probably two to three years.
(02:19):
And and if I'm off on that Hawaii
system, I apologize. But that was what I
was informed, was that it took about two
to three years for them to
start to get the the budgeting and start
to get all of the pieces in place
for this training to take place.
And I just wanna first commend, there was,
a few different hospitals that were involved in
this, but there was two main hospitals,
(02:41):
and both of their directors of rehab
were
incredible
champions
for bringing fees in. And neither of them
were SLPs.
But I wanna give the SLPs so much
props for
continuing to advocate for why they needed fees
in these hospitals in Hawaii. So all that
to say, thank you so much to these
two DORs who
(03:02):
were just incredible advocates,
and they helped make this training they they
were what made this training successful. All that
to say, they were the middle women
between all the SLPs and all of the
administrators.
And going to all these budget meetings and
going to all these compliance meetings
and figuring out, you know, how and and
(03:22):
talking with SPD, and they were the ones
that really put all of these pieces in
place.
And so I think if you're thinking about
getting fees training or or getting fees brought
into your hospital,
there's so many steps. There's so many things
that have to take place
when you do that. So getting a champion
in your hospital, whether it's your DOR or
whether it's infection control or whether it's someone
(03:44):
in IT who can, you know, help get
the the software uploaded because that was another
big thing that had to happen too. There's
a lot of pieces that have to go
into it. So the more I think you
know about that in the future, the less
curve balls
there will be when it's go time. And
I think that's something that this hospital did
such a great job of. When I got
on-site, SPD was totally familiar. You know, they
(04:06):
they knew this was coming. Right? You know,
they didn't know exactly what it was gonna
look like, but they knew this was coming.
They were prepared for it. Same with IT.
We had a few different scopes, a few
different software systems. They were prepared. They were
on-site. They were able to help. So it
was I just I can't say enough good
things about how smoothly this training went,
and that is all because of the preparation
(04:28):
that the DORs put into this. That is
all attributed to what the SLPs did to
prepare them for everything. So that being said,
the way that it worked was I flew
out gosh. I flew out on a Thursday,
so I had Friday to recover from jet
lag. Thank goodness. And then I taught the
two day basic course over Saturday and Sunday.
So I I'm I can't remember how many
(04:50):
of the USLPs were in the room with
me. Gosh.
But I I but we were all sitting
at a conference table. I wanna say maybe
there was six six or seven. We sat
at a conference table, and I delivered the
entire two day basic course over the span
of the two days, the Saturday and the
Sunday. And what was nice about having twofold.
What What was nice about having a small
intimate group from the same hospital
(05:10):
is that we could troubleshoot
their hospital issues
as they were learning things about fees. So
a lot of times, like, I've taught a
few of these I've taught a lot of
these fees courses before, and sometimes you just
have to teach broadly. You know, sometimes you
have SLPs that are in private practice or
SLPs that do outpatient fees or SLPs that
work in sniffs or outpatients
(05:31):
or SLPs that work in hospitals. And the,
you know, regulation's different, the billing's different, the
cleaning's different, the report writing's different. So in
in those trainings, just the teacher has to
teach generally broadly. Right? What was awesome, awesome,
awesome about having this tailored hospital system was
it was just so streamlined. So I was
able to just if there was some stuff
that didn't apply, I would just tell them
(05:52):
this doesn't apply. If there was something that
was very pertinent to the ICU, specifically, this
hospital had,
had a very intensive burn unit. So we
spent a lot of time talking about that.
So it was I really, really like that
we were able to just get to the
details, and we got into a lot of
details. So that being said, on the second
day, which is Sunday, which if you take
a basic fees course, usually, you know, Saturday
(06:13):
is all day instruction, and then usually maybe,
like, Sunday morning is more instruction, and then
Sunday afternoon should be getting tons of passes.
And this is where I'm very, very, very
opinionated. And I will go on record and
say all of this stuff because I I
feel so, so, so strongly about this. I
made all of the SLPs
do their first passes on pool noodles, and
(06:34):
that's for a few reasons. Number one, I
cannot tell you the amount of SLPs
and or fees courses that I have gone
to where the first time an SLP picks
up a scope, they stick it in someone's
nose. They don't know what they're doing. They
don't have a handle on the scope. They
know nothing about the body mechanics. They know
nothing about what the scope does. They know
(06:56):
nothing about any of this stuff. They ram
it in their colleague's nose. The colleague is
in pain. And now the SLP says, crap.
This is painful. I don't wanna do this
procedure anymore. And I've seen this happen so
many times, and this is why I am
so passionate about this. So those of you
that are fees, teachers, fees, educators, I implore
you. I beg of you. Like, do not
make your patients blindly pick up a scope
(07:18):
on their first time with a scope in
their hand and go go jab a colleague.
Like, that's just it's it perpetuates. I I
I firmly believe because I've also heard this
as well. I've had SLPs in other basic
fees courses that have come back to take
fees again maybe two, three two, three years
later
because the first one they were in, they
said they felt so bad that they hurt
(07:38):
the SLP
that they just didn't wanna do it. And
now their hospital's making them do it again.
And that's not what this is about, you
guys. Fees is an incredible, incredible, incredible tool
that can help so many patients. There are
so many things we can do with this
tool. There's so many patients in rural hospitals,
in in low accessible places that we can
help swallow and gain back quality of life
(08:00):
with this tool. And that is why I
am so incredibly passionate about this, and I'm
so incredibly passionate about fees, but also making
sure that we're teaching and supporting our SLPs
best so that they feel truly feel comfortable
doing fees.
And that is by making sure that their
patients are comfortable as well. And we're gonna
talk a lot about that later on in
the episode. I've got lots of research articles
(08:21):
that I'm gonna cite as well, and this
is actually a presentation I'm doing at ASHA
the ASHA convention,
coming up this year, and it's also part
of my dissertation.
And I'm hoping to finish up in the
next few months as well. So there's a
lot a lot lot to this, and it
comes from just years and years of experience
and years and years of passion
trying to make sure that SLPs SLPs feel
comfortable and supported in doing this. So that
(08:41):
being said, let me rewind. So I had
them do their first passes on pool noodles,
and it was so you know, it's eye
opening. They and I tell them, you guys,
like, I know you think I'm nuts. Like,
I know this seems very silly, but I
assure you this this it will help. And
and, actually, we didn't have pool noodles the
one day. So I literally just folded like,
rolled up a manila folder so that it
(09:03):
just had, like, a an opening a small
opening, and that's all we did. We just
practice passing the scope, practice manipulating the throttle,
practice moving your wrist
up forward, left, right, noticing what that does
on the camera. Then we added some fun
things inside the pool noodle and inside the
middle of folder. Like, you know, I found
some buttons and some gems. I just whatever
(09:23):
you guys can find around this conference center
or and they found some stuff in some
other office in the hospital, and we glued
them onto these middle of folders on the
inside. So, basically, they could practice navigating
around these objects that we placed inside this
folder. And that's how you what you have
to do when you're putting a scope in
a patient's nose. You have to manipulate around
the turbinates, and sometimes patients have swelling and
(09:45):
there's gunk in there, and sometimes there's expressences
and polyps, and it's it can be a
mess in there. And you have to learn.
You have to feel confident with the scope,
and you have to be comfortable and confident
navigating that patient's nose. If you're not comfortable
and confident, if you're hurting them, if if
you don't seem like you're comfortable and confident,
it's going to be apparent to the patient,
(10:06):
and they are not going to want to
participate.
And then you are going to say the
patient didn't participate, and you didn't get good
results. And now you're going to say these
fees did not work, and it was a
fail. And this is the
exact thing that I am on a mission
to prevent from happening. So that being said,
we spent a lot of time, like I
said, you know, scoping pool noodles and and
manila folders. And I just said, we will
(10:27):
not practice on each other, you guys, until
you feel so comfortable with this scope. And
I and I honestly don't even remember how
long it took, but it was it was
a learning curve. And it's something that I'm
really passionate about, and and I know that
there's a lot of instructors that do scope
with the pool noodle first, but give build
your SLPs confidence. Like, don't throw them to
the wolves and have them go jab their
friend in the nose the first time. Like,
(10:47):
that's not fun for anybody. Like I said,
we did that till they were good and
comfortable, then they practiced on each other. That's,
like I said, that's the first thing that
I'm very passionate about is making sure that
they feel confident manipulating the scope. The other
thing that I'm very passionate about is the
language that we use when we introduce the
scope to our patient. Like I said, I'm
gonna talk about a few research studies in
a little bit. But let let's just talk
(11:09):
about common sense. Right? If if you approach
a patient and you say, I'm going to
stick the scope in your nose. It's going
to be painful. It's going to hurt. I'm
not really sure what I'm doing. I'm just
gonna try to get it in the right
spot, and then I'm gonna give you some
food and drink. How do you think that's
going to go? How do you think that's
going to go? Right? And and I get
that I over exaggerated there. Right? But I
have heard SLPs go up to patients before
(11:31):
and say, I'm gonna put this scope in
your nose. It's gonna hurt. It's gonna be
painful. I'm sorry. I'm doing my best. And
when you say that, what do you how
do you think the patient's gonna feel? Right?
You instantly elevate their anxiety. They're not excited
to be there in the first place. Their
anxiety is already high. They're getting a scope
getting put in their nose probably puts their
anxiety even higher. And now you're telling them
how painful and how comfortable it's gonna be.
You're lucky if they sit for the study.
(11:53):
Right? So let's think about how we approach
our patients in this way. And
this is why I want you to get
so comfortable and confident in manipulating the scope
so that you can feel confident when you
tell the patient, hey. I'm gonna stick this
scope in your nose. Okay? You'll you might
feel a little pinch. It might be a
tiny bit of discomfort.
But once I get it passed once I
(12:14):
get it in the pharynx, you should be
fine. You'll feel something there, but shouldn't shouldn't
be uncomfortable. Okay? How do you think that
sounds? Right? That sounds like I'm an SLP
that feels confident with this camera in my
hand that I can safely navigate your turbinates
and get this camera in position where it
needs to go in your ferrets. Right? Okay?
(12:36):
So
the these are things that I've just learned
from years and years and years of experience.
And I'm I'm gonna pick on one of
the SLPs at this training and I I
love her dearly and I'm so proud of
she's doing fees like a champ now. But
it was so funny because
when she first started doing them, so like
I said that that second day, that base
basic course day,
(12:57):
they finally started passing on each other. The
next day, they started passing on other employees
in the hospital, and she would go up
to them and say, okay. I'm gonna stick
this camera in your nose.
It's gonna hurt. It's gonna, you know, it's
gonna hurt when I go, you know, you
might cry. And I was like, hey, no.
Like, that is not how we need to
prepare our patients. Right? You don't know for
every patient that it's gonna hurt. And most
(13:19):
patients, it doesn't hurt. You so this is
also an an important thing. I'm not sugarcoating
it, but think about the patients that you
are scoping. Okay? If it is a normal
human, normal person, normal person, you or I,
we are sensitive and we will feel it.
Right? Think of our patients.
If they're older, they're desensitized,
they're already in the ICU.
(13:40):
A lot of times, they are so much
more desensitized
that it does not bother them. So get
to know your patient population too that you're
gonna be passing on. I will not say
that for for some patients, especially I know,
a lot of us LPs that do, like,
fees and outpatient for ENTs. You know, sometimes
they may use numbing agents, but sometimes they
may not. And so for the some of
those patients, it might be a little bit
(14:01):
more uncomfortable, but it's all in how you
frame
what you are going to do to the
patient and and educate them from a power
stance, from a confident position, not from a,
I don't know, like, it might hurt, like,
sorry. I'm gonna try to be really gentle,
but it might really hurt. That that that
uncertainty is not comforting. Right? So that was
(14:22):
something that I was very, very passionate about
making sure that they felt confident in their
language going up and talking to patients. So
we practice that with each other. And we
practice, you know, when you're setting up the
equipment, you know, what do you say to
the patient? And what do you say to,
you know, the a nurse or a CNA
or a family member that's in there? And
they wanna know that you're confident and you
know what you're doing. And I really firmly
(14:43):
believe that the only way to get confident
is by practicing in a safe environment. And
so, you know, I even told them, you
know, after the whole experience was done, just
keep keep keep passing the scope on your
Manila folders or your pool noodles. Just get
so comfortable that you could scope anything, to
be honest.
And I can confidently say that I feel
like I can pass on on anything. I've
(15:03):
done thousands and thousands and thousands of fees.
I've there's three patients in my entire career
that I have not been able to pass
on.
And I say that confidently. I feel very
good that I can pass on anyone, and
that just comes with lots and lots and
lots of experience.
So that being said, so we did the
two day basic course. And then the next
day, we passed the whole day. They just
(15:24):
passed the scope on,
on other employees of the hospital. And, again,
I can't stress enough, that these DORs were
just such rock stars because they had people
lined up the entire day. They had every
fifteen minutes, they had a new employee. So
it was they had all the PTs come
through, all the OTs come through. We had
a bunch of nurses come through, and there
was a lot of doctors too, which I
loved. So a lot of the hospitalists, a
(15:45):
lot of the intensivists came in so they
could see and get an understanding of fees
too. So, again, I commend those those DORs
for really getting them all in there so
they could feel it, experience it. A lot
of them just had really, you know, awesome
questions to ask about it. And they it
it really turned them immediately into champions for
fees. And, you know, while while the SLPs
(16:06):
were passing on them, they're like, oh, you
know what? How soon can you guys do
this? I'm I'm just thought of a patient
on, you know, in 03/2004 that could use
the fees today. And I'm like, well, we'll
put them on our list for tomorrow when
we start scoping patients. So in that aspect,
it was so, so, so great to be
able to have this real time training in
the hospital
with the patients now getting all the staff
on board. It was awesome. So the next
(16:27):
day, I believe all my days were blurted.
I should have kept a better, a better
diary of of what days what what what.
So once they got comfortable passing on, you
know, everybody got all of their passes in
with normal subjects.
So they all got their 25 passes in
with normal subjects. I know each state has
some some states. Some states do not. But
(16:48):
some states do have requirements about what's needed
as far as passes for normal patients and
or normals and abnormals.
So just make sure that you guys look
that up if you're interested in going through
fees training, see what your state requires. So
we went with the 25
for the SLPs here. And
after that, then, you know, they were good,
I say, in quotes,
(17:08):
to go start passing on patients. I was
very, very,
very hands on. I will say that. And
I I did tell them, hey. Probably this
first day that you guys are passing on
patients, I am going to be hand over
hand with you because I will not let
you hurt a patient. Because as I said,
what what happens if you hurt the patient?
You don't feel good about what you're doing,
and you don't wanna continue to do this.
(17:28):
Okay? And I started to see that with
one of the SLPs, she was getting frustrated.
She was not
she just her her SLP interpretation brain was
incredible, but as far as the mechanic, she
was really having trouble with it. So we
I went back and just gave her, you
know, so many and actually, she was a,
she was a surfer. And I was like,
you know, what's so funny is you ride
(17:48):
these, like, 40 foot waves, but you're you're
scared to stick the scope in the nose
and she would do great. She just would
hesitate. So she'd get it in the turbine
and I would say ride the wave, ride
the wave, keep going. Like, she had great
positioning. She was just nervous herself. We made
it fun. And and I think that's what's
important. Like, they're you know, SLPs are not
gonna wanna do this unless they feel good
about it themselves, and they really truly see
(18:10):
the direct impact that it has on patients.
So, the the like I said, that that
first day we started passing on patients, I
was very hand over hand. Hand. I basically
you know, I helped them get everything set
up. I I didn't throw them to the
wolves. And I know in a lot of
settings, I've been asked to maybe supervise some
fees, passes, and things like that. And I've
just seen these poor SLPs
just thrown in these situations without really good
(18:32):
guidance and supervision.
And this is just one thing that I
just don't want us to mess up you
guys. Like, this is such a powerful tool,
but it's also it needs a level of
hand holding that I think a lot of
other things don't.
This is an actual endoscope that we're sticking
inside people's botanies. Right?
This isn't, you know, that I I'm I'm
not trying to downplay anything else that we
(18:52):
do in our field, but this just really
it it warrants some good supportive mentorship.
And so like I said, we passed passed
the scope on on the patients that day,
and then the next day we started you
know, I I let them be a little
more independent.
So at that point, we were actually identifying
patients on the floor. With that first day,
they had had some patients already lined up.
(19:12):
And then the the next next day, we
made sure that, you know, we talked to
different unit supervisors, things like that, and we
identified some more patients. So one thing I
I do wanna share is we had gone
into the burn unit. There was one patient
in the burn unit, and
I will probably remember this patient for the
rest of my life. I'm mind I'm trying
to be mindful of it, but I don't
wanna share too many details. But,
(19:32):
very, very young gentleman had burns on most
of his body,
if not all of his body.
He was basically in, like, a full body
cast, and I could see his eyes and
I could see his mouth. And by the
grace of God, he was able to verbalize
and communicate. And also by the grace of
God, these SLPs had a great relationship with
him and his wife. And, you know, she
(19:55):
said, I just feel like since he can
talk and since, you know, he's he's wanting
ice chips, he's wanting to eat, we should
probably do a feast and see if he
can. And this is one of those patients
that probably if you walked in off the
street and you looked to him, you would
say there is absolutely no way on this
earth that this patient can swallow. And this
is why I love FEES. This is why
(20:15):
I love FEES so much. And so I
commend this SLP
so much for advocating for this patient,
because it made this patient's life. It made
the patient's wife's life. It and and I'll
share more about what the burn director burn
unit director said as well. So, again, we
do the fees. This patient's swallow was perfect.
For someone that was just completely, completely covered
(20:36):
in burns and full body cast, the patient's
swallow was perfect. And so we were joking,
you know, the the patient said, well, can
I order a cheeseburger? And I was like,
let's get the man a cheeseburger.
You know? And and the patient's crying, the
wife's crying. We're almost all in tears too.
And it's just a testament to what this
tool can do because I believe this patient
(20:57):
had been in there for about I'm I'm
sorry if I'm wrong, you guys, about four
to five months already.
Right? Has gone through this horrific,
horrific ordeal. And what is what is his
quality of life while he's improving? And and
his wife was just the most amazing, incredible,
supportive woman, had not left his side. And
so when we said he could eat a
cheeseburger, it was just incredible. You know? And
(21:20):
so the burn unit director comes in, and,
thankfully, he was he was a a very,
very, very kind man. And he's like, what
are you doing to my patients? And I
said, well, this is fees. You know, we
they've been trying to get it for years
and, you know, we got this tool and,
you know, I'm Teresa. I said, I'm board
certified swallowing. I've been doing these for years
and years and years and years, and I
shared more about it and what we did.
And he's like, you gotta be kidding me.
(21:41):
And he's like, he can eat. And I
said, yeah. He can eat. And he said,
I don't think you understand how much better
and faster my patients can get now that
they can get actual nutrition by mouth? And
he said, do you understand the nutrition that's
involved
with healing burns? And I said, oh, I
do. And that's why I'm here. And that's
why I'm very passionate about this tool. And
it was such a powerful learning moment for
(22:02):
everybody in the room,
and for this conversation that I had with
the burn unit director. And and I'm grateful,
that he was so open minded about everything.
And it was just like I said, it
was just such a overall overwhelmingly
incredible
experience. And we ended up the next day,
passed on even more patients. We spent a
lot more time those last two days on
(22:23):
a lot of report writing. And that's something
that, you know, of course, you have to
get better at, but I wanted to spend
the bulk of my time while I was
there really, really, really making sure that we're
driving home, how to feel comfortable with patients,
how to feel comfortable with the scope in
your hands so that you feel comfortable and
confident,
and how to feel comfortable and confident when
(22:43):
you stick that scope in that patient's nose.
And so I felt like that was where
all of my time was
was worth spending. Like I said, of course,
we spent some a lot of time on
on report writing. I gave them tons of
resources for reports. I said I'm more than
happy to do calls and Zooms with you
guys and and review reports and and continue
on with that. But that's sort of one
(23:03):
of my gripes
with with some fees,
training is that I just think we spend
way too much time on report writing and
just don't
let SLPs feel comfortable with it. And and
I've experienced some SLPs that, you know, they're
like, I can write the best fuse report
in the world, but I just still don't
feel comfortable sticking a scope in a patient's
nose. And and that defeats the purpose. Right?
So, this is why I'm just very, very
(23:25):
passionate about this topic. So one of one
of the things I really wanna impress upon
with this is that if you guys are
a hospital system looking to bring fees in,
if you can bring a fees trainer to
you, it is it's a world of difference
because the training can be tailored directly to
your facility. You don't have to learn
general things.
(23:46):
You don't have to take what I tell
you or what what a fees and structure
tells you and try to take it back
and interpret it in language that, you know,
maybe SPD will understand in your facility.
And there's a bunch of different companies out
there that do this. If anybody wants to
reach out to me privately, I can you
know, I'm happy to share
companies that I contract with to do fees
training.
(24:07):
I'm I'm very happy to share share some
names, but that's just one thing that I
want
to share is that if you as a
hospital system are wanting to go to training,
it's so much better if you can bring
someone to you and actually train
in your hospital with the equipment that you
purchased,
with your SPD department, with your IT department,
and on your patients,
(24:28):
and and let the trainers just help you
get comfortable in your home environment.
And so I just think this was such
a fantastic
learning opportunity. It was such a rich learning
opportunity for me. I I'm so grateful I
got to do this.
It's like I don't honestly, my, like, dream
job
is just, like, in in day hospitals and
do fees training all day long.
(24:50):
I was, like, beyond exhausted. I got home
and, like, could not even formulate words to
order, like, food or dinner at, like, 07:00
at night, but it's you know, I I
love doing this. I'm so passionate about doing
this, and I'm super, super grateful to the
Hawaii system that brought me out and and
allowed me to do things my way because
they're a little bit different than the way
(25:10):
that other SLPs and and and training programs
do things. So, that being said, like I
I said, I wanted to talk about why
it's so important
to be confident
and in and comfortable in holding the scope,
but then also the way that you approach
the And I I alluded to this a
little bit
earlier in the in the conversation. This is
what I'm gonna be talking about at the
ASHA convention in November,
(25:32):
is how do we communicate effectively
with our patients to be informative and
reduce anxiety, not induce anxiety,
reduce anxiety.
And there's a few studies that I want
to share.
And there was a study in the Digestion
Journal in 2016
that introduced
structured informational leaflets. And
(25:53):
what's that? Like a brochure? It takes even
though we don't even really use brochures. We
use,
you know, iPads and things like that. But
also along with staff communication training. So the
staff actually went through training on how to
communicate these procedures to their patients, and the
patient's anxiety
dropped, their understanding of the procedure improved and
their overall patient satisfaction ratings skyrocketed to ninety
(26:17):
five percent.
They even reported less discomfort during the scope
itself. So what I take away from this,
right, is we talk about, you know, there's
some SLPs that you'll see on the Facebook
groups. Like, they're like, I just don't like
fees because I just can never see anything
or, like, my patients hate it.
And they just have these negative views of
fees. And a lot of times, once I
(26:38):
start talking to them, it's because they had
a very poor experience with their training, and
they weren't properly mentored. And I know that
happens. Right? I I I get get get
that that happens. But there's something there's things
we can do about it. Right? And so
that's why I think this is such a
bigger, more important topic
because we want to be able to get
fees
into some of these more rural areas. We
(26:59):
fees has so much portability and so much
capability and so much accessibility.
Let's maximize that. And that starts with being
able to say that, you know, if I'm
gonna drive you know, I used to do
mobile fees all the time. I would drive
to a facility four hours away to scope
one patient. But I would do that because
I was about 99.9%
confident that I could pass the scope on
(27:20):
that patient. I know there's a lot of
SLPs that'll say, oh, you know, I don't
think this patient's a good candidate. And it
might be because they don't feel like they
can pass the scope on that patient. There's
I will tell you there's not a patient
I don't. I'm intimidated to scope. I will
share with you this burn patient.
I
wasn't sure, but I was 1000%
willing to attempt it.
(27:41):
And I can probably tell you there's a
lot, a lot, a lot of people that
would have just said, you've gotta be out
of your mind to think you can pass
the scope on this patient
and that this patient will actually pass.
So there's just there's a lot to be
said about giving our patients the benefit of
the doubt, not projecting our own fears, not
projecting our own weaknesses, but how can we
get better at our craft? How can we
(28:01):
get better at using this tool? How can
we get better at communicating
more effectively with our patients, which will in
turn reduce their anxiety,
help the
procedure go more smoothly.
Therefore, we get better results.
Therefore, the patient can eat, which is the
end goal. Right? So it's a huge, huge,
huge overarching issue,
(28:22):
with a lot of pieces that I think
need to fall in line better. And then
another study that I would like to quote
was in Digestive Diseases and Sciences in 2025.
And it says you know, and and just
think about it. Right? Like, endoscopy, video stroboscopy,
it means scopes are in sensitive areas like
the nose, like the scope. Patients feel anxious.
This study that that was found in Digestive
Diseases and Sciences found that more than half
(28:44):
of patients, fifty two percent, reported significant anxiety
before
non sedated endoscopy.
And interestingly, just knowing about the procedure didn't
lower their anxiety. It's not information
alone that matters. It's how that information is
delivered. So that's why it's so, so, so
important for us to
deliver this information, but deliver it in a
(29:06):
confident way that is not projecting our fears
and our discomforts
on our patients. Anyways, just a little sneak
peek of what's coming up for my, my
ASHA talk this year and some things that
I'm gonna be including in my dissertation. But
hope this episode was helpful for you, those
of you that might be looking to get
fees trained in the future, some things to
consider. If you're looking to get your whole
(29:26):
hospital system trained or if you yourself are
a fees mentor,
and you found some value in this, please
do let me know, and please do share
because
I I I love that we have people
out there doing the lord's work, teaching fees.
Don't wanna knock anybody doing that, but I
just think those of us that are fees
trainers can do a better job of helping
to make our SLPs feel more comfortable and
(29:48):
confident and supported. So that is my ask
to you. That is what I'm putting out
into the universe.
I would just love for every SLP in
the world to be totally comfortable and confident
performing fees. That would just be my absolute
wish. So, that is my quest. That is
my passion. That is the hill die. That
is the hill I will die on. So
thank you everybody for listening.
(30:08):
And that's a wrap for this episode. As
always, thank you so much for listening.
If you'd like to download the show notes
from this episode, please visit swaddlerpridepodcast.com.
There you can also sign up for our
email list so that you'll never miss another
episode.
If you do like what you hear, then
please subscribe and leave a review on iTunes
or share it on social media with your
(30:30):
friends and colleagues because that is what keeps
these episodes coming.
If you'd like to be a guest, share
feedback, or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
catch you next week.
Welcome to the Swall Your Pride podcast. I'm
your host, Theresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders,
a mobile thieves business owner, and founder of
the MedSLP Collective.
This podcast is all about delivering the latest
evidence based practice to medical SLPs everywhere.
Whether you're a new clinician seeking tangible tools
for treatment or a seasoned vet stuck in
(00:33):
a rut, my goal is to help ditch
the old school ways of the past that
no longer serve you or your patients, to
reinvigorate your passion for our field, to broaden
your knowledge about our scope of practice, and
to inspire you to practice at the top
of your license. So if you're listening, I
encourage you to swallow your pride, be open
and willing to learn because let's face it,
your patients deserve that kind of care. With
(00:54):
that, let's dive right in.
Just a quick
disclaimer that all statements and opinions expressed in
this episode do not reflect on the organizations
associated with the speakers and are their own
opinions solely.
Hello, my friends.
It is me, Teresa Richard. I am back
with another solo episode today. So hope you
don't mind that I'm hogging the mic all
to myself today.
(01:15):
But wanted to get a few of these
solo episodes out before we have some amazing
guests coming up in the next few weeks
that I'm really excited about. But I recently,
took a trip to Hawaii. I was asked
to come out and do fees training for
a hospital group out there, and there are
so many insights, so many lessons that I
learned
from a professional level, from a personal level,
(01:37):
and it was just it was such a
rich learning experience that I have a lot
that I wanna come back and share with
you. So I'll share a little bit of
the logistics first because, you know, that's the
important stuff, and then I'll share some of
the insights that still you know, it's been
a few months since I did this trip
that I think about
so, so, so often. And I think about
this a lot with patients that I work
(01:58):
with, with situations
that I have with my son.
And
yeah. So I'm I'm excited to dive into
this stuff. Let me rewind. I again, as
I said, I was asked to come out
and do fees training for a hospital system
in Hawaii. And the way that they had
set this up was, gosh, I think it
took them I'm I'm not even joking when
I say probably two to three years.
(02:19):
And and if I'm off on that Hawaii
system, I apologize. But that was what I
was informed, was that it took about two
to three years for them to
start to get the the budgeting and start
to get all of the pieces in place
for this training to take place.
And I just wanna first commend, there was,
a few different hospitals that were involved in
this, but there was two main hospitals,
(02:41):
and both of their directors of rehab
were
incredible
champions
for bringing fees in. And neither of them
were SLPs.
But I wanna give the SLPs so much
props for
continuing to advocate for why they needed fees
in these hospitals in Hawaii. So all that
to say, thank you so much to these
two DORs who
(03:02):
were just incredible advocates,
and they helped make this training they they
were what made this training successful. All that
to say, they were the middle women
between all the SLPs and all of the
administrators.
And going to all these budget meetings and
going to all these compliance meetings
and figuring out, you know, how and and
(03:22):
talking with SPD, and they were the ones
that really put all of these pieces in
place.
And so I think if you're thinking about
getting fees training or or getting fees brought
into your hospital,
there's so many steps. There's so many things
that have to take place
when you do that. So getting a champion
in your hospital, whether it's your DOR or
whether it's infection control or whether it's someone
(03:44):
in IT who can, you know, help get
the the software uploaded because that was another
big thing that had to happen too. There's
a lot of pieces that have to go
into it. So the more I think you
know about that in the future, the less
curve balls
there will be when it's go time. And
I think that's something that this hospital did
such a great job of. When I got
on-site, SPD was totally familiar. You know, they
(04:06):
they knew this was coming. Right? You know,
they didn't know exactly what it was gonna
look like, but they knew this was coming.
They were prepared for it. Same with IT.
We had a few different scopes, a few
different software systems. They were prepared. They were
on-site. They were able to help. So it
was I just I can't say enough good
things about how smoothly this training went,
and that is all because of the preparation
(04:28):
that the DORs put into this. That is
all attributed to what the SLPs did to
prepare them for everything. So that being said,
the way that it worked was I flew
out gosh. I flew out on a Thursday,
so I had Friday to recover from jet
lag. Thank goodness. And then I taught the
two day basic course over Saturday and Sunday.
So I I'm I can't remember how many
(04:50):
of the USLPs were in the room with
me. Gosh.
But I I but we were all sitting
at a conference table. I wanna say maybe
there was six six or seven. We sat
at a conference table, and I delivered the
entire two day basic course over the span
of the two days, the Saturday and the
Sunday. And what was nice about having twofold.
What What was nice about having a small
intimate group from the same hospital
(05:10):
is that we could troubleshoot
their hospital issues
as they were learning things about fees. So
a lot of times, like, I've taught a
few of these I've taught a lot of
these fees courses before, and sometimes you just
have to teach broadly. You know, sometimes you
have SLPs that are in private practice or
SLPs that do outpatient fees or SLPs that
work in sniffs or outpatients
(05:31):
or SLPs that work in hospitals. And the,
you know, regulation's different, the billing's different, the
cleaning's different, the report writing's different. So in
in those trainings, just the teacher has to
teach generally broadly. Right? What was awesome, awesome,
awesome about having this tailored hospital system was
it was just so streamlined. So I was
able to just if there was some stuff
that didn't apply, I would just tell them
(05:52):
this doesn't apply. If there was something that
was very pertinent to the ICU, specifically, this
hospital had,
had a very intensive burn unit. So we
spent a lot of time talking about that.
So it was I really, really like that
we were able to just get to the
details, and we got into a lot of
details. So that being said, on the second
day, which is Sunday, which if you take
a basic fees course, usually, you know, Saturday
(06:13):
is all day instruction, and then usually maybe,
like, Sunday morning is more instruction, and then
Sunday afternoon should be getting tons of passes.
And this is where I'm very, very, very
opinionated. And I will go on record and
say all of this stuff because I I
feel so, so, so strongly about this. I
made all of the SLPs
do their first passes on pool noodles, and
(06:34):
that's for a few reasons. Number one, I
cannot tell you the amount of SLPs
and or fees courses that I have gone
to where the first time an SLP picks
up a scope, they stick it in someone's
nose. They don't know what they're doing. They
don't have a handle on the scope. They
know nothing about the body mechanics. They know
nothing about what the scope does. They know
(06:56):
nothing about any of this stuff. They ram
it in their colleague's nose. The colleague is
in pain. And now the SLP says, crap.
This is painful. I don't wanna do this
procedure anymore. And I've seen this happen so
many times, and this is why I am
so passionate about this. So those of you
that are fees, teachers, fees, educators, I implore
you. I beg of you. Like, do not
make your patients blindly pick up a scope
(07:18):
on their first time with a scope in
their hand and go go jab a colleague.
Like, that's just it's it perpetuates. I I
I firmly believe because I've also heard this
as well. I've had SLPs in other basic
fees courses that have come back to take
fees again maybe two, three two, three years
later
because the first one they were in, they
said they felt so bad that they hurt
(07:38):
the SLP
that they just didn't wanna do it. And
now their hospital's making them do it again.
And that's not what this is about, you
guys. Fees is an incredible, incredible, incredible tool
that can help so many patients. There are
so many things we can do with this
tool. There's so many patients in rural hospitals,
in in low accessible places that we can
help swallow and gain back quality of life
(08:00):
with this tool. And that is why I
am so incredibly passionate about this, and I'm
so incredibly passionate about fees, but also making
sure that we're teaching and supporting our SLPs
best so that they feel truly feel comfortable
doing fees.
And that is by making sure that their
patients are comfortable as well. And we're gonna
talk a lot about that later on in
the episode. I've got lots of research articles
(08:21):
that I'm gonna cite as well, and this
is actually a presentation I'm doing at ASHA
the ASHA convention,
coming up this year, and it's also part
of my dissertation.
And I'm hoping to finish up in the
next few months as well. So there's a
lot a lot lot to this, and it
comes from just years and years of experience
and years and years of passion
trying to make sure that SLPs SLPs feel
comfortable and supported in doing this. So that
(08:41):
being said, let me rewind. So I had
them do their first passes on pool noodles,
and it was so you know, it's eye
opening. They and I tell them, you guys,
like, I know you think I'm nuts. Like,
I know this seems very silly, but I
assure you this this it will help. And
and, actually, we didn't have pool noodles the
one day. So I literally just folded like,
rolled up a manila folder so that it
(09:03):
just had, like, a an opening a small
opening, and that's all we did. We just
practice passing the scope, practice manipulating the throttle,
practice moving your wrist
up forward, left, right, noticing what that does
on the camera. Then we added some fun
things inside the pool noodle and inside the
middle of folder. Like, you know, I found
some buttons and some gems. I just whatever
(09:23):
you guys can find around this conference center
or and they found some stuff in some
other office in the hospital, and we glued
them onto these middle of folders on the
inside. So, basically, they could practice navigating
around these objects that we placed inside this
folder. And that's how you what you have
to do when you're putting a scope in
a patient's nose. You have to manipulate around
the turbinates, and sometimes patients have swelling and
(09:45):
there's gunk in there, and sometimes there's expressences
and polyps, and it's it can be a
mess in there. And you have to learn.
You have to feel confident with the scope,
and you have to be comfortable and confident
navigating that patient's nose. If you're not comfortable
and confident, if you're hurting them, if if
you don't seem like you're comfortable and confident,
it's going to be apparent to the patient,
(10:06):
and they are not going to want to
participate.
And then you are going to say the
patient didn't participate, and you didn't get good
results. And now you're going to say these
fees did not work, and it was a
fail. And this is the
exact thing that I am on a mission
to prevent from happening. So that being said,
we spent a lot of time, like I
said, you know, scoping pool noodles and and
manila folders. And I just said, we will
(10:27):
not practice on each other, you guys, until
you feel so comfortable with this scope. And
I and I honestly don't even remember how
long it took, but it was it was
a learning curve. And it's something that I'm
really passionate about, and and I know that
there's a lot of instructors that do scope
with the pool noodle first, but give build
your SLPs confidence. Like, don't throw them to
the wolves and have them go jab their
friend in the nose the first time. Like,
(10:47):
that's not fun for anybody. Like I said,
we did that till they were good and
comfortable, then they practiced on each other. That's,
like I said, that's the first thing that
I'm very passionate about is making sure that
they feel confident manipulating the scope. The other
thing that I'm very passionate about is the
language that we use when we introduce the
scope to our patient. Like I said, I'm
gonna talk about a few research studies in
a little bit. But let let's just talk
(11:09):
about common sense. Right? If if you approach
a patient and you say, I'm going to
stick the scope in your nose. It's going
to be painful. It's going to hurt. I'm
not really sure what I'm doing. I'm just
gonna try to get it in the right
spot, and then I'm gonna give you some
food and drink. How do you think that's
going to go? How do you think that's
going to go? Right? And and I get
that I over exaggerated there. Right? But I
have heard SLPs go up to patients before
(11:31):
and say, I'm gonna put this scope in
your nose. It's gonna hurt. It's gonna be
painful. I'm sorry. I'm doing my best. And
when you say that, what do you how
do you think the patient's gonna feel? Right?
You instantly elevate their anxiety. They're not excited
to be there in the first place. Their
anxiety is already high. They're getting a scope
getting put in their nose probably puts their
anxiety even higher. And now you're telling them
how painful and how comfortable it's gonna be.
You're lucky if they sit for the study.
(11:53):
Right? So let's think about how we approach
our patients in this way. And
this is why I want you to get
so comfortable and confident in manipulating the scope
so that you can feel confident when you
tell the patient, hey. I'm gonna stick this
scope in your nose. Okay? You'll you might
feel a little pinch. It might be a
tiny bit of discomfort.
But once I get it passed once I
(12:14):
get it in the pharynx, you should be
fine. You'll feel something there, but shouldn't shouldn't
be uncomfortable. Okay? How do you think that
sounds? Right? That sounds like I'm an SLP
that feels confident with this camera in my
hand that I can safely navigate your turbinates
and get this camera in position where it
needs to go in your ferrets. Right? Okay?
(12:36):
So
the these are things that I've just learned
from years and years and years of experience.
And I'm I'm gonna pick on one of
the SLPs at this training and I I
love her dearly and I'm so proud of
she's doing fees like a champ now. But
it was so funny because
when she first started doing them, so like
I said that that second day, that base
basic course day,
(12:57):
they finally started passing on each other. The
next day, they started passing on other employees
in the hospital, and she would go up
to them and say, okay. I'm gonna stick
this camera in your nose.
It's gonna hurt. It's gonna, you know, it's
gonna hurt when I go, you know, you
might cry. And I was like, hey, no.
Like, that is not how we need to
prepare our patients. Right? You don't know for
every patient that it's gonna hurt. And most
(13:19):
patients, it doesn't hurt. You so this is
also an an important thing. I'm not sugarcoating
it, but think about the patients that you
are scoping. Okay? If it is a normal
human, normal person, normal person, you or I,
we are sensitive and we will feel it.
Right? Think of our patients.
If they're older, they're desensitized,
they're already in the ICU.
(13:40):
A lot of times, they are so much
more desensitized
that it does not bother them. So get
to know your patient population too that you're
gonna be passing on. I will not say
that for for some patients, especially I know,
a lot of us LPs that do, like,
fees and outpatient for ENTs. You know, sometimes
they may use numbing agents, but sometimes they
may not. And so for the some of
those patients, it might be a little bit
(14:01):
more uncomfortable, but it's all in how you
frame
what you are going to do to the
patient and and educate them from a power
stance, from a confident position, not from a,
I don't know, like, it might hurt, like,
sorry. I'm gonna try to be really gentle,
but it might really hurt. That that that
uncertainty is not comforting. Right? So that was
(14:22):
something that I was very, very passionate about
making sure that they felt confident in their
language going up and talking to patients. So
we practice that with each other. And we
practice, you know, when you're setting up the
equipment, you know, what do you say to
the patient? And what do you say to,
you know, the a nurse or a CNA
or a family member that's in there? And
they wanna know that you're confident and you
know what you're doing. And I really firmly
(14:43):
believe that the only way to get confident
is by practicing in a safe environment. And
so, you know, I even told them, you
know, after the whole experience was done, just
keep keep keep passing the scope on your
Manila folders or your pool noodles. Just get
so comfortable that you could scope anything, to
be honest.
And I can confidently say that I feel
like I can pass on on anything. I've
(15:03):
done thousands and thousands and thousands of fees.
I've there's three patients in my entire career
that I have not been able to pass
on.
And I say that confidently. I feel very
good that I can pass on anyone, and
that just comes with lots and lots and
lots of experience.
So that being said, so we did the
two day basic course. And then the next
day, we passed the whole day. They just
(15:24):
passed the scope on,
on other employees of the hospital. And, again,
I can't stress enough, that these DORs were
just such rock stars because they had people
lined up the entire day. They had every
fifteen minutes, they had a new employee. So
it was they had all the PTs come
through, all the OTs come through. We had
a bunch of nurses come through, and there
was a lot of doctors too, which I
loved. So a lot of the hospitalists, a
(15:45):
lot of the intensivists came in so they
could see and get an understanding of fees
too. So, again, I commend those those DORs
for really getting them all in there so
they could feel it, experience it. A lot
of them just had really, you know, awesome
questions to ask about it. And they it
it really turned them immediately into champions for
fees. And, you know, while while the SLPs
(16:06):
were passing on them, they're like, oh, you
know what? How soon can you guys do
this? I'm I'm just thought of a patient
on, you know, in 03/2004 that could use
the fees today. And I'm like, well, we'll
put them on our list for tomorrow when
we start scoping patients. So in that aspect,
it was so, so, so great to be
able to have this real time training in
the hospital
with the patients now getting all the staff
on board. It was awesome. So the next
(16:27):
day, I believe all my days were blurted.
I should have kept a better, a better
diary of of what days what what what.
So once they got comfortable passing on, you
know, everybody got all of their passes in
with normal subjects.
So they all got their 25 passes in
with normal subjects. I know each state has
some some states. Some states do not. But
(16:48):
some states do have requirements about what's needed
as far as passes for normal patients and
or normals and abnormals.
So just make sure that you guys look
that up if you're interested in going through
fees training, see what your state requires. So
we went with the 25
for the SLPs here. And
after that, then, you know, they were good,
I say, in quotes,
(17:08):
to go start passing on patients. I was
very, very,
very hands on. I will say that. And
I I did tell them, hey. Probably this
first day that you guys are passing on
patients, I am going to be hand over
hand with you because I will not let
you hurt a patient. Because as I said,
what what happens if you hurt the patient?
You don't feel good about what you're doing,
and you don't wanna continue to do this.
(17:28):
Okay? And I started to see that with
one of the SLPs, she was getting frustrated.
She was not
she just her her SLP interpretation brain was
incredible, but as far as the mechanic, she
was really having trouble with it. So we
I went back and just gave her, you
know, so many and actually, she was a,
she was a surfer. And I was like,
you know, what's so funny is you ride
(17:48):
these, like, 40 foot waves, but you're you're
scared to stick the scope in the nose
and she would do great. She just would
hesitate. So she'd get it in the turbine
and I would say ride the wave, ride
the wave, keep going. Like, she had great
positioning. She was just nervous herself. We made
it fun. And and I think that's what's
important. Like, they're you know, SLPs are not
gonna wanna do this unless they feel good
about it themselves, and they really truly see
(18:10):
the direct impact that it has on patients.
So, the the like I said, that that
first day we started passing on patients, I
was very hand over hand. Hand. I basically
you know, I helped them get everything set
up. I I didn't throw them to the
wolves. And I know in a lot of
settings, I've been asked to maybe supervise some
fees, passes, and things like that. And I've
just seen these poor SLPs
just thrown in these situations without really good
(18:32):
guidance and supervision.
And this is just one thing that I
just don't want us to mess up you
guys. Like, this is such a powerful tool,
but it's also it needs a level of
hand holding that I think a lot of
other things don't.
This is an actual endoscope that we're sticking
inside people's botanies. Right?
This isn't, you know, that I I'm I'm
not trying to downplay anything else that we
(18:52):
do in our field, but this just really
it it warrants some good supportive mentorship.
And so like I said, we passed passed
the scope on on the patients that day,
and then the next day we started you
know, I I let them be a little
more independent.
So at that point, we were actually identifying
patients on the floor. With that first day,
they had had some patients already lined up.
(19:12):
And then the the next next day, we
made sure that, you know, we talked to
different unit supervisors, things like that, and we
identified some more patients. So one thing I
I do wanna share is we had gone
into the burn unit. There was one patient
in the burn unit, and
I will probably remember this patient for the
rest of my life. I'm mind I'm trying
to be mindful of it, but I don't
wanna share too many details. But,
(19:32):
very, very young gentleman had burns on most
of his body,
if not all of his body.
He was basically in, like, a full body
cast, and I could see his eyes and
I could see his mouth. And by the
grace of God, he was able to verbalize
and communicate. And also by the grace of
God, these SLPs had a great relationship with
him and his wife. And, you know, she
(19:55):
said, I just feel like since he can
talk and since, you know, he's he's wanting
ice chips, he's wanting to eat, we should
probably do a feast and see if he
can. And this is one of those patients
that probably if you walked in off the
street and you looked to him, you would
say there is absolutely no way on this
earth that this patient can swallow. And this
is why I love FEES. This is why
(20:15):
I love FEES so much. And so I
commend this SLP
so much for advocating for this patient,
because it made this patient's life. It made
the patient's wife's life. It and and I'll
share more about what the burn director burn
unit director said as well. So, again, we
do the fees. This patient's swallow was perfect.
For someone that was just completely, completely covered
(20:36):
in burns and full body cast, the patient's
swallow was perfect. And so we were joking,
you know, the the patient said, well, can
I order a cheeseburger? And I was like,
let's get the man a cheeseburger.
You know? And and the patient's crying, the
wife's crying. We're almost all in tears too.
And it's just a testament to what this
tool can do because I believe this patient
(20:57):
had been in there for about I'm I'm
sorry if I'm wrong, you guys, about four
to five months already.
Right? Has gone through this horrific,
horrific ordeal. And what is what is his
quality of life while he's improving? And and
his wife was just the most amazing, incredible,
supportive woman, had not left his side. And
so when we said he could eat a
cheeseburger, it was just incredible. You know? And
(21:20):
so the burn unit director comes in, and,
thankfully, he was he was a a very,
very, very kind man. And he's like, what
are you doing to my patients? And I
said, well, this is fees. You know, we
they've been trying to get it for years
and, you know, we got this tool and,
you know, I'm Teresa. I said, I'm board
certified swallowing. I've been doing these for years
and years and years and years, and I
shared more about it and what we did.
And he's like, you gotta be kidding me.
(21:41):
And he's like, he can eat. And I
said, yeah. He can eat. And he said,
I don't think you understand how much better
and faster my patients can get now that
they can get actual nutrition by mouth? And
he said, do you understand the nutrition that's
involved
with healing burns? And I said, oh, I
do. And that's why I'm here. And that's
why I'm very passionate about this tool. And
it was such a powerful learning moment for
(22:02):
everybody in the room,
and for this conversation that I had with
the burn unit director. And and I'm grateful,
that he was so open minded about everything.
And it was just like I said, it
was just such a overall overwhelmingly
incredible
experience. And we ended up the next day,
passed on even more patients. We spent a
lot more time those last two days on
(22:23):
a lot of report writing. And that's something
that, you know, of course, you have to
get better at, but I wanted to spend
the bulk of my time while I was
there really, really, really making sure that we're
driving home, how to feel comfortable with patients,
how to feel comfortable with the scope in
your hands so that you feel comfortable and
confident,
and how to feel comfortable and confident when
(22:43):
you stick that scope in that patient's nose.
And so I felt like that was where
all of my time was
was worth spending. Like I said, of course,
we spent some a lot of time on
on report writing. I gave them tons of
resources for reports. I said I'm more than
happy to do calls and Zooms with you
guys and and review reports and and continue
on with that. But that's sort of one
(23:03):
of my gripes
with with some fees,
training is that I just think we spend
way too much time on report writing and
just don't
let SLPs feel comfortable with it. And and
I've experienced some SLPs that, you know, they're
like, I can write the best fuse report
in the world, but I just still don't
feel comfortable sticking a scope in a patient's
nose. And and that defeats the purpose. Right?
So, this is why I'm just very, very
(23:25):
passionate about this topic. So one of one
of the things I really wanna impress upon
with this is that if you guys are
a hospital system looking to bring fees in,
if you can bring a fees trainer to
you, it is it's a world of difference
because the training can be tailored directly to
your facility. You don't have to learn
general things.
(23:46):
You don't have to take what I tell
you or what what a fees and structure
tells you and try to take it back
and interpret it in language that, you know,
maybe SPD will understand in your facility.
And there's a bunch of different companies out
there that do this. If anybody wants to
reach out to me privately, I can you
know, I'm happy to share
companies that I contract with to do fees
training.
(24:07):
I'm I'm very happy to share share some
names, but that's just one thing that I
want
to share is that if you as a
hospital system are wanting to go to training,
it's so much better if you can bring
someone to you and actually train
in your hospital with the equipment that you
purchased,
with your SPD department, with your IT department,
and on your patients,
(24:28):
and and let the trainers just help you
get comfortable in your home environment.
And so I just think this was such
a fantastic
learning opportunity. It was such a rich learning
opportunity for me. I I'm so grateful I
got to do this.
It's like I don't honestly, my, like, dream
job
is just, like, in in day hospitals and
do fees training all day long.
(24:50):
I was, like, beyond exhausted. I got home
and, like, could not even formulate words to
order, like, food or dinner at, like, 07:00
at night, but it's you know, I I
love doing this. I'm so passionate about doing
this, and I'm super, super grateful to the
Hawaii system that brought me out and and
allowed me to do things my way because
they're a little bit different than the way
(25:10):
that other SLPs and and and training programs
do things. So, that being said, like I
I said, I wanted to talk about why
it's so important
to be confident
and in and comfortable in holding the scope,
but then also the way that you approach
the And I I alluded to this a
little bit
earlier in the in the conversation. This is
what I'm gonna be talking about at the
ASHA convention in November,
(25:32):
is how do we communicate effectively
with our patients to be informative and
reduce anxiety, not induce anxiety,
reduce anxiety.
And there's a few studies that I want
to share.
And there was a study in the Digestion
Journal in 2016
that introduced
structured informational leaflets. And
(25:53):
what's that? Like a brochure? It takes even
though we don't even really use brochures. We
use,
you know, iPads and things like that. But
also along with staff communication training. So the
staff actually went through training on how to
communicate these procedures to their patients, and the
patient's anxiety
dropped, their understanding of the procedure improved and
their overall patient satisfaction ratings skyrocketed to ninety
(26:17):
five percent.
They even reported less discomfort during the scope
itself. So what I take away from this,
right, is we talk about, you know, there's
some SLPs that you'll see on the Facebook
groups. Like, they're like, I just don't like
fees because I just can never see anything
or, like, my patients hate it.
And they just have these negative views of
fees. And a lot of times, once I
(26:38):
start talking to them, it's because they had
a very poor experience with their training, and
they weren't properly mentored. And I know that
happens. Right? I I I get get get
that that happens. But there's something there's things
we can do about it. Right? And so
that's why I think this is such a
bigger, more important topic
because we want to be able to get
fees
into some of these more rural areas. We
(26:59):
fees has so much portability and so much
capability and so much accessibility.
Let's maximize that. And that starts with being
able to say that, you know, if I'm
gonna drive you know, I used to do
mobile fees all the time. I would drive
to a facility four hours away to scope
one patient. But I would do that because
I was about 99.9%
confident that I could pass the scope on
(27:20):
that patient. I know there's a lot of
SLPs that'll say, oh, you know, I don't
think this patient's a good candidate. And it
might be because they don't feel like they
can pass the scope on that patient. There's
I will tell you there's not a patient
I don't. I'm intimidated to scope. I will
share with you this burn patient.
I
wasn't sure, but I was 1000%
willing to attempt it.
(27:41):
And I can probably tell you there's a
lot, a lot, a lot of people that
would have just said, you've gotta be out
of your mind to think you can pass
the scope on this patient
and that this patient will actually pass.
So there's just there's a lot to be
said about giving our patients the benefit of
the doubt, not projecting our own fears, not
projecting our own weaknesses, but how can we
get better at our craft? How can we
(28:01):
get better at using this tool? How can
we get better at communicating
more effectively with our patients, which will in
turn reduce their anxiety,
help the
procedure go more smoothly.
Therefore, we get better results.
Therefore, the patient can eat, which is the
end goal. Right? So it's a huge, huge,
huge overarching issue,
(28:22):
with a lot of pieces that I think
need to fall in line better. And then
another study that I would like to quote
was in Digestive Diseases and Sciences in 2025.
And it says you know, and and just
think about it. Right? Like, endoscopy, video stroboscopy,
it means scopes are in sensitive areas like
the nose, like the scope. Patients feel anxious.
This study that that was found in Digestive
Diseases and Sciences found that more than half
(28:44):
of patients, fifty two percent, reported significant anxiety
before
non sedated endoscopy.
And interestingly, just knowing about the procedure didn't
lower their anxiety. It's not information
alone that matters. It's how that information is
delivered. So that's why it's so, so, so
important for us to
deliver this information, but deliver it in a
(29:06):
confident way that is not projecting our fears
and our discomforts
on our patients. Anyways, just a little sneak
peek of what's coming up for my, my
ASHA talk this year and some things that
I'm gonna be including in my dissertation. But
hope this episode was helpful for you, those
of you that might be looking to get
fees trained in the future, some things to
consider. If you're looking to get your whole
(29:26):
hospital system trained or if you yourself are
a fees mentor,
and you found some value in this, please
do let me know, and please do share
because
I I I love that we have people
out there doing the lord's work, teaching fees.
Don't wanna knock anybody doing that, but I
just think those of us that are fees
trainers can do a better job of helping
to make our SLPs feel more comfortable and
(29:48):
confident and supported. So that is my ask
to you. That is what I'm putting out
into the universe.
I would just love for every SLP in
the world to be totally comfortable and confident
performing fees. That would just be my absolute
wish. So, that is my quest. That is
my passion. That is the hill die. That
is the hill I will die on. So
thank you everybody for listening.
(30:08):
And that's a wrap for this episode. As
always, thank you so much for listening.
If you'd like to download the show notes
from this episode, please visit swaddlerpridepodcast.com.
There you can also sign up for our
email list so that you'll never miss another
episode.
If you do like what you hear, then
please subscribe and leave a review on iTunes
or share it on social media with your
(30:30):
friends and colleagues because that is what keeps
these episodes coming.
If you'd like to be a guest, share
feedback, or request a topic to be discussed
on the show, please email podcast@TeresaRichard.com.
Thank you so much for listening, and we'll
catch you next week.
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