3 Reasons You Should Never “Fake it Till You Make it” in Dysphagia

I really don’t know where the phrase “fake it till you make it” came but it’s one phrase that absolutely makes me cringe in relationship to dysphagia.

Don’t get me wrong.  You should always go in confident in your skills.  How can you possibly be confident though in skills you don’t possess?

The scary part is, with dysphagia, if we don’t know what we are doing, but go in to diagnose and treat on the “fake it till you make it approach” we can play a key role in the person’s death.

Not necessarily that the person even chokes on something.  When we change a patient’s liquids and thicken the liquids, the person can then experience dehydration, sepsis, UTI or a multitude of other effects.

So let’s get to it.  The THREE reasons why you should never fake it till you make it in dysphagia therapy.

Reason One

It’s actually against our code of ethics provided by ASHA.

“Individuals shall not misrepresent their credentials, competence, education, training, experience, and scholarly contributions.”

When we “fake it” we are actually telling patients that we are competent in an area that we may not have a clue and misleading that patient.   Ideally, we should help that patient find a competent clinician if you do not feel that you fit that bill.

Reason Two

How can you assess and diagnose what you don’t know?

Yes, we diagnose dysphagia.  This is the reason we are Speech Language Pathologists in the US.  We are able to diagnose a range of speech and swallowing related disorders.

If you don’t understand the normal swallowing process and know the deficits, how can you possibly diagnose dysphagia?  Did you know that when a diagnose is given to a patient, that diagnosis stays with the person.

Misdiagnosis often leads to inappropriate diet changes, unnecessary therapy services and possibly secondary issues that can arise from those inappropriate diet changes.

I mean, do you really know any person that has been excited about having thickened liquids?  Have you ever had a patient comment on the amazing taste of thickened liquids?

What if you are the person responsible for the Modified Barium Swallow Study (MBSS) or Flexible Endoscopic Evaluation of Swallowing (FEES)?  Do you know how to complete the test or interpret the test.  If the answer is no, then you’ve just wasted, money, time and effort.  Accurate completion and reporting of either of these assessments is vital in diagnosing, referring or providing treatment for dysphagia.

Reason Three

Just like you can’t assess and diagnose dysphagia, how can you possibly treat dysphagia when you don’t understand it.

I mean sure, you can throw a list of exercises at a patient, you can modify the diet, but what are you doing for the patient?   What are you actually accomplishing with this patient?

This patient is relying on you to be the expert, to be honest with them and to help them with an issue that is a major roadblock in their recovery.

What can you do?

Don’t turn to social media the night before an evaluation or treatment session knowing nothing about the disease process, the assessment or the treatment protocols.

If you are interested in dysphagia but don’t feel comfortable or confident in dysphagia, find a mentor, read journal articles, shadow, read textbooks.  Learn everything you possibly can about dysphagia.

Be honest with your patient.  I am terrible with fluency.  If I have a referral for a patient with dysfluency, I will more than likely refer them out to an SLP with more experience.  It’s the right thing to do.

Hold paramount your patient’s best interest and never, ever “fake it till you make it.”

  • Tanner, D. C. (2010). Lessons from nursing home dysphagia malpractice litigation. Journal of gerontological nursing36(3), 41-46.
  • American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists performing videofluoroscopic swallowing studies.
  • American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders.
  • Boaden, E., Davies, S., Storey, L., & Watkins, C. (2006). Inter professional dysphagia framework. University of Central Lancashire, Preston.
  • McAllister, L., & Rose, M. (2000). Speech-language pathology students: Learning clinical reasoning. Clinical reasoning in the health professions, 205-213.
  • Kamal, R. M., Ward, E., & Cornwell, P. (2012). Dysphagia training for speech-language pathologists: Implications for clinical practice. International journal of speech-language pathology14(6), 569-576.
  • ASHA Code of Ethics www.asha.org

7 thoughts on “3 Reasons You Should Never “Fake it Till You Make it” in Dysphagia

  1. Not only that, but I read an MBS (I work in HH) yesterday where the patient had significant aspiration with NTL; not thin with Chin Tuck and Supraglottic swallow. An experienced clinician won’t make assumptions that NTL is less problematic than thin (and Chin tuck sometimes increases the risk oddly enough). Good Post!

  2. I have read your post it’s very informative and helpful too for readers .Thanks for sharing your knowledgeable content with us and keep updating us with such great informative post.Keep writing.

  3. Hi Tiffani. I just ordered The Adult Dysphagia Pocket Guide that you co-authored with Yvette McCoy. I wanted to get in touch with either you or Yvette to see if you had any knowledge on ‘delayed timing of swallow trigger’ based on VFSS. I see this quite a bit and occasionally can be the only deviation to a swallow. My question is, do you have any knowledge in terms of rehabilitation/compensation? I’m more interested in evidenced based rehabilitation techniques of increasing timing swallow trigger.

    1. Thank you so much for ordering! My first question would be, how is the timing affecting the swallow? There are so many variations of normal! An effortful swallow or Mendelssohn can change timing of the swallow. Also if you are trained in MDTP that can change many factors of the swallow!

  4. This is one reason I left my job in an outpatient hospital clinic. You were expected to fake it till you make it. Clients were placed on your schedule whether you had the skills or expertise to help them or not. I cringe when I think about the times I tried to facilitate an AAC eval with no business doing so. I wish I could take it back but all I can do now is make sure I am never afraid to refer out and encourage others to do the same!

  5. As a graduating SLP student starting her CFY, I’m so grateful for this post. Ive noticed how common language it’s become to say “fake it till you make it” even during internships when given unhelpful supervisors. There is just so much liability at stake, it’s crucial for supervisors to really teach their students correctly as well.

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