Why You Should Never Fake It Till You Make It in Dysphagia Therapy

I don’t know who first coined the phrase “fake it till you make it,” but I can tell you one thing—when it comes to dysphagia evaluation and treatment, that phrase makes me cringe.

Now, don’t get me wrong. Confidence is key. You should walk into a session with a belief in your abilities. But here’s the kicker: how can you be confident in skills you haven’t actually learned?

In the world of dysphagia, faking it isn’t just unethical—it can be downright dangerous.

Swallowing disorders are complex. If we walk into an evaluation or begin treatment without a solid understanding, there can be real consequences. And no, I’m not just talking about someone choking on a sip of water. I’m talking dehydration, malnutrition, aspiration pneumonia, sepsis, and UTIs—all of which can result from inappropriate diet recommendations or poor clinical decisions.

So let’s break it down.

The Three Reasons You Should Never Fake It Till You Make It in Dysphagia Therapy

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1. It’s Against the ASHA Code of Ethics

Let’s go straight to the source. The ASHA Code of Ethics clearly states:

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

If you’re “faking it,” you’re essentially misleading your patient. You’re telling them you’re qualified in an area where you may lack training or understanding. That’s not just unethical—it’s a breach of the trust our patients place in us.

If you don’t feel competent in dysphagia, the best thing you can do is refer the patient to someone who is.

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2. You Can’t Diagnose What You Don’t Understand

Yes—SLPs in the U.S. have the power to diagnose dysphagia. But with that power comes responsibility.

You must understand what normal swallowing looks like and be able to recognize the breakdowns in the system. Misdiagnosing a patient with dysphagia (or missing it entirely) can lead to:

• Unnecessary diet modifications
• Useless or even harmful therapy recommendations
• Long-term consequences that follow the patient through the continuum of care

Let’s be honest—have you ever had a patient rave about the amazing flavor of thickened liquids?

And what if you’re the one completing the MBSS or FEES? Do you truly understand how to conduct, interpret, and report those assessments accurately?

If not, you’re potentially wasting time, resources, and more importantly, putting your patient at risk.

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3. You Can’t Treat What You Don’t Understand

Dysphagia treatment isn’t just handing out a list of oral motor exercises or slapping a mechanical soft diet on the chart.

This is a complex, often life-altering disorder. Our patients need targeted, evidence-based interventions. They’re counting on us to be the expert, not someone who Googled a protocol the night before.

Throwing exercises at a patient without understanding the physiology of their swallowing disorder is like prescribing antibiotics for a sprained ankle. It’s not just ineffective—it’s irresponsible.

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So What Can You Do?

📌 Be honest—with yourself and your patients.
It’s okay to admit dysphagia isn’t your strong suit. I’ll be the first to say—I refer out for fluency. It’s not my thing, and that’s okay.

📌 Get educated.
Read journal articles. Take CEUs. Shadow experienced clinicians. Revisit your anatomy books. Knowledge is power, and there’s no shame in learning as you go—as long as your patients aren’t the test subjects.

📌 Find a mentor.
Mentorship can make all the difference in developing clinical reasoning, confidence, and skill in dysphagia management.

📌 Prioritize your patient.
Always. If you’re not ready, refer. If you’re unsure, ask for help. If you want to get better, invest in your growth.

Increase your confidence.

Have you ever wanted a way to create a more standardized protocol for your Clinical Swallow Evaluation?   Do you often forget or leave out parts of the CSE, you know, the parts that are important for your Plan of Care?  You probably need the Clinical Dysphagia Assessment Toolkit if you answered yes.   You can get your copy here.  

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Bottom line:
“Fake it till you make it” has no place in dysphagia care. Our patients deserve better—and so do you.

If you’re ready to stop faking it and start assessing and treating with confidence, it may be time to join the Dysphagia Skills Accelerator.

Are you ready for a deeper dive with even more resources available? Join the Dysphagia Skills Accelerator today. You will get so many great tools with new tools being added all the time! Click here to join now!

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References

• Tanner, D. C. (2010). Lessons from nursing home dysphagia malpractice litigation. Journal of Gerontological Nursing, 36(3), 41–46.
• American Speech-Language-Hearing Association. (2002). Knowledge and skills needed by speech-language pathologists providing services to individuals with swallowing and/or feeding disorders.
• American Speech-Language-Hearing Association. (2004). Knowledge and skills needed by speech-language pathologists performing videofluoroscopic swallowing studies.
• Boaden, E., Davies, S., Storey, L., & Watkins, C. (2006). Interprofessional Dysphagia Framework. University of Central Lancashire.
• McAllister, L., & Rose, M. (2000). Speech-language pathology students: Learning clinical reasoning. In Clinical reasoning in the health professions (pp. 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 Pathology, 14(6), 569–576.
• American Speech-Language-Hearing Association. ASHA Code of Ethics. Retrieved from www.asha.org