Fighting Dysphagia with an Unlikely Weapon: Math (Part 1)
A Guest Post by:
George Barnes MS CCC-SLP
Co-author: Doreen Benson MS CCC-SLP
Thinking about thinking
Congratulations. You made it this far. The mathematical title didn’t scare you away. But it’s ok if it makes you a little nervous. I mean, you haven’t touched math since college, maybe even grade school. But there’s a lot we can do with math to change the way we practice for the better. In this blog we are going to tell you why using statistics is important as an SLP. Next week we are going to tell you how to do it.
How our intuition has failed us
We are smart animals. Some argue the SMARTEST of the animals. Our brains are certainly wonderful things, but they often play tricks on us. This is because we like shortcuts. Shortcuts help us think fast. Thinking fast is important today, but 10,000 years ago it kept us ALIVE. Instead of analyzing a lion’s teeth, appetite, eating habits, and running speed; the only association we had to make was lion = RUN. Now, we are trying to backtrack because the quality of our thinking is often more valuable than its speed. Let’s talk about a few ways our ancient brains are failing us in the modern world.
The availability bias tells us that we tend to use what’s top of mind to make an overarching judgment on something. For example, we heard about a shark attack on the news and now we’re at the beach and it’s all we think about. This makes us think that a shark attack is way more likely than it is. We do this with plane crashes too.
We like taking things that are associated and create a cause and effect that doesn’t actually exist. This is called a causal fallacy. For example, we associate kids who eat sugar with hyperactivity, but it’s actually the parties where they eat the sugar that makes them hyperactive. It’s also the reason why we think underdressing in cold weather makes you sick when only germs can do that (this one’s for you, mom).
We also have a tendency to over-weigh anecdotal information and ignore the bigger picture. This is known as the base rate fallacy. For example, you are introduced to a shy lady with glasses who loves to read. Do you think this lady is more likely to be a librarian or a salesperson? The answer: Salesperson. If you thought ‘librarian’ that’s because you made the common mistake of over-weighing your personal experience or knowledge about librarians and completely ignoring the base rate: There are way more salespeople than librarians in the world.
Why you should care
Enough about sharks, candy, and librarians, how does this relate to dysphagia? I’m so glad you asked. Let’s address how important each of these faulty lines of thinking is related to our clinical practice.
The availability bias– As soon as we see a patient we think of dysphagia first. As soon as we see a cough we think of aspiration. And as soon as we see an abnormal CXR we think of pneumonia. That’s because we were trained to think this way. We read case studies about abnormality, we study disease, and we focus on the impairment. It’s what’s top of mind.
The causal fallacy– Why is it that we think that aspiration and aspiration alone causes pneumonia. Because we love this easy cause and effect formula: Something goes down the wrong pipe and causes an infection down there. But this misses the other factors that need to come into play in order to develop pneumonia.
Base-rate fallacy– We see a patient with pneumonia and immediately think it’s aspiration-related. This of course misses the base rate: The actual percentage of pneumonia cases that is aspiration related. Which is only about 10%. Or how about the patient who has confirmed aspiration and we quickly fear that they are going to get pneumonia immediately. In fact, some of us discontinue an instrumental study the second a patient presents with trace aspiration because of this fear. But this ignores the base rate: The actual number of people who develop pneumonia after aspiration, which is tiny.
Stay meta my friends
So maybe you’re letting your mind play tricks on you. Don’t fret, we all do it. Yet many don’t recognize it and most don’t even care about it. But you’re different. Feels good to be different, doesn’t it? And what should make you feel even better is the fact that there are fool-proof ways to protect you against it. It involves math. Statistics in particular. See our next blog here in order to see how we can use statistics to assess the risks and benefits involved in our clinical decision making. If math is all around us as they say, we might as well put it to use.
Are you ready for Part 2? You can find out how to combine statistics and dysphagia.
You can also listen to more about this at Swallow Your Pride.
George Barnes MS CCC-SLP has clinical experience in a variety of settings including acute care, acute rehab, skilled nursing, and critical illness recovery. This variety has developed his specialization in dysphagia management with a focus on diagnostics through instrumental swallow evaluations. His concentration is on geriatric patients with complex medical status. He is co-founder of FEESible Swallow Solutions, a mobile speech pathology company dedicated to improving access to high-quality dysphagia services for patients in the skilled nursing setting.
George has a track record of supporting the field of speech pathology by paying his knowledge forward to other professionals via graduate-level education, clinical fellowship and student supervision, the Student to Empowered Professional (STEP) mentorship program, The Medical SLP Collective mentorship service, ASHA special interest groups, peer review for ASHA course material, the SIG13 dysphagia editorial committee, and participation in various interdisciplinary teams and committees in the hospital setting. He is a multiple ASHA ACE Award recipient for his dedication to continuing education. George actively conducts and supports new research aimed to improve efficiency and accuracy in dysphagia diagnostics, management, and care.
With a passion for food and a deep appreciation for the joy and connection it brings to us all, he has dedicated his life to helping others enjoy this simple, but deep-rooted pleasure.
Doreen Benson, MS CCC/SLP is a Speech-Language Pathologist with over 25 years of experience. She is currently employed at Shenandoah Memorial Hospital in Woodstock, Virginia where she pursues her passion for evidence-based clinical practice in evaluation, treatment, and program planning for adults with dysphagia. She has presented at a number of state and national conventions.