Abbie Yates

As a speech and language therapist, working in Specialist Medicine and Dementia at Nottingham University Hospitals NHS Trust, I hold the greatest pleasure of advocating for patients whose voices can’t be heard. It’s both a responsibility and a privilege.

I once supported a lady with aphasia to tell her husband in her own words that she had cancer and to express how she wanted to be cared for in the last few months of her life, using pictures. That’s what I love about speech and language therapy – we can enhance the power of human interaction when it’s most needed.

Working with family and friends can really enhance someone’s care. I’ve tonnes of knowledge about how communication and swallowing works, but that can be redundant until I learn what makes people tick. For instance, I once did a swallow assessment for an individual who had been offered a cup of tea, at her request, by everyone on the ward, but every time it arrived, she would become very distressed and decline it. I spoke to her daughter who gave me specific instructions on how she liked it made. You should have seen me counting how many seconds I left the bag in, but she downed it all in one!

We can't be expected to know instinctively what our patients like, but it should be considered a priority to explore this with them, or their advocates, so we know we’re getting things right for the individual.

My idea of patient-centred care is about empowering people to be the ‘leader’ in their care. We should learn what our patient's wishes and goals are and ensure we don’t fall short of the basics, such as calling someone by their name - not their bed number. It's about being genuinely interested in someone's life story, their dreams and their past. This is so important, because it’s what makes them who they are. It's also about building a collaborative alliance with the patient, where we understand them, and they understand us, because as much as my patient's learn from me, I also learn from them. Trust me – I will never be short of dating advice!

The first steps to getting a patient to communicate or speak is different for everyone, but I like to focus on what someone can do and play it to our advantage. If someone can't say the word, but they can describe it, then we work on different prompts to do this – like: ‘What does it look like? Where might you find it? What colour is it?’. If someone's good at using facial expression to enhance meaning, I encourage the use of gesture to enhance this further. We can then begin to provide intervention for things that are more difficult.

Supporting someone to eat, drink and swallow starts with information gathering – finding out what’s caused the difficulty and if it’s been happening for long. During the assessment, I may provide someone with different textures of food and drink and observe how they manage. I consider if things could be going down the ‘windpipe’ instead of the ‘food pipe’ or if chewing is effective or too tiring? Some people can eat and drink right away. For others, it's not as straight-forward and they may need more time to get better or have a camera/Xray study of their swallowing. Sometimes, enteral feeding, such as a tube in the nose or the tummy to provide nutrition, is the better short term or, occasionally, long-term option. In decisions like these, I work closely with the patient, their family, and other healthcare professionals to make a plan that’s best for the person. Some people will eat and drink acknowledging the risks and complications of food and drink going down the wrong way, as they feel it's the better alternative to enteral feeding.

I think gold standard speech and language therapy intervention focuses on what the patients and their loved ones want. As professionals, we should always be asking the patient: ‘What matters to you?’.

I had an intensive care unit rehab patient whose goal was to eat a McDonalds. It was like she’d won the lottery when I told her to order that Big Mac. That was a moment that I thought: ‘Yes, this is the career for me.’ Not every day can be as brilliant as that, but when they are, it makes the harder times and the perseverance worth it.