Parting Words for my Intern


Ten days from now you will have a diploma to frame and a caseload to manage. I know it feels as though you’re finally crossing the finish line, but in actuality you are just getting into position at the starting blocks. A few words of advice before you take off:

1) Remember this: just because your patient cannot speak does not mean he has nothing to say. You will work with many nonverbal patients. Talk to them as though they hear and understand everything you say. Many probably can but have no way of demonstrating their comprehension. Give them the benefit of the doubt.

2) Consider what is important to the patient and her family. I remember early in my career assessing a child, determining that I should start by teaching her the “k” sound, and then drilling that velar pressure consonant with great fervour. When the child’s mother came in for a conference, I had the child recite a list of “k” words: key, kite, kiss. The mother said, ‘Oh, that sounds wonderful! Do you think you could help her say her name?” It had escaped my attention that this child couldn’t say her own name. I don’t know about you, but I say my own name much more often than I say kite.

3) Write every report assuming that the patient or his family will read it at some point. Imagine how your report would sound if an attorney were to read it aloud in a courtroom.

4) Cut yourself some slack. None of your coworkers or patients expect for you to have all the answers on the first day, and you shouldn’t expect yourself to have them, either. Demonstrate that you have the inclination to find the answers, then go look for them. Your initiative is enough.

5) Don’t say or do anything in a closed-door session that you wouldn’t say or do if the patient’s family members were in the room. When I was doing outpatient pediatric work, the mothers of the children sat in on the session about 25% of the time. Sometimes I would notice a mother tense up if I used a stern voice or was especially firm with the child. I would stop and say, “This is just how I talk, and I know you don’t want me to change the way I work just because you’re here,” and then I’d go back to treating. After that brief explanation the mother always seemed to relax, and I can honestly say that it was never an issue.

6) Be kind to the office staff.

7) Be on time. If you’re working in the school, get to the classroom on time. If you’re working with outpatients, be in the lobby on time.

8) Listen first. When you pick up your patient, be it from a teacher if you’re in a school or a nurse if you’re in the hospital, give that teacher/nurse/whomever a moment to tell you her concerns before you start in on your plans or the results of your assessment. Her concern probably generated the referral in the first place. She has a heart for the patient and a good idea about what needs to be done.

9) Take on the patient that your colleagues don’t want. My friend Rachel and I call this patient “the cyclops mermaid.” This is the patient who is so rare and unique that no one wants to take her on for fear of looking incompetent. Take her on and do your best. Pretty soon the cyclops mermaid will be your favorite patient.

10) Put manners on hold. This is a tough sell in the south, but a speech impaired child does not need to worry about saying “please” and “yes ma’am” if he cannot even tell you when he is hungry. Start with words that will motivate the child, like “cookie.” His family can teach him “yes ma’am” later.

11) Don’t use pediatric materials with adults, even if the content is the same.

12) Don’t lose sight of the fact that taking care of your patient is your job. When paperwork is out of hand and there are lots of meetings to attend, it is easy to see the speech therapy session as an inconvenience. Remember that the therapy session is not a hurdle to slow you down when you’re trying to complete your job, it is the job.

KaLeigh and Katie: You have both been delightful and are going to be terrific speech therapists. Happy graduation!


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