The Clinical Evaluation: A Necessary Tool for the Dysphagia Sleuth

Abstract

There is controversy about the necessity of clinical (bedside) swallowing examinations. Some argue that screening provides enough information to thoroughly manage a case. In instances in which the risk of an adverse event is very high, screening legitimizes short-term intervention to temporarily mitigate that risk. But comprehensive treatment based on screening is always an unguided and imprecise strategy because screening cannot identify the nature of the problem or the method that best treats the problem. As physicians and public health experts know, the diagnostic process begins with case-finding procedures that predict the presence of risk, and progresses through increasingly precise methods until the clinical problem is resolved. Sometimes the more costly gold standard examination is unnecessary. And sometimes the gold standard test is unavailable because the patient is seen in a system in which the infrastructure and expertise for conducting diagnostic instrumental testing are inaccessible, or because of wait lists, or funding issues. Such situations require the speech-language-pathologist (SLP) to determine how to gather the most and best information available under these constraints. This article will discuss the clinical examinations' role in the diagnostic process and refute the claim that it is unnecessary.