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Some weeks just come up to you and punch you in the face. I still don’t know what happened, but I know I have a lot of planning to do.

It’s been a wacky up/down week. The main issue I need to solve (or in Type-A-Personality-Speak: Organize, organize, organize), is how to better manage my now bulging out-patient schedule. (Which, of course, immediately defies it’s own immensity by having half of my patients no-show today. But…that’s probably a rant for another post. My fellow out-patient SLPs can relate, I’m sure.)

I have a few patients who require additional set-up and break-down time and I am struggling to work this into my schedule without throwing off other parts of my schedule that are already established.  Plus I need to find some very simple hands-on craft activities and learn All The Baby Signs. ALL OF THEM.

Did I mention this week punched me in the face? Time to spend part of the weekend brainstorm ideas. And then maybe blogging about them.

So I had been working on an entirely different post this week, but decided to opt for a completely different piece because the other one seemed unpolished and unfinished.

I might have mentioned I work at a hospital where I sometimes work in the acute setting and sometimes in out-patient care. Some days I jump back and forth between both. Some days, it’s almost as though I don’t get anything accomplished in either place. On the other hand, the idea of sitting still in either setting puts my type-A personality on edge.

I’ve been doing this over a year now, and while it has gotten easier to switch between the two (switch populations, switch ages, switch my brain), I am still searching for that balance. If I really love something (and I love SLPing) or if I really want to succeed at something (and I really, really want to be a kickass SLP) I throw myself into it. In a sometimes-kind-of unhealthy way. (In fact, I should add to my goals: take some frigging vacation even when you don’t have anywhere to go.  Ahem. Anyway.)

In that way, it’s probably a good thing, especially this early in my career, that I have to keep hopping back and forth between many very different SLP-type things. I can obsess about twenty different types things all at the same time!  I mean, I can work hard towards balancing my time among all the different things I do.

Now I realize I am not a special snowflake who spends their SLPing jumping around between adults, children, swallowing, voice, evaluations, treatment, phonological disorders, playing Simon Says  to giving families the facts about NPO versus signing a waiver given the risks of aspiration. What do you guys do for balance? Does it get easier? Does it get harder? Do you think you provide the best care possible to so many different types of patients? (I know this is something I worry about all the time. I can’t be an expert at everything, can I?) Do you ever feel like banging your head against the wall? Oh, wait. I guess that’s all of us.

This week has been a frustrating week. To put it mildly. (Which is why there wasn’t a post last week. Sorry.)  So, I will take time to talk about something that has been frustrating me recently in my out-patient therapy.

It’s where my history in child care and my odd obsession with environmental modifications collide.

(Short disclaimer: I am pretty satisfied with the set-up at my out-patient clinic. This is a general frustration that I don’t have any suggestions to fix it. So I don’t really expect it to change, nor do I necessarily require it to change. It’s just something I’ve been thinking about.)

All day long, while I’m at out-patient, I dream of turning each individual session into Montessori-style language pre-school that lasts for under an hour. Yep, I’m clearly living in a fantasy world. Well, and to be honest, not all my therapy needs to be language pre-school style.  I still shudder to recall trying to do articulation therapy in the language pre-school at grad school.

But for very young children who are expressively and/or receptively delayed, or children who are on the autism spectrum, I can’t imagine a better way to address these goals. A small kitchen for us to play with and a table to sit and eat at. A real fridge we could walk to, open, and choose food or drink. An outdoor space with a playground where we could move around and practice verbs, or functional requests the child may use at school or at home. Hell, I wish we could go to the grocery store and practice learning the names of common fruits and vegetables that way.

I do try to come up with specific activities to give my parents to practice language skills at home, but I can never be sure how it’s going. Plus, speaking from personal experience, I always learned more when my graduate supervisor would demonstrate the technique than necessarily trying to tell me how to do it. (Guess it’s time to somehow institute a Hanen program.)

So then, is the very way an out-patient clinic structured make it too inflexible to accommodate all types of patients? Of course, we all tailor our goals and our approaches to our patients, but is there a certain rigidity that can’t be overcome in an out-patient setting? (And let’s not even get into how insurance probably would not support any slightly unorthodox approach to treatment.) All I know is that I have a few patients where I find the confines of the out-patient setting deeply frustrating. Time to get creative.

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