Sunday, September 18, 2011

Do specialists get better outcome than generalist clinicians?

I had an idea for some useful piece of research, which would be a change to the research time wasted on useless research.

The treatment of non-specialist SLTs always struck me as scandalous from my own experience and that of others. These are people who have visited university for four years with one course at best on stuttering by an expert, but more typically a few lectures giving by a semi-crackpot prof on what causes stuttering. Then, due to the dictatorship of academic degrees and professional qualification, society gives them the monopoly to treat people who stutter even though they have no clue whatsoever. The clever ones openly admit to their cluelessness on the matter and refuse to treat. Thank you for your professionalism and putting ethics before money! Even though you are probably the non-specialist who would best treat people who stutter! The others are the "I am a qualified SLT and I know what to do." Run, run fast!

Well that is theory! But is correct? What I want to see is the following outcome study. Take 100 people who stutter, assign them to expert SLTs and generalist SLTs, and let's see what's happening. Will the experts get better results???


Anonymous said...

Nice post. And as to your proposed study, I think the answer depends. If the 100 people children are children, then I think you can expect the group with expert SLTs to *probably* get better results. But if they are adults, then it will be a wash--not because the generalist SLTs have better success, but neither group will have better outcomes. Why? Lack of evidence that therapy has any direct effect on positive outcomes in the speech of adult stutterers.

Rok said...

very good post and so true

the intelligent people who does not understand stuttering all too well says thats not my research area.... and the not so tolerante and intelligent ppl with a "degree" thinks they know everything, so thats really a problem which I experienced also
but i try to avoid these people as much as i can

Norbert said...

Two issues to consider here:

In the NHS, we know that a specialist service will attract a higher number of referrals and clients than a service that doesn't have a specialist. That means a lot more children, for example, will get help (and their parents some proper advice) than if you don't have a specialist.

The other issue isn't necessarily related to quality of therapy provided. A generalist may be able to deliver Lidcombe therapy very well. But they're probably *only* able to deliver Lidcombe very well, whereas a specialist can pick and choose approaches and will be better able to adjust their therapy to the client's needs.

Anonymous said...

This is all just money making business..

most of the doctors study to make money. there is no compassion.

very few people with compassion treat you for free even if they are not aware of the treatment. atleast they try to.

for doctors everyone is a CLIENT and their patient is their MONEYTREE

If i crack the stuttering mystery or if someone else cracks it, i will go all FREE :)
if they want to pay me they can donate whatever they want else not a problem :)

Ashley said...

I just ran across your blog - looking for resources to share with my students, and I think this is a very interesting question. My reaction is this: In the U.S. most SLPs who see children are school SLPs who do not make money "per child" - they are salaried and get paid for being the SLP at the school and seeing whatever kids need SLP service. If they get children who stutter on the caseload, they can't just say "I don't know how to do this.." it is generally considered within the realm of SLP duties and they would be expected to do some investigation into the best plan of action. So...I don't think they would be treating children to make more money as much as because it is their job requirement...however, the question of whether outcomes would be better with a specialist is an interesting one, and I think a reason that ASHA is focusing so heavily on evidence-based practice - if there are treatments proven to work generalists should know about them because a large percentage of the school-age population will be serviced by generalists.

Kirsten said...

It's an interesting question, but one I'm not sure can be answered in such clear-cut terms. In my experience, stammering intervention is a journey in which one may expect to participate in (different forms of) intervention at different stages during life. Each different therapist may be able to offer something new or different. The value of generalist therapists is that they may have a broader range of current experiences to draw upon. Also, I believe that the collaborative relationship between the client and clinician is the most powerful factor in any intervention. I'm not suggesting that specialist therapists aren't incredibly valuable, just that generalist therapists can facilitate beneficial intervention too.

And when the spesialist therapists started out, they were learners too!

Hiten said...

Interesting question Tom. I'm looking at it from the perspective of a person who stammers seeking help. I would always pick an expert over a generalist for help anytime. But this is also a perception thing.