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Intro

Kate Grandbois: Welcome to SLP nerd cast your favorite professional resource for evidence based practice in speech, language pathology. I'm Kate grant wa and I'm Amy 

Amy Wonkka: Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. Each 

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Episode

Kate Grandbois: welcome to SLP Nerd Cast. We are really excited for today's conversation. For anyone who is new to SLP Nerd Cast, this is a podcast where you can earn ashes, eus for listening. We are really, really excited to welcome our guest today, Jackie Rodriguez. Welcome [00:02:00] Jackie. Thank you for having me. I'm really excited to be chatting with you guys.

Announcer: Thank you so much for sharing your time with us today. Uh, you're here to talk to us about health literacy and vascular cognitive impairment, the missing links in stroke care. Uh, before we get started, can you just tell us a little bit about yourself? Sure. So I am a speech language pathologist that's based in Atlanta, Georgia.

Jackie Rodriguez: Um, I've been practicing for nearly a decade, and at this stage in my career, it's easier to tell you what settings I haven't worked in. Um, so I've worked in pretty much every setting except for home health, long-term acute care, and pediatric, um, medical settings. So I started in schools as a bilingual diagnostician, transitioned into the medical world as a traveler during COVID, which was just wonderful and a great time to make that transition.

And then from there, um, now I'm back permanently in Atlanta. And [00:03:00] so instead of having one full-time job, I have multiple PRN jobs. Um, mostly at this point in, um, inpatient rehab and outpatient, and occasionally Smith. S um, and I'm also bilingual. I am a native. My, uh, native language is English, and then my second language is Spanish.

And Spanish is my heritage language, but I'm not a native speaker of it. I learned it in school. So I'm, um, some of my areas of expertise are dementia care, um, bilingualism and cultural and linguistic diversity. I. I've always wanted to speak a second language. I just wanna say that that is it To me. It's like a superpower.

Kate Grandbois: It really is. It's just like, so interesting. I mean, just, I just makes me feel all the jealous feelings. Well, we're really excited to have you today. Um, as our audience knows, Amy and I are not met SLPs. So this particular, um, topic is gonna be new to us, but I I, we were talking a little bit before we hit the record button.

There are a [00:04:00] lot of pieces of this that are pervasively helpful across all of our fields. So if you are listening and you're a pediatric SLP or you're working in a school, this is going, there are lots of pieces of this conversation that are going to be relevant for you because as it turns out. Health literacy touches nearly 100% of areas of speech language pathology, as it is all related to health and advocacy and all those kinds of things.

So I'm very excited to dive into this with you today. Before we get started, we do need to read our learning outcomes, so I will get through those quickly. After listening to today's episode, participants will be able to self-report knowledge gains related to vascular cognitive impairment and identification of symptoms within their patient.

Listeners will also be able to self-report knowledge gains related to ways to increase accessibility to speech therapy services in a language that their patients can understand, as well as knowledge gains related to holistic therapy. [00:05:00] Ideas that you can incorporate, um, for incorporating health literacy into speech therapy services for all of the financial and non-financial disclosures, as well as any course disclosures for today's episode.

You can read all of those in the show notes or look for them on the landing page of the course on our website. The, um, link to that as well as the post-test for CEOs will be in the show notes. Um, so as well as will any reference or, um, additional online learning that we discussed today. So without further ado, let's do the fun stuff.

Announcer: Let's do the good stuff. Let's start off with health literacy. Jackie, can you give us a definition and just tell us a little bit about what. Health literacy is? Yes. So health literacy is, um, basically a combination of all these factors that we use in order to understand our own body in order to make an informed [00:06:00] decision about our health.

Jackie Rodriguez: So, um, there's two types of health literacy. There is personal health literacy and organizational health literacy. And so personal health literacy is what we do and what we do as individuals in order to better understand our health. So let's say that. I'll give an adult and a child example. Let's say that you are, you've had a stroke, right?

And you're at the hospital, or maybe you are the mom of a child who's just been diagnosed with autism. So you're gonna come home, you're gonna get on the internet. Your people like to joke about Googling your symptoms, but you sh you should do that. You should. Some effort to try to learn about what is a stroke?

What is autism? What does the treatment look like? What questions should I ask to my doctor? So that's personal health literacy. Then organizational health literacy is the role that speech language pathologists play in helping our patients to understand their own body. So health [00:07:00] literacy per organizational health literacy from the perspective of a speech language pathologist, if we've got a patient who has dysphagia and we're trying to help them decide what diet they want to be on, we wanna make sure that this patient really understands how their larynx, their lungs, their esophagus, how all those parts of the body come together during swallowing and where the impairment is and what the risk of aspiration is for that patient.

And when. You know, if we're, um, in the schools and you're talking to a parent about, um, creating an IEP, we wanna make sure that they really understand like your child when you're giving them directions, like they have a language disorder. So they're not under understanding all these different aspects.

They're not understanding like basic concepts above, below and front, behind. They're not understanding when we put two steps together. Um, so we wanna make sure that they really understand how their child's brain is working so that they could better [00:08:00] advocate for them both in the at school and even at home and in the medical setting as well.

Um, so those are our two types of health literacy. And then. Um, in order to in, you know, inform health literacy, we have these factors that are called social determinants of health. And so these are just all these factors that lead to how well you understand your body. So some examples are, um, economic stability, um, your neighborhood and built community, which we're gonna talk about later.

Um, your level of education. So think about like some of the patients that we see. So our patient, if you have a patient who comes in who is a neurologist by trade and who's had a stroke, like you're not gonna have to do as much educating about anatomy as you would to someone who has a third grade education level.

Also, um. [00:09:00] Uh, the, um, even just thinking about like within education, like our literacy level, um, our language. Like what language were you educated in? So if you only have materials that are available in English, those are not gonna be accessible to our Spanish speaking patients or our Farsi speaking, um, patients.

And then even the materials that we hand out, like we should try to test the readability, like what reading level are a lot of these materials on. So when you go onto websites like, um, WebMD and you read like even an article about like dysphagia or dyslexia, there's these huge big words. And if you read below a fifth grade level, you're not gonna understand that.

So that could play a role in how well you're understanding this diagnosis. So right out of the gate, this is so much more than. Medical SLP context, I mean, [00:10:00] every, everything you're saying touches every single patient that we work with. Mm-hmm. I don't care if you're in a school, a private practice, uh, home health, wherever you are, if you are working as a speech pathologist, you are working with a human being.

Kate Grandbois: Right. That human being adult or child has care partners, has parents, has caregivers, right. Who are also going to need to advocate for services and have a good understanding of the quote unquote problem that they are seeking help for. Right. That they're, that they're looking for supports. And I'm, as I'm listening to you talk, I'm thinking of, I dunno, in my mind it's like a, a wheel with many spokes.

All of the things that are gonna impact that. So. Mm-hmm. Are they, you know, you've already mentioned literacy. I hadn't thought of that one. I was thinking about, um, you know, language barriers. Mm-hmm. I was thinking about, um, cultural barriers, right? If they have [00:11:00] other thoughts, beliefs, feelings, values related to health that have prevented them from getting care up to this point, or are bringing them to care super early for, for, because of some value system or belief system, there are just.

So many things Yes. Uh, that are related to this, that are so important for us to understand. And I, I have to imagine that this is going to impact, and you'll tell us at some point how this impacts us as SLPs when we are thinking about, you know, the patient in front of us and how all of these variables are going to impact the care we deliver.

Jackie Rodriguez: Yes, absolutely. And I think the biggest problem that I often see is that providers are way too quick to say that a patient is non-compliant or family members are non-compliant. Like oftentimes the root of this quote unquote noncompliance, I don't like to use that term, is a breakdown and or a mismatch between like patient and provider level of health literacy.

And we're all often like not thinking about these things. [00:12:00] So, you know, this patient who, um, came in and had a stroke because they were medically non-compliant, were they non-compliant or do they live in a community where the closest pharmacy is five miles away and they have to wait for a bus to take them and the bus only comes once an hour and it's 98 degrees right now in Atlanta, and we're gonna miss.

We're going to risk having a heat stroke sitting out, waiting for the bus to come. So which one do you, you know, we have blood pressure problems when we're out in the heat, it makes our blood pressure issues worse. So which one are we gonna do? Are we gonna stay inside in the cool and risk not having our medication?

Or do we risk passing out trying to get to the medication? So just thinking, you know, stopping and thinking about these social determinants of health and like what is influencing how your patient is making progress or even like what led up to their hospitalization. And I would say keeping [00:13:00] judgment out of it.

Kate Grandbois: Right? Absolutely. So instead of being like free, instead you were noncompliant, you got a stroke because you didn't take your medicine, being a little bit more curious just mm-hmm. What their human experience is, you know, using an ethnographic interview style or mm-hmm. You know, just showing a little bit of compassion, you know, something about the term.

Non-compliant is just very judgy. Yes, very much so. Yep. And even I was thinking about like, I wish that doctors would and SLPs too, but I, I do feel like doctors, you know, they, they're the first ones that see the patient and so they kind of set the ball rolling. And I wish that instead of like putting, you know, patient, the, so like when you have a stroke, they write like, what was the potential cause?

Jackie Rodriguez: So like due to hypertension, related to like non-compliance. But I wish they would say like, due to hypertension, due to lack of access [00:14:00] to medication, um, you know, like stroke due to, um, vascular origin related to diabetes, due to lack of access to materials to learn to understand how to properly. Um, manage diabetes.

'cause then it really spells out like, here's the actual problem that led to whatever this hospitalizing event was. Here's what we need to focus on. Um, here, here's how we need to focus on helping the patient to prevent another rehospitalization. Well, and I think that's gotta be such a big piece of it too, right?

Announcer: If you're problem solving and individualizing your care for your patients' needs, some patients are gonna need more support in different areas and some will need more support in other areas. And I'm gonna, I promise I'm not gonna go down the path of complaining about our healthcare system here, which is for profit.

I am so united, I with your self restraint right now. Oh, I really, so I'm trying hard, I'm just gonna, [00:15:00] I'm just gonna not say too many more things about that. But I do think when you're in a for-profit healthcare system, one thing that we have a lack of is time with our patients. And so, you know, when you're going over, um, just the overall, these social.

Determinants of health. I, in order to even determine, I know you shared with us, one of them is economic stability, another one is education access and quality. Um, in order to find this information out and in order to share, you know, your organizational health literacy in a manner that meets your patient's needs, um, you know, we also have to have the time to gather this information.

So I didn't know if you, if there were other social determinants of health you wanted to talk about. Um, but even in these first two, I think that's a conversation to figure this stuff out. So towards the end of this discussion, I want you to bring this point back up again about time because, um, that is actually a driving force in, um, the, like when I have [00:16:00] conversations about health literacy, I think that SLPs are in a very privileged position where we have a lot of time with our patients.

Jackie Rodriguez: And I wanna talk about how we can make up for that lack of time that patients don't have with their doctors in our speech therapy sessions. And then, so you asked me about, um, a particular, um, social determinant of health. So why don't we talk about, um, the social determinant neighborhood and built community and how that has led to a lot of the, um, chronic vascular disorders that lead to vascular cognitive impairment.

Kate Grandbois: Do tell, tell us everything. Okay. So, um, when we think about neighborhood and built community, what I mean by that is the systemic ways that this country, the United States of America, has been structured by historical laws. Um, so many of us are [00:17:00] familiar with. Jim Crow segregation. Many of us are familiar with Native American forced displacement to reservations, um, and how these have had very devastating effects on, um, black folks, on Native American folks.

Jackie Rodriguez: And it's led to a lot of inequities in healthcare, but not as many people are familiar with the concept of redlining. Um, so redlining was, um, this, uh, federal policy that was created by this federal agency that was called the Homeowners Loan Corporation. This was an organization that was developed in the 1930s and basically redlining was a racist practice that zoned people strictly based on skin color, and then determined whether or not you could receive a loan or a mortgage based on your skin color.

And so. There were four zones. So there was the gl, the green zone, which was like the best zone, and that was white [00:18:00] neighborhoods. Then you had blue Zones, which were still considered to be desirable. So that was maybe like a middle class white neighborhood. Then you had C which a yellow zone, um, that was definitely declining.

So this was, you know, um, some black neighborhoods, um, people of color, other, other people of color and other immigrant groups. And so consider, this is the 1930s, right? And the, the concept of race has changed so many times in this country. And so. Um, uh, this might be people, you know, like different immigrant groups from Europe, from Europe who were not seen the same as Anglo immigrants.

So people like Italians, Irish people, Jewish people, eastern Europeans. Um, those are gonna be people who are grouped into the yellow, um, zone neighborhoods. And then you had your red zone neighborhoods. And so this was typically when we talk about redlining, typically you hear it, um, [00:19:00] uh, referring to the African American community, but they were also Latino neighborhoods and Asian neighborhoods and Native American neighborhoods that were redlined as well.

Kate Grandbois: And if my history is serving me correctly here, this was a quote unquote strategy from an economic standpoint for po also for pointing out quote unquote risks in investment. So the red line districts were considered a higher risk investment, right? For people to not invest money. This was a, this was a, this is my healthcare economics hat that I have on now that I now can't take off.

This was purely an economic, not purely obviously, but intended as an economic strategy for, in like to warn investors from a, from like a financial, an infusion of cash, correct. 

Jackie Rodriguez: And so what ended up happening is that it created these huge [00:20:00] gaps in, um, generational wealth in this country because white people had better access to loans, to mortgages.

So when we think about loans, like consider that you get a mortgage to buy a house, and then people also take out loans to maintain their house. So white folks in, um, our green lined neighborhoods had much better access to home ownership than black folks and some other, um, groups of people of color as well.

And so what ends up happening is that, um, black people are unable to access home ownership. If they did have access to home ownership. Oftentimes they didn't have access to money to be able to maintain their homes. So homes are built with very cheap material and, um, homes often fell into disrepair. Um, a lot of black people were forced to rely on public housing, and that is why things like the projects and the ghetto are stereotyped as being [00:21:00] black environments.

To this day, that's because of redlining. And then, um, another thing, so you mentioned like investing in communities. So, um, grocery stores and hospitals did not invest in these communities, in these redlined communities. And then, um, redlined communities were often, um. Uh, like factories and, um, construction sites and farms also would, would tend to buy the property surrounding these redlined areas.

And then also the government would often build highways through these redlined neighborhoods. So many of the like major highway systems that exist in the United States today were built over formerly African American communities and divided the communities, which also divides resources within the communities.

Um, and so there's a lot of things that happened here. So one environmental factors, which continues today. [00:22:00] Um, recently on my Instagram I made a post about, um, AI and how these AI buildings, how, um, buildings that run org, uh, things like chat, GPT, they use a lot of our environmental resources. So they use a lot of water.

They, um, omit a lot of like. Um, gas into the air and they get, they tend to be, um, built right next to black neighborhoods. So these cycles are continuing today. And so, um, people in redline neighborhoods because of the factories, because of the industrial, um, buildings that were built next to them, and then also you're living in houses that were not built with quality materials.

People are at risk of things like COPD, asthma, cancer, all things that we know can cause dysphagia and can also lead to cognitive impairment. And then grocery stores did not move into these areas. So these [00:23:00] neighborhoods tend to rely. On corner stores. And if you go into a corner store, what do you have there?

Overly processed foods. You don't have fresh fruits and vegetables. Um, so one activity that I often do in presentations, and I've done it a couple of times on my Instagram as well, is I'll have, um, people Google grocery stores in a predominantly black part of town, and then I'll have them Google grocery stores in predominantly white parts of town.

And so we like to say, you know, well, redlining was abolished and I believe the seventies, don't quote me on that, it was abolished, right? Quote unquote abolished. But all these negative stereotypes continue today. So that's the reason why you hear things like, oh, black neighborhoods are bad and dangerous.

Latino neighborhoods are bad and dangerous. Black neighborhoods are ghetto. Black people live in the projects. That's all because of redlining. So even though this, um, [00:24:00] law has been. Uh, dismantled. We still are suffering, suffering from the consequences of it today. And it's also a reason why we have segregated neighborhoods, why we have white neighborhoods and black neighborhoods.

And so when you do this Google search, you'll see the lingering effects of redlining, and you'll see that in predominantly black neighborhoods. You're not gonna see things like Trader Joe's and Whole Foods and Sprouts and places that have fresh quality organic foods. You're gonna see corner stores.

Kate Grandbois: Totally. And, and given everything that you've said prior to this, connecting this with our health, right? There are, there are studies upon studies upon studies that connect these, um, economic gaps to correlations of health. There is not a single person. On this planet who studies any of these things, who could argue that there is not a [00:25:00] relationship between economic, standing and social communities and health.

That is a, in, that is a well established fact, uh, that has been studied across medicine and economics for decades and decades and decades. And so when you start talking about, or teaching us this history lesson of redlining and all of the economic variables that were associated with it, when you look back and reflect on everything you already told us about social determinants of health, you can see that these are not silos.

They're like layered on top of each other. Like, like, um, I don't know, like some sort of paper mache, I dunno, that's too positive. Some sort of pile, you know what I'm saying?

It's a, yeah. It's a pile of mess 

Jackie Rodriguez: is what it is. 

Kate Grandbois: Mm-hmm. It's 

Jackie Rodriguez: layers upon layers of oppression. Yep. 

Kate Grandbois: Yes. Thank you. Thank you. That's much better. Much, much better said. 

Announcer: Well, and there's the infrastructure piece too. I mean, what, what listeners are, are not seeing is some of our like air [00:26:00] quotes with like, oh, the redlining has been abolished.

Right. Okay. And legally, perhaps it's been abolished. In practice, all of these problems persist and you have the problems persisting in the infrastructure. If we never built the grocery stores, the grocery stores didn't just magically come in, um, and populate these areas. If we split a neighborhood with a highway, that highway's still there.

Um, the walkability of the neighborhood, that's still, that's still in place. Um, so there's also all of those layers to Kate's point about the, the messy pile. But like there, there are a lot of components here that are going to affect our patient's health, um, and access to health preventative measures as well as, you know, post, post-event, what they're able to access and what the barriers are.

'cause it sounds like there's a lot more barriers in these redline neighborhoods. 

Jackie Rodriguez: Yes, for sure. And you mentioned like walkability, so even just thinking about like some of the chronic, um, cardiovascular conditions like diabetes, [00:27:00] hypertension, high cholesterol. Like what, what do the doctors always tell you?

Oh, like, change your diet and exercise. And so like if you live in a community where there aren't paved sidewalks where you can't afford a gym membership because there's, it's economically very repre oppressed and there's not a bunch of jobs, you don't have a job. So you can't afford a fancy gym membership.

You can't go outside and go exercise. Or maybe you're working three or four jobs to make ends meet and you don't have time to exercise. And then when you want to get healthy foods. You don't have access to these quality grocery stores. So it's like the perfect storm of just a lack of resources. And then too, like thinking about the infrastructure as well, like, so we mentioned how grocery stores and hospitals don't wanna move into these communities, but also pharmacies, doctors, you know, private practice, doctors offices like these, um, areas, it's harder to get access to care if you rely on public transportation and there's not [00:28:00] a doctor who's close to you where you live.

Um, so lots of things to think about. 

Kate Grandbois: Well, and I think when you consider all of these variables and how I so poorly in eloquently said pile of mess, when, when you think about. The infrastructure that's involved here, and I just wanna make a parallel statement. Everybody listening to this podcast is a worker.

We have jobs, right? We get up in the morning and we drive our cars, or we walk down the street, or we take the bus and we go to work. As workers, we are part of an infrastructure, right? We are part of a system of an economy, of, you know, all of these things. And your patient is also a person. They are a patient who is also part of another infrastructure.

And it of, of various kinds been depending on where they live and whether or not they can take the bus and whether or not they have access to food and all these things. And I'm, I'm now thinking [00:29:00] back to what you said at the beginning of the episode about non-compliance, right. It puts so much more context, um, on who, what our roles are as, as people who workers who support the infrastructure of healthcare and the.

You know, barriers that someone may be experiencing to their own healthcare, not because they're not compliant. That, again, so judgy, it's because of all of these other infrastructure related barriers. And it's really an, an ecosystem that we're talking about. And this is like, you know, 30,000 foot view. Um, you know, really big picture concept. I would love to hear a little bit more about how this impacts us as professionals, specifically as it relates to cognition and, and the components of, of your clinical area of expertise. 

Jackie Rodriguez: Okay. [00:30:00] Yes. So, um, now, you know, we're, we talked about how a lot of these communities rely on corner stores and how we don't have access to great nutrition, right?

And so what ends up happening, so a lot of people who live in redlined communities and, uh, with these, um, cardiovascular conditions, so things like hypertension, high blood pressure, diabetes, mellitis, so type two diabetes, and then, um, hypercholesterolemia, hyperlipidemia, high, um, cholesterol, right? So some quick facts on all three of these disorders.

So. 80 million Americans have high blood pressure. 171 million Americans have type two diabetes, and one third to one half of all pediatric diabetes cases are actually type two. We tend to, um, associate type one diabetes with children, but we're seeing more and more children get [00:31:00] diagnosed with type two.

Um, and then going back to hypertension, um, with those 83 million Americans who have a diagnosis of hypertension, 70%, um, have uncontrolled hypertension, meaning that they're either not taking medication to control it or controlling it with exercise or, um, maybe they're taking medication and it still is poorly controlled.

And then 30% of people don't even know that they have high blood pressure. So one thing that I tell my patients. Constantly who have had strokes is, you know, your risk of, have you, once you've had one stroke, you have a risk of having another one. And, um, you have symptoms of low, most people like have symptoms of low blood pressure, right?

You feel, um, like you're gonna pass out. But a lot of times with high blood pressure, like people don't have symptoms and unfortunately your first symptom is a stroke. Um, so Ari at AL 2018, they did, um, so a study [00:32:00] on hypertension and how it impacts cognition. And so basically what hypertension does is it narrows your blood vessels and scars the blood vessels.

And so I always tell my patients, you know, your blood vessels are like tubes that bring your heart, that bring, um, blood from your heart up to your brain, right? And blood is like food for the brain. And, um, when you are repeatedly having these high blood pressure episodes, kind of think of like a hose that you've been using all summer.

It's hot out in the sun and it kind of gets stiff after a while and it's time to buy a new one and the water isn't gonna flow through that hose like it should. That's what high blood pressure does to our, um, blood vessels. And so this can cause this study found, um, deficits in abstract reasoning, executive function memory and mental processing speed.

So. Um, a lot of times on the medical side, you know, when we get [00:33:00] patients who are referred to us for cognition and they need to have like a qualifying diagnosis, and you'll hear people say, well, you know, they don't have dementia, or they haven't had a stroke like hyper. We need to see hypertension as a qualifying diagnosis for cognitive impairment because the, the research is right there, it's clear as day.

Um, next type two diabetes. So we have our blood brain barrier, which is basically like a security gate, and it says like, this is good nutrients that can pass into our brain. This is bad nutrients that can pass into our brain when we have periods of chronic high blood pressure. I mean high, um, blood glucose.

So when we've got our sugar levels are way too high, this causes a lot of stress and inflammation in the brain, and that impacts the way that that blood brain barrier works. And so what happens when our blood brain barrier is not working? We have, um, Calisa at AL 2018 found deficits in verbal fluency, verbal memory, and working [00:34:00] memory.

So type two diabetes uncontrolled can lead to ch brain changes that cause cognitive deficits. And then, um, we have high cholesterol. And so high cholesterol causes plaque that builds in our blood vessels, right? So it starts to line the walls.

So I always like to kind of describe our blood vessels and high, um, cholesterol, kind of like a shower drain with lots of hair. So the more hair that builds in the shower drain, the harder it is for, um, the water to flow through the blood. So. High cholesterol can either cause a complete blockage so blood is not flowing up to the brain, and that's a stroke where the tissue starts dying, right?

Or chronically, we have a, uh, the blood is not flowing as well as it should, right? So think about how, like in your bathtub when you've got a lot of hair, but like the water's flowing, but it takes like 10 minutes. Like that's a long time, right? [00:35:00] So, um, this also can impact, you know, a buildup of, um. Plaque can lead to, um, trouble with the nervous system, and that could lead to cognitive impairments.

And we already know that, um, with things like Alzheimer's dementia, that there's these plaque deposits that build up in the brain and that cause these tangles, which cause cell death. And so a lot of these disorders that cause a change to the way that blood is flowing up to the brain, they're a precursor for a stroke and they're also a precursor for dementia later on.

Announcer: I have so many thoughts. I, so first of all, I, I super appreciated your example. So you, what you did. I feel like was, you worked on that health literacy piece with your examples of both. Yes. The high blood pressure and like the high cholesterol. Like so you took, and I, and I do feel like sometimes, I don't [00:36:00] know, maybe it was just me.

I feel like I've, I've made a concerted effort to be better with this later on in my career. But when I first started, especially, I feel like there's this tendency for us to like be the expert and use all of the jargon that we learned and like throw these fancy words around when we're working with our clients.

Um. But really that's, that's not as helpful as breaking it down and be like, you know how when your hose gets really hot and then it like gets really hard over time and you need a new, like, I completely understood the concepts that you were explaining, which are like somewhat complex, right? These like, somewhat complex things are happening in our vascular system.

Um, so I think number one like that was, that was just like a very nice example, like multiple examples of how you could do that and make a complicated topic, feel accessible, um, and make like. Make your patient who may or may not feel comfortable asking for clarification, have like a nice entry point to the topic that you're talking about.

Yeah. I also thought about, with the high blood pressure, it was, [00:37:00] it just did make me think back to the comments you were making about the redlining and the social determinants of health. And just how, again, I think sometimes we take for granted things like, like I am, I'm a privileged middle class white lady and I go to my doctor for a physical every year and they take my blood pressure, right?

Mm-hmm. And so there's also this piece of like, if you don't have so much access to primary care, there's these like monitoring pieces that just aren't available. Mm-hmm. So, I don't know, those were, those were, those were all my thoughts while you were talking, but I do feel like that's like, I can't wait until we get to the part where you talk to us about how we use our time as speech pathologists to help our help.

Jackie Rodriguez: Yes. So, yep. Um, you know, you're, you're making those connections perfectly. Right? And I remember like really ignorantly, when I first started working with sns, I would always laugh because I would feel, I would be like, oh my gosh, I don't even need to do like a chart review on my patient because I already know they're gonna [00:38:00] have like diabetes, high blood pressure and high cholesterol.

And now I know better. And I know that this is what we call vascular cognitive impairment. And so it's basically cognitive impairment that is happening because of a vascular etiology. And when we think about vascular cognitive impairment, so we have vascular cognitive impairment, and then we have vascular dementia, right?

So, um, vascular cognitive impairment basically is cognitive impairment that is caused by these underlying cardiovascular etiology. So we mentioned the big three, um, type two diabetes, high blood pressure and high um, cholesterol. But then anything that, you know, think about what I was saying about blood pressure and blood flowing up to the brain.

So anything that's gonna play a role in that, that is particularly in the heart, is also going to be a risk factor for vascular cognitive impairment. So AFib and aortic aneurysm, coronary artery [00:39:00] disease, heart failure, and also chronic kidney disease. And I'll be honest, chronic kidney disease is something that I don't know a lot and I don't like to talk about things that I don't know a lot about.

But it also. Is a risk factor for vascular cognitive impairment. And so, um, when we think about vascular cognitive impairment, um, vascular cognitive impairment differs from vascular dementia and that vascular cognitive impairment can impact one area of cognition. So people with vascular cognitive impairment, their memory might be okay, but they're like having these problems with attention and they're having trouble, you know, maybe managing like their medications and their, um, their finances because they're having trouble attending to details and they're making little errors, but their memory is within functional limits.

Whereas dementia is where you have two or more areas of cognitive impairment and [00:40:00] it's now impacting your ADLs. So now you know, like the person with vascular cognitive impairment, we might be able to like. Get them trained that they could still participate in their IADLs. Maybe they're still working, but a person with vascular dementia now most likely cannot work.

Um, they're gonna need a lot of support. Um. So that's kind of the difference between the two. And I think when I was in grad school, like I did not learn an anything about this period. I, I feel like I had very minimal Same, yeah. And I feel like I had very minimal education and like cognition. And really what I was taught to do was, um, you know, you look at the MRI and you look for a lesion.

So, you know, you look for, okay, this person had a stroke. Like we're looking to see like, oh, well they had a right-sided stroke, so that's what we expect to see cognitive impairment from. Or they had a frontal lobe stroke or [00:41:00] they had a basal ganglia stroke. So we expect to see like high level cognitive impairment, but no one told me about this, like chronic blood flow changes that leads to this vascular cognitive impairment that you don't necessarily have to have had a stroke to have this diagnosis.

So. That's so interesting. I don't, I mean, I went to graduate school 10 million years ago, so I don't remember much of it if I'm being honest, but I definitely don't remember that either. Um, and I, I can't help but, you know, continue to reflect on kind of seconding what Amy said about our ability as clinicians to speak to patients in a way that's understandable, right.

Kate Grandbois: To leave, you know, leaving the jargon at the door using analogies so that they feel empowered, but also in the context of everything we talked about at the beginning with the infrastructures that they are a part of and their lived experience and, and what barriers they may have to help may the, what barriers they may have to [00:42:00] accessing care.

Their ability to understand what is going on with them is going to highly influence, I assume you can confirm or deny it's really going to influence their ability to advocate for themselves. Mm-hmm. And so we're like those analogies of the hose or, or the, you know, the tubes or whatever that is what is going to empower them to go on and do that.

I mean, we are direct based on what you're saying. I'm just kind of reflecting this back to you. We are directly responsible for giving them language around their health literacy. Absolutely. Absolutely. And so, okay, so you guys talked about in the beginning about how, um, time is like such an issue in our messed up healthcare system, right?

Jackie Rodriguez: How doctors don't have time to educate patients or give patients the education that they need. Um, so [00:43:00] there's a really interesting research study. Okay, it is, um, cross Mul and Nopa 2023. Um, and this study, this was a really big study, so it looked at, um, Athena Health's, EMR, so their, um, medical record system, and they reviewed, um, 8 million one hundred and nineteen a hundred and sixty one.

Thousand visits for over 4 million patients. And so, um, these were, uh, primary care physician patients. And so what they did was they just reviewed the amount of time that doctors were spending with their patients. And so the way the Athena Health EMR healthcare system works is the doctor enters the room, he checks in, he does his assessment, he does, um, any counseling.

He [00:44:00] puts in orders and then he checks out. Okay? So that is the amount of time that is documented in Athena's healthcare system, and they looked at the average amount of time. Can you guys guess what the average amount of time doctors in the Athena Health EMR were spending with their patient? 

Announcer: I'm gonna say, uh, seven minutes.

Oh, 

Kate Grandbois: I was gonna go eight. 

Announcer: Oh, all right. Okay. Well, 

Jackie Rodriguez: luckily it's better than y'all's guessing. 

Announcer: We're, we're a little pessimistic here about, it's the dune crew, our healthcare system. 

Kate Grandbois: We didn't say two minutes. Okay. So not good at all. We knew it was gonna be bad. We, we we're a biased sample, 

Jackie Rodriguez: so the average was 18.9 minutes.

Announcer: Oh, wow. I'm, I'm shocked honestly, that 

Jackie Rodriguez: yeah, we don't, we don't have a lot of, in our, he in our healthcare system, 

Kate Grandbois: 18 minutes. But that's still not a lot. That's not many minutes. Not 

Jackie Rodriguez: a lot of time either. So many minutes. And, you know, remember that's [00:45:00] like to do the assessment and counsel and put in orders. So let's say you come in and you've just been diagnosed with high blood pressure, high cholesterol, and diabetes, that is not enough time, right?

Diabetes alone, they have a whole like. Section of healthcare on diabetes education, right? We have professional diabetes educators just for that one disorder. Right? And that's not even mentioning, um, high blood pressure. And that's not mentioning high cholesterol. Right? And then, you know, when they're putting in those orders, are they putting in an order for a consult with a diabetes educator?

Are they putting a diet order in with a dietician? And then, you know, we have all the same issues in those fields that we do in the field of speech pathology. So we know the field of speech pathology is 92% white. There's often a client patient mismatch, [00:46:00] right? So you refer your patient. You know, you're, um, black African American patient to a white dietician who might not be familiar with the patient's cultural diet, or you pr refer your, um, Latino patient to a dietician that is not familiar with their cultural diet.

Right? And then they're like, well, I don't eat any of these foods, so like, I'm really struggling. Right? And then what do we do? We turn it around and we blame people's cultural diets. And we say things like, you know, black people end up with high blood pressure and high cholesterol and diabetes because all they eat is fried chicken.

Or Latinos eat rice and tortillas with every meal, and that's why they have diabetes instead of looking at all these systemic problems happening. Um, and so, you know, again, that's a, that is a completely separate topic. Like we could have a whole discussion about that. But, um, bringing it back, I like to [00:47:00] talk about this study because.

Your average speech language pathologist, with the exception of maybe your like acute care SLPs, we're seeing our patients anywhere from 30 minutes to 45 minutes to sometimes an hour in a session. Right? So at the bare minimum, it's almost double the amount of time that a doctor sees their patients for, and we see our patients way more frequently than a doctor does.

Okay? So SLPs have a choice. You could either pull out your walk books, you could pull out, you know, your games, and do something that you know is not very functional, or you can easily incorporate health literacy into your therapy session. 

Kate Grandbois: And that's gonna, that's gonna, it's one of those, um, skills that keeps on giving, is what I'll say, right?

Because mm-hmm. Having a deeper understanding or, or working towards a deeper understanding of [00:48:00] health literacy empowers your patient for the lifetime that they are struggling with, with whatever it is, right? So as therapists, we're transient. We are not in our patients' lives. They, they might get, what, eight visits approved by their insurance, you know, 30 visits we might move on, right?

They might move, go to a different hospital, go to a different setting. We are not permanent fixtures in our patients' lives. But their care partners are or might be. Mm-hmm. And they certainly are, you know, if they have the skills to advocate for themselves cognitively or what have you, when we empower them, that serves them for much longer than playing checkers or whatever game you've pulled out.

No dis no shade on checkers. Checkers is fine. I didn't mean to be dispar disparaging against checkers, but this is worth our time is what I'm hearing. 

Jackie Rodriguez: Absolutely, absolutely. So we could talk about, why don't we talk about like a couple of examples of like, what this [00:49:00] might look like. So, um, I'll, I'll just, you know, start with in my own practice, so.

Um, being, you know, I mentioned in the beginning that I'm bilingual, I'm Spanish, I speak Spanish and English. And, um, one thing that I often see with my Spanish speakers because of the language barrier, is so many times, like my patients just have no idea what happened to them because people cannot be bothered to use the language line.

So I, it has gotten to the point now where like, this is kind of bad. Maybe I shouldn't admit this on a podcast, but like, when I get called patients who are Spanish speaking, I don't even look at their goals. I'm like, my first session. Is we're gonna do health literacy. So I look to see, you know, what their hospitalizing event was.

Um, if they had a stroke, you know, what was the cause, um, where in the brain was their stroke. And, um, I, I go through those [00:50:00] examples like what I did earlier. I talk about the, so we start off with the base, most basic concepts. We start with, do you understand what, what, um. Your brain does what your heart does.

Do you know what the blood vessels are? 'cause a lot of times people just have not had that kind of education. Like we make an assumption, we're master's clinicians who have advanced education and anatomy and a physiology, and your average person doesn't have the education that we do. But now think about someone who has minimal education, maybe from another country, right?

Or maybe they just haven't had the opportunity to hear their education in their, the language that they speak most proficiently. And so a lot of times my patients don't really understand, even my patients, um, my English speaking patients, they don't, they don't understand what a stroke is, right? So the doctors just say, oh, like you had a stroke.

You had a stroke because you have high blood pressure. That's what caused the stroke. Um, [00:51:00] it happened in, you know, whatever part of your brain, but. I don't think I fully understood what a stroke was before I became a speech pathologist. Like I didn't understand that it was like an a disruption of blood flow that leads to tissue dying that results in these deficits.

So just starting with that, making sure that my patients can tell me back what is a stroke and what happened to you. Then we work on, um, talking about the parts of the brain. If they're not able to tell me the part of the brain, like honestly, who cares? That's not important. But can they point to their head and tell me what part of the, um, brain they had their stroke in?

Like even if, if my patient can tell me left or right, like, cool, I don't expect you to necessarily memorize basal ganglia. If you can, that's great, but if you could tell me I had a stroke in my deep brain. Okay, great. Right? And then from there we talk about the role. What does that part of the brain do? So you have swallowing deficits [00:52:00] because you had a stroke in your pons, and that's the part of the brain that sends all the messages to you.

Your, um. Your swallowing muscles. Um, and then think about all the cognitive things that you could work on from that alone. So recall, can they tell you that back? So if we're working on external memory aids, can they take notes on what you just shared with them and can they re tell, um, based on their notes, can they tell you back what they've just learned?

Um, next with my patients with high blood pressure, um, the American Heart Association is a wealth of information. They have amazing articles about, um, their, my favorite is let's talk about high blood pressure and stroke. And so it breaks down, um, what systolic and diastolic blood pressure is. It talks about how that leads to strokes.

And then at the end. There's a chart that has blood pressure levels and, um, it shows what [00:53:00] normal blood pressure is, what elevated, um, hypertension, stage one, stage two, and then a hypertensive crisis. And so, um, we'll work on sequencing. So I'll go grab the blood pressure machine and I'll ask them, you know, to show me, like when you're putting the cuff on, do you understand that the cuff, the line needs to line up with your, um, blood vessel?

Um, do you understand that? Like, don't take your blood pressure while you're walking around. Don't talk uncross your legs, sit up straight. Um, and then working on them, sequencing it and then interpreting their reading. So like, you could have a, you could tell a patient to take their blood pressure all day long, but if they don't know that like 200 over 90 is putting, you're like gonna have a stroke, then, you know, like that's not useful.

So. Even just working on like, so that's calculations, right? Having them read and then interpret. That's also scanning. Scanning the chart. Can you [00:54:00] read and correctly interpret if your blood pressure is 1 23 over 80? That's pretty good. And then problem solving, if you're, if you've noticed like you're on medication in the last two days, your blood pressure has been one 40 over 90, what should you do?

I should call my doctor. If your blood pressure is one 90 over 90, that's a hypertensive emergency, I need to call 9 1 1. If your blood pressure is, you know, 100 over 70, that's too low. Don't take your blood pressure medication. So these are all like, so there's so much cognition in there to be able to manage.

So high blood pressure, and I feel like high blood pressure is probably like the easiest out of the three. Well, maybe high cholesterol, there's not as much that you do for that. But then diabetes, I mean even you could just read articles about like, um, most hospitals have diabetes education books and so.

So [00:55:00] I'll grab those books with my patients and we'll read them together and I'll ask them questions about that too. And usually the diabetes education books will have like little practice pages where, um, they'll, you know, where you could practice like counting carbs or like practice if you eat this many carbs, like how much insulin should you take?

So like the math involved in managing your blood sugar. So those are some functional ways that you can incorporate, like we're still working on all the things that SLPs do. So recall scanning attention, um, sequencing. But you're do, instead of playing a game or doing a workbook, you're teaching the patient about their body at the same time.

Kate Grandbois: I'm sitting here listening to you reflecting on all of the mistakes I've made. I, I'm, I'm, I don't even work in, you know, I've never worked in a medical setting, but thinking about using our time to. You think of language and language [00:56:00] goals because you're right, you're still addressing your goals. The activity in and of itself is just also enhancing their health literacy.

And I would, you know, I just, that I made a million mistakes, but I've never done this in therapy before. I've never considered, I mean, I've worked on self-advocacy, but for some of the older, you know, individuals I've worked with. Giving them language around how to describe their disability or how to ask for help.

Or recall. Or recall. I mean, it's just, this is brilliant. 

Jackie Rodriguez: It's awesome. Absolutely. Yep. And yeah, exactly the same thing can apply to kids. You know, do they understand what a learning disability means and, um, do they understand what autism is? That's, you know, what we call, um, disability iden, disability affirming therapy and disability identity.

So you're building this concept of an identity in a disability for our patient. So, yeah. 

Kate Grandbois: It's bringing me to a [00:57:00] related question, which is slightly off topic, but related. I wonder if you could tell us a little bit about the components of counseling that go into this, because real realistically, I mean, I thought of it when you're talking about, you know, working with children and talking about their disability because they might have feelings associated with being autistic or having a learning disability, right?

There could be shame surrounding that, that, you know, requires a little bit more of like a counseling lens instead of, let's talk about your disability today, right? Mm-hmm. And people who have suffered a stroke, you know, they've suffered a loss, they may have suffered a significant loss, they might not be in the place where they wanna talk about it.

So how do you, how do you tend to approach that? I mean, I guess it's, it's slightly, we we're talking about two different settings, you know, pediatrics and, and, um, maybe educational and medical. And I, I suppose they're pretty familiar with being at a doctor's office by the time they get to you, but there's still a counseling component involved here.

What can you tell us about. How you approach that. 

Jackie Rodriguez: [00:58:00] Yeah, for sure. So I loved, um, my supervisor in, um, grad school, my medical supervisor. She did like a really great, um, exercise with one of my patients. And even I, I didn't mention this in the beginning, but, um, one of the reasons why I got into this field was my mom, um, she had rheumatoid arthritis and she had three inpatient rehab stays.

And so I actually, you know, um, at this stage in my life, had more experience being on the caregiver side of the, of the rehab world than I do on the therapy world. And I remember using this with my mom as well during her rehab stays and my, um. My supervisor said, you know, it's really easy to get into this pattern where you're comparing your body to how you were before the stroke, right?

And, oh, I'm so frustrated because I can't remember anything. And like before the stroke, I could just remember everything and or my patients with [00:59:00] aphasia get really frustrated 'cause they can't, they're struggling to talk. And prior to the stroke it was so easy. And so she says like, try to think of the very first.

Thing that you could remember after having your stroke? Like, could you, and it might be something as simple as like, could you sit up at the side of, at, in the bed? No. Like, do you remember anything? No. Like, were you able to, um, tell me the date? No. Were you able to, um, take a step? No. Well, I, I still can't walk now.

Okay. Well you can't walk, but you just stood for 15 minutes with physical therapy, right? Or so just, um, helping to reframe that We've made progress, but then at the same time, the other side of that coin is we have to be careful with not always talking about progress. Because a lot of times our patients are not gonna get better and they're gonna have a disability for the rest of their life.

And we don't wanna, um, you [01:00:00] know. Talk so much about rehabilitation. So it could even be like, okay, well, um, you know, at the beginning of that stroke, like you, you couldn't remember anything, but you just used your strategies and you were able to tell me X, Y, and Z. You were able to like, take a note and recall this information to re um, lay it later on.

So like, positively reframing the way that a person is able to do things and able to use the strategies that they're being taught in therapy. And then also, um, I think increasing awareness and being able to advocate too, that that's a huge part of counseling because a lot of people feel really out of control when they're in the hospital.

They're like, I just had this, you know, think about like if you were in the hospital and you know. You had a stroke, but like you don't fully understand what happened to you. Like that's terrifying. [01:01:00] And so just to be equipped with this knowledge and to have someone like explain this to you, and when we talk about like vascular cognitive impairment in these like cardiovascular risk factors, the empowerment of like what you can do to prevent another hospitalization is huge for some patients.

Like I remember I had. A patient who, um, so I work in inpatient rehab at a hospital and then I also work in outpatient. So a lot of times I'll see a patient when they're in the hospital and then I'll see them when they're outside of the hospital. And I have this, um, man who I saw inside of the hospital and every time he sees me he's like, oh, you're the girl that like taught me where my stroke was.

And I feel like that is like just so, like that was so important for him to like have that information. 'cause now he understands and you get better buy-in. Um, and and another thing that I'll say in my [01:02:00] presentation sometimes too is like a lot of times we get those cognitive patients who are just so like unaware of their deficits and have no insight and they don't wanna do, they think speech therapy is like the stupidest thing ever.

And then when you start teaching them about their body, they're like, oh, this is actually really interesting. And they still might not think they have anything. Um, going on cognitively, but like now that you're teaching them, they're interested in that and you get better buy-in that way because sometimes the activities that we do cognitively feel condescending.

But when you're teaching someone about their body, that feels more meaningful. So there's, you know, power to that as well.

Kate Grandbois: I also have to assume that. As part of that lesson about their own body, that for some people that could feel like a really, like a counseling healing experience. Being given an opportunity to talk about what that was like, to talk about their experience [01:03:00] to, you know, be in a place that is encouraging, uh, communicating about it and, and thinking forward about, about how they can advocate for themselves to continue to get better.

I have to assume that for a lot of people, maybe not everyone, but that has a, a positive, um, there are some positive feelings associated with that. Yeah, for sure. I mean, and we know that when, um, your nervous system, if you're in a fight or flight state because you're so anxious with adjusting to a change like that plays a role in healing as well.

Jackie Rodriguez: So, yeah, definitely. Um, and I think too that when we approach things from a perspective of questioning, instead of assuming, um, you know, like. On. Conversely, when we approach our patients from a standpoint of assumption instead of questioning, there's a lot of implicit [01:04:00] bias that you might not realize, but that your patients are feeling, that they're feeling like they're judged, they're feeling like, you know, you think you're passing judgment on why they were at the hospital.

And, um, when you come in from that perspective of like, oh, this, this patient hasn't had the opportunity to like, receive the education that they deserve, it just is much more compassionate. And I think that our patients pick up on that compassion as well. And that also can have a very positive impact on your readiness to learn on your, how your body is feeling calm and able to access learning and just feeling safe because you feel very out of control when you're in the hospital.

Announcer: Yeah, the hospital is a no fun place to be in, in my experience. Mm-hmm. I mean, I don't know, especially when you're the person being hospitalized. Um, and so when you're [01:05:00] there and you're, you're in your acute, you're, you're providing services in an acute based environment, that person is really like often dealing with that very emergency, very uncomfortable, like scary situation.

And then if you're seeing them, you know, outpatient, some of some of your clients are probably like normalize the experience a little bit by then. Mm-hmm. Is there a difference in how you're support, I think it sounds like in both environments you're providing support around health literacy, but is there a difference in your focus?

Like do you ever help your clients work on maybe navigating some of the barriers they might have connected to social determinants of health? Or like, is that something you do more in the outpatient setting? Um, I don't know if you wanna talk about that a little bit. Yeah, no, I definitely feel like I continue to, um.

Jackie Rodriguez: You know, work on advocacy in the outpatient setting. And honestly, I think that's, um, one of the downsides of being on the outpatient of working in the [01:06:00] outpatient setting is like sometimes you get these patients who, you know, either have had a stroke or, um, you get a lot of patients that come from the community who haven't had an a hospitalizing event, but who have chronic illnesses.

So I'll see patients with like a LS MS and you see the same situation. I, I had a patient who, um, I actually have an example post on my Instagram of a patient with MS who had cognitive impairment and low health literacy and just really didn't understand his diagnosis. And so we could do those same things where we're, you know, I'm just assist.

What I see it as is like I'm assisting my patients in their journey of personal health literacy. So we find these articles from the internet. And we help the patient, we break it down in a way that can help a person, one who has cognitive impairment 'cause that's our job. But then also making these, um, adjustments because of the low health [01:07:00] literacy.

And I think, um, you know, once the patients get home, if, if, you know, it's a patient who's had a hospitalizing event that's led to speech therapy, you know, when you're in the hospital, you're, everybody's kind of like dot not, I don't wanna say dotting on you, but like you have like CNAs to help you clean yourself up.

You have a physical therapist, the nurses and doctors there all right there. And then you go home and it's like, oh my gosh, like I'm on my own. And like, this is my first time managing my, um, disability without this care team like super accessible. So that's like another feeling of overwhelm is that adjustment to the home environment and.

We can definitely bridge the gap with, um, as with reaching out to other healthcare providers as well. And then, you know, with, um, my area of expertise being dementia. Um, and a lot of times, you know, this, these that co these cardiovascular disorders start off [01:08:00] as a vascular cognitive impairment. And if we don't step in to improve the way that our patients are able to manage these cardiovascular diseases, it turns into dementia.

Right? And so I get a lot of patients with dementia from the community, and I think one big thing that you could help with, um, health literacy that I see all the time is doctors will just. Document. Dementia, dementia, dementia, dementia in their notes until they're blue in the face and no one tells the family, and this is the hill that I will die on.

Like everyone just assumes that this family knows that their family member has dementia. People who are listening can't see me and Amy's reaction where our jaws are on the floor and my eyes are gonna fall out of my head. But yeah, if you, if you, it sounds crazy, but if you work on the medical side, like it happens all the time, so, so even just [01:09:00] being like that clinician who.

Sets the fire like, Hey, just FYI like, this family has no idea that their family member has dementia and they've been referred for speech. You know, we're always just like with autism, we're the first ones who the patient gets referred to because it's, it's more for people in their grieving process of a disability, it's easier to accept that your family member is having some speech problems that can be quote unquote fixed by the speech therapist.

Right. And so, but no one initiates that hard conversation of, oh, like, I think there's more than just some memory problems going on. Or, I think there's more than just, you know, some language problems coming on. And so just being that person that could say, Hey, actually I don't think you're, are you aware that like this family, they don't, they're not aware that this person has dementia?

Or, oh, like in addition [01:10:00] to working on this person's. Dysphagia, I've noticed that they can't remember any of my strategies and I'm concerned let's get them to the neurologist. So advocating that way. Or another thing that I'll do sometimes too is if a patient, if I'm talking to a patient and it's like very clear that they're not understanding, I'll send a message to the doctor and be like, Hey, um, this patient during my session, like they gave me x, y, z questions.

I would appreciate it if you could follow up with a patient about this. Or if it's an inpatient, I'll just go get the doctor and be like, I need you to go to the patient's room and follow up on this. Um, or I'll have them like write a list of their questions that they have that I don't have the answer to.

So. I love the idea of us just continuing as professionals to advocate within these systems. Kind of going back to this idea from the beginning of the episode about infrastructure, uh, and systems and our role within them, [01:11:00] right? Are rolled in in terms of bridging the gap between the systems that our patients are a part of.

Kate Grandbois: Approaching things with compassion and empathy, understanding their lived experience, the barriers that they face, and also being advocates within the systems and the infrastructures that we work in. Mm-hmm. Um, and the ripple effect that that has. 

Jackie Rodriguez: To add to that about like ways that our patients, ways that we can light that fire of like self-advocacy for our patients too is I think also like, um, just thinking about like medical management. Like sometimes we have a really like linear way of like working on medical management as LPs.

Like we'll work on like sorting pills into the pill box and we'll ask our patients like, do you know what each one of these medications are are for? But even like advocating like, um. Making sure our patients know, like some of my patients don't realize that like, you have to call the [01:12:00] pharmacy to get a refill for your prescription.

Like that's not an automatic thing, especially my patients who are not from the United States and don't come from countries that have the same like healthcare systems like we do. So even just advocating there, um, or advocating, um, a, a funny story that I like to share sometimes is, so my mom, um, she had her arthritis was throughout her entire body, but towards the end of her life, her arthritis was starting to move into her, um, spine and she had to have a spinal, two spinal fusions.

And those were two of her three rehab stays. And um, my mom. I think that she has really influenced how passionate I am about health literacy. And she had me, my dad and my brother, um, sit down and she was like, okay, we're gonna have, um, our, I'm gonna have my appointment with my neurologist. He was the one who did her first [01:13:00] surgery.

And, um, I want you guys to all, um, do your research and I want you to come up with any questions. And we all went to the doctor's office and we pummeled this man with questions. I mean, even my dad, who like is your typical dad that just sits in the corner and never says anything, like he was asking all these questions.

And I know like, you know how sometimes when you have a speech therapy session with a super intense family and afterwards you're just like, and you just need some time to like catch your breath. Like that is what that neurologist felt after. I love that description. 

Kate Grandbois: We've all, we've all done that. We've all had that experience.

We have all 

Jackie Rodriguez: done that. Right. But. Two, one of two things happened. One, like we all had such a good understanding of like what was going to happen to my mom. And then two, I think the doctors were also like, this family is probably gonna sue us if we don't do things correctly. So they were like on top of their game.

And that's what I wish for [01:14:00] all of my patients. Like obviously I don't want all healthcare providers to like feel stressed constantly, but I want my patients to have that strong of an understanding of what's happening with their body so that, that they could advocate. And I think that's what clinicians should be thinking about as well.

Kate Grandbois: And again, just, oh, sorry. Go ahead. A 

Announcer: I was just gonna say I love that and I, and I also feel like. Be having been on the giving and receiving end of that medical appointment with all the questions. As somebody, you know, when I have clients who do come in and I have one of those sort of, like, intense moments, I also appreciate it.

Like, I appreciate that, that, that that client, that their caregivers cared enough to come up with all of these questions because it's also showing that they are so engaged in that process as well. Mm-hmm. Um, so while it can like, in the moment feel a little intense, it's actually, it's awesome, you know, and it's awesome.

It's, it's, it is. Yeah. I, I think that, that, that was such a [01:15:00] great story. Thank you for sharing that with us. 

Jackie Rodriguez: Yeah. Kate, were you gonna say something? 

Kate Grandbois: I was just gonna reiterate that this applies to everyone again, you know, and just thinking about how we can talk to. The parents, how we can talk to, because, you know, having been on both the receiving end and the, and the, uh, the personal and professional end of some of, of this, these types of appointments, if you are the patient, sometimes it's really hard to take it all in.

Right? You don't have the bandwidth to ask the questions because you're having your own personal emotional reaction to a news diagnosis. Right? And I think the same extends to parents and, uh, the same extends to care partners. I love the story you told about your whole family coming together, and I, I think that's another thing that we could help advocate for is do you have a partner you can care partner that you could bring to therapy next week?

Do you have, you know, parents for pediatrics are always [01:16:00] in the room, but are there any. Other, um, people in this person's life who you wanna invite in to help strengthen their entire, and again, I'm gonna use the word ecosystem as my new favorite word recently. Mm-hmm. You know, to really strengthen their ecosystem so that there is a shared understanding.

And they're not the ones who are solely responsible for going home and being like, let me try and remember every single thing I learned today about my brain, or about my disorder, or my disability, or whatever it is. So I was just really making the comment that it, this, this again, is pervasive across our entire discipline.

I wonder if you could tell us just on that note, a little bit about the call to action here. Right. So for anyone listening who is working as a med, SLP, or not anybody who's even like working in a school or working in pediatrics, um. How can we continue this conversation? How can we kind of [01:17:00] bring this into our, our therapy sessions tomorrow?

Jackie Rodriguez: Yeah. So really quickly, going back to y'all's point, I think, um, to like Amy's point, I think that, um, it, I love like the idea of bring, like, I think sometimes it's jarring when we have these situations where the family members are really intense. And I think one of my calls to action is just to rem to consider like my experience being on the other side, right?

That when you have these moments and you're, these family members are, you know, coming off maybe as like a little aggressive, like, whoa, she's doing too much. Like they're just trying to advocate. And what I have found is that like. Your feedback can look like, oh wow, that was a great question. Like, thank you for asking me this.

Like, it sounds like you guys have such a great handle on this and you'll, a lot of times it's rooted in fear, right? So like, when my mom had that surgery, it was very [01:18:00] scary. Like that was a, a very risky surgery. And so a lot of times families are scared 'cause they don't understand and because there's so much, so many question marks and unknown.

So, um, and then also, you know, Kate, to your point, I also had with bringing in like family members, that's something that I often encourage my patients to do. Um, and I used to have a, when I worked with children, I had a mom who like, she would rotate like her. She had two, this was a mom of an autistic child who I think he was like an accident baby.

'cause he was a lot younger than his siblings. And she would rotate and have the two older siblings come. And then dad came, abuela came a couple of times. So it was nice to have that like. Support, like what you mentioned. Um, and so I think one of my calls to action definitely is gonna be like, just take a step back and, you know, try to remember when you have those, in those intense, um, [01:19:00] families that they're, you know, they care and they're scared and they wanna learn more.

And then I also think, you know, as we've said throughout this session. To always lead with curiosity and questions, because a lot of times our bias gets in the way, right? And, um, so often there are so many of these health literacy, social determinants of health factors that are influencing why, you know, your patient is not consistently coming to therapy or why they're 30 minutes late every single time, or why your patient is quote unquote noncompliant, or why, you know, this patient has had two strokes and two rehab stays.

Why are they, why do they keep coming back? Like, what's going on? So, um, when we lead with compassion instead of judgment and curiosity and just asking why and trying to figure out where the breakdown is, we get better results and our patients get better results and, but get better care. [01:20:00] 

Kate Grandbois: And I think that's a huge takeaway, right?

That our patients get better results. That is why we show up. That's why we're going to work. That's why we as people continue to get out of bed in the morning. That is our job, is to support other individuals getting better results. And I, I, I, I think that that was just so well said in our last couple of minutes.

I wonder if you've just given us so many words of wisdom, but I wonder if there, for the speech pathologist who is listening, who feels intimidated or not supported by their boss or is new to the field and isn't, you know, that comfortable with health literacy because they feel like they had to stick to their plan and stick to their goals.

What can you say to, um, our audience who is maybe feeling a little intimidated or unsure about what to do next? 

Jackie Rodriguez: Yeah, so I think the biggest thing that I, [01:21:00] um, like the pushback that I get when I talk about health literacy is people will say like, well, is that like within our scope of practice? And so, you know, remember one, your patients have already been diagnosed with these disorders, like we're not diagnosing anyone with anything.

And just think back to that personal health literacy. So we're using our organizational health literacy to aid a patient in their ability to. Improve their own personal health literacy. So I talked about in the beginning how we should be googling our symptoms. We should be trying to learn as much as we can on our own, but there's so many barriers.

So you could just start very easily. You could start with, you know, um, pages like, like the American Health um, association, or I'm sorry, the American Heart Association. Um, and then within the American Heart Association, there's the American Stroke Association. They have great resources. [01:22:00] Um, there's also the kidney school modules, they have, they're literally like modules about chronic kidney disease.

So you could watch those with your patient. And so basically what you're just doing is you're just taking any resource that's already pre-made. About health and just breaking it down in an easier way for your patient to be able to understand. And honestly, once I started working, like incorporating health literacy, it's so much easier.

Like I don't have to like plan sessions. Like I could just like, there's so many free pre-made things that you could already incorporate into your therapy and you know, like taking your blood pressure is an A DL for many of our patients. Managing your diabetes is an A DL. So we're just thinking outside of the box and I personally feel like it's a lot easier to use some of these [01:23:00] resources that are already out there and available.

We just need to make sure that they're better accessible to our patient. 

Kate Grandbois: Thank you so much for sharing so much with us today. Everything from the incredibly important history lesson to all of the advocacy that we could be doing for our patients and families. We are tremendously grateful to you and for your time.

I also, uh, wanna say a quick thank you to some of the other people on our team who make this podcast possible. Uh, so Dr. Anna Paul Mui, who is our CE administrator, she makes our ashes EU possible Tegan or her and our project manager. She wears a million hats, uh, keeps the project alive. Darren Lopez, our production assistant who produces all of our course materials.

Tracy Callahan, our advisory board member, along with Dr. Mary Beth Schmidt, who both helped to consult and make our peer review process possible, um, as well as our advisory board, who we bring into the fold to help us review when we don't have the [01:24:00] internal expertise. For anybody listening who would like to our national CEUs for this episode, the link is in the show notes.

Anybody who is listening to this episode who would like to earn as to see use the link is in the show notes. Also, if you learned anything today, if you enjoyed today's episode, please, please, please leave a comment. Uh, rate us in your podcast player.

Find us on social media, find Jackie Rodriguez on social media. We love to hear from all of our listeners, and we're very grateful for, for everyone who, um, everyone who participates. So thanks again, Jackie, so much. 

Jackie Rodriguez: Thank you for having me. Thanks, Jackie. Thank you.

Outro

Kate Grandbois: Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or [01:25:00] you can go to our website, www.slpnerdcast.com all of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at [email protected]

thank you so much for joining us and we hope to welcome you back here again soon.

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