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C. Evans' comments about the National Dysphagia Diet (NDD) in the March 18 issue are unfair and misinformed. I have only a cursory knowledge of the NDD, and from the in-service I attended, I believe the NDD was developed thoughtfully and carefully with plenty of sound food and nutritional science behind it.
I would much rather have a patient with mild bolus prep difficulties have soft, easily chewable meat pieces than the dried, flaky, and visually unappealing crumble that masquerades as mechanical soft meat in most places.
I work in a large metropolitan area, with many HMOs and health systems. There is a critical need for standardization among diets at acute and subacute facilities. My colleague has a very busy chart comparing the different dysphagia diet stages or levels at most of the hospitals in the area. When I worked in long-term care, I often found myself interpreting what a particular hospital's "Stage IV" diet was for the dietary manager. Dangerous mistakes can happen when these monikers are misinterpreted. Patients inevitably transfer, and having a shared dietary vocabulary would be welcome.
Maybe Evans should do more to educate the physicians whom she says write blanket diet orders without first consulting an SLP. The physicians I work with know what I do and when to issue a consult—in part because I've gone out of my way to reach out to them through regular and consistent professional communication.
Evan B. Page
St. Paul, MN
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