American Speech-Language-Hearing Association

Ethics Roundtable: When Student and Supervisor Disagree About Patient Care

Response by Sara Gambs

Sara Gambs
Clinical Fellow-Speech-Language Pathology
Audiology/Speech Pathology Services
Ann Arbor VA Health System.
Ann Arbor, Michigan

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As a student in speech language pathology, Scott should be bound by the same code of ethics that guided his supervisor' s conduct, and his responsibility as a patient advocate and clinician is stated therein. The code instructs Scott to hold the welfare of the patient paramount, and states that "Individuals shall not provide professional services without exercising independent professional judgment..." Scott is therefore obligated to pursue his concern about Ms. Robertson' s swallowing, despite the delicate nature of the student-supervisor relationship.

Unfortunately, ASHA' s code of ethics provides Scott little guidance as to how to resolve this conflict. It confers a profound responsibility upon him, that of Ms. Robertson' s welfare, but offers little instruction in how to approach his supervisor and ask her to reconsider her opinion. Scott' s best plan of action may be to re-open the issue as a teaching case. Scott could explain that he has not seen many swallowing cases, and that he was unable to distinguish between "getting over pneumonia" and aspiration. He could ask his supervisor how to discriminate between the two groups, and what criteria she uses to decide when a patient should be assessed for swallowing problems. During this discussion, Scott can bring out points specific to Ms. Robertson, and ask the supervisor to explain the differences between aspiration and this patient' s behavior. Presenting the topic in this manner is non-threatening and should not cause the supervisor to feel that she is being challenged. At the same time, the information that she provides may help clarify the situation. It is possible that Scott may learn something about the patient' s condition that leads him to understand the supervisor' s viewpoint. He may discover that there is a difference between this case and others that logically precludes a swallowing assessment for this patient. Another possible outcome is that the supervisor will provide an unsatisfactory response to Scott' s query, and he remains concerned that this issue is being managed improperly. In this case, it is difficult to press the issue much further. The student is in a uniquely precarious situation, and whether or not the conversation should continue will have to be determined by the student' s individual judgment.

Obviously, some supervisors are more approachable than others, and would not feel as though they were being contradicted by continued discussion. Others may interpret this persistence very negatively, which could impact their view of the student' s performance as a clinician or as part of a team. A logical next step might be for Scott to consult with his university. The clinic director or other advisor may be able to put the issue in perspective and help Scott recognize his responsibility. However, taking further action with the supervisor or other hospital personnel is ill advised. The bottom line in this scenario is that the student must approach the supervisor and ask for clarification about this situation. If the supervisor does not see the need for swallowing intervention after the discussion, then the student has little recourse.

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