When Student and Supervisor Disagree

Ethics Roundtable: Case Study

Ms. Robertson, a 78-year-old is hospitalized after a hip fracture. A speech-language consultation is requested because her physician is concerned about her cognitive abilities. The evaluation is conducted by Scott, a student clinician. He observes mild cognitive deficits, but also notes that Ms. Robertson coughs immediately after taking sips of water and that she has a wet voice quality for several minutes after drinking. From the medical record, Scott notes that she had pneumonia on admission to the hospital and has been treated for pneumonia at least three times in the past nine months.

Scott discusses his observations with his supervisor. He recommends a "bedside" swallowing evaluation and possible videofluoroscopic swallow examination. His supervisor suggests that she coughs because she is recovering from pneumonia. Furthermore, they were consulted for a cognitive assessment, thus his observations about her swallowing are inappropriate to include in his report. Scott is concerned about the patient, but unsure of his role as a student and questions how to interpret his own observations.

Questions to Consider

  • Does the Code of Ethics provide guidance in this case?
  • What is the role of a student in advocating for patients and handling disagreements with a supervisor?
  • What approaches could Scott take to continue the discussion with the supervisor?

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