AN INTERVIEW WITH ANDREW REDMANN, MD
What other non-physician professionals does an otolaryngologist work closely with?
Otolaryngologists work with a variety of other allied health professionals, but the most common people we work with on a day-to-day basis are audiologists and speech language pathologists. We also work with nurses and physician assistants to take care of patients, including both nurse practitioners (NPs) and registered nurses (RNs). Along with nurses, there are a broad range of other professionals that help us take care of our patients including social workers, nutritionists, physical therapists, and occupational therapists.
What are their roles in patient care along with the otolaryngologist?
Audiologists are hugely important in taking care of any patients with otologic (ear) concerns and assist with hearing aid fitting, cochlear implant evaluations, and vestibular (balance) testing. The most important test for any patient with an otologic complaint is an audiogram, which are usually performed by audiologists (though otolaryngologists can administer this test as well in some situations). Audiologists and otolaryngologists work closely together on wide variety of patients.
Speech language pathologists primarily work with patients who have voice and swallowing concerns, and assist with swallowing studies, videostroboscopy, and speech and language therapies. Often speech language pathologists will schedule regular therapy sessions for patients with swallowing/voice concerns, allowing a more regularly scheduled contact point and consistent therapy.
Nutritionists often work closely with head and neck surgical oncologists to maximize nutritional plans for patients undergoing surgical, radiation, and chemotherapy. Nutrition is extremely important for healing during treatment and is an often overlooked portion of therapy.
What are the challenges in working across roles and disciplines?
There are few challenges to working together, but a few do arise. In particular, audiologists are seeking to expand their scope of practice to more independently dispense hearing aids and limit the input of physicians in this respect. The American Academy of Otolaryngology–Head and Neck Surgery does not support this movement, primarily due to the different training that physicians and audiologists receive. To dispense a hearing aid to a patient who has a potentially treatable cause of hearing loss would not be in the best interest of our mutual patients. The current collaborative model is better for patients and both audiologists and otolaryngologists. There are fewer scope of practice issues with speech language pathologists, as most videostroboscopies are performed in conjunction with both speech language pathologists and otolaryngologists. Overall however, ENTs and allied health professionals have good relationships and there are plenty of opportunities for close collaboration.
What are the differences in what an otolaryngologist does versus others on the patient team?
Audiologists and speech language pathologists cannot diagnose medical pathologies and cannot dispense prescriptions or recommend surgery. There are plenty of areas for collaboration, but the scopes of practice are different. Otolaryngologists are the “quarterback” of the healthcare team for patients with ear, nose, and throat issues, and thus generally drive care for these patients in conjunction with allied health professionals.
What other types of physicians do otolaryngologists work with on a regular basis?
Otolaryngologists work with almost every other medical specialty, and this depends slightly on the subspecialty. For example, pediatric otolaryngologists work with gastroenterologists and pulmonologists to treat conditions of the aerodigestive tract and bring different perspectives to treatment for these complex patients. Head and neck oncologists work extensively in multidisciplinary teams with radiation and medical oncologists, as well as pathologists, radiologists (both interventional and diagnostic), and general surgeons (for gastrostomy tubes). Neurotologists and rhinologists work with neurosurgeons on a regular basis to treat tumors of the skull base. Almost all otolaryngologists will work with critical care physicians, allergists, anesthesiologists, and primary care physicians depending on the patient’s primary issue. Collaboration with anesthesiologists deserves special mention, as many otolaryngology patients have altered airway anatomy, and close communication is of paramount importance to best care for these patients. However, overall it would be difficult to find a medical specialty that otolaryngologists don’t interact with.
About Andrew Redmann
Andrew Redmann, MD, is a current resident in training at Cincinnati Children’s Hospital Medical Center after finishing residency at the University of Cincinnati Medical Center.