I am not a medical doctor, nor do I pretend to be one, but I am a very informed “patient.” I learned the hard way (feel free to peruse my Trial of Labor blog, last update 2015) that it is my responsibility and right to obtain high-quality health care solutions that are evidence-based and meet my unique (unique in that I am an individual not a disease/disability/multipara/abnormality/etc.) needs and desires. Patient wishes are largely undervalued in the medical system, and I see this bleed over into my primary field, vocal performance and teaching.
Nearly all of my collegiate teaching has taken place at state universities that primarily serve 1st-generation, in-state, college students. It is a blessing to be able to serve in this population base as I feel some kinship here… my dad was the first on his side to finish college, but I am the first on my mom’s side to receive an undergraduate degree. I don’t know many on either side of my family (like maybe NONE) who earned a doctoral degree. That said, I grew up for a good portion of my life in a privileged setting. My folks were poor as church mice when I was young but quickly climbed the social & economic ladder. I remember both lives and the happiness and stress attached to living with and without money. I am also privileged in that I am white – my experience in the health care system is very different because of that. Many of the students I work with have no health insurance or are underinsured and come from very diverse backgrounds, and well sorry for beating around the bush to get to my point, but:
Many of my students do not have health insurance, are under-insured, or deal with other blockades to access the critical, time-sensitive health care that they need as vocal athletes.
It’s all good and fine for me as a teacher to know that I’m not a psychologist or a GI specialist or a laryngologist or a speech pathologist. However, when my students can’t access specialists due to COST and LACK OF TIME-SENSITIVE ACCESS, I’m all they’ve got beyond their GP who might not really be able to help them. This means that, YES, in my teaching studio:
- Some lessons are more about their personal (and/or professional) struggles than they are about singing. When my students are on the verge of tears, I don’t believe they benefit from singing through it. It’s ok if you don’t agree with me. And yes, I often refer obviously distressed students (and MIA students) to the appropriate specialists on campus.
- Sometimes I hand out a reflux survey and based on their results, recommend they speak with their GP about reflux, or with persistent hoarseness, recommend they get scoped. Sure, I may mention an OTC med as a trial (which was a rec given to me by a SLP friend & professor)… just like I’d given anyone my solicited advice on this if they care enough to ask and I feel comfortable giving them a recommendation. A recommendation is not a medical diagnosis; it’s an act of caring. I also ask about their diet and give them basic recommendations (that are widely accessible) for diet modifications and other best practices for reflux management. I always ask them to check with a medical provider.
- Sometimes a student returns from a summer break or an acute URI, and it’s obvious that they are struggling with muscle imbalances that are best treated with voice therapy in addition to their voice lessons. However, most of my students can’t afford speech therapy, so I am left to help them to the best of my ability. I have learned a lot from dealing with a couple of students with diagnosed (and suspected) Muscle Tension Dysphonia. Was their progress as quick as if they had done speech therapy – nope. That’s the price they pay for not being able to pay for therapy. It’s really unfair.
It’s amazing to me how many people want to define my Scope of Practice for me as if I can’t figure out what I know and what I don’t know. Expertise is gained in many ways; expertise is developed when and where it is lacking (hopefully). Just because I live in a larger city does not mean the medical community has the capacity to keep up with demand much less with specialized needs. It is my job, then, to help my students navigate the medical system to the best of their ability and help them fill the gaps left behind by inadequate and inaccessible care. I haven’t even addressed the socio-economic and racial components here, but you betcha that they’re ever present.
If you deal with an affluent student population that do not experience the very typical barriers to timely and affordable health care, that is WONDERFUL. Those are not my students; that is not my community. I am not a medical doctor and never claim to substitute as one. I am a patient advocate, an informed practitioner, and often my students’ only hope for sound and affordable advice and care.
PS – I have an advanced certificate in the newer field of Vocology,
earned under Dr. Ingo Titze through the National Center for Voice and Speech
Evidence Informed singing 