Dr. Robert Miller’s clinical focus is in the area of adult neurogenic communication disorders, with an emphasis on dysphagia in adults. He’s worked at the Department of Veterans Affairs as a speech-language pathologist and at the VA Puget Sound Health Care System as the Chief of Audiology and Speech Pathology. Dr. Miller is currently a Senior Lecturer Emeritus at the University of Washington in the Department of Speech and Hearing Sciences. He is a Fellow of the American Speech-Language-Hearing Association and was awarded Honors in 2014.
What inspired you to become an instructor?
The most rewarding aspect of teaching is to observe the learning. Not learning as in the recollection of facts — no matter how important the facts may be — but insightful learning, which in some instances leads to the emergence of wisdom. It’s the “aha” learning that stays with a student long after facts dim and blend. From the classroom lectern you know when inspiration dawns, as the tenor of questions shifts and discussions transform to center on more vital concepts. In the clinic a student clinician’s posture, inflection, and facial expression adjust to reflect a new level of confidence in their decision-making. At the same time, when this level of learning is genuine, it is clear that the student appreciates the delicate nature of what they have attained and realize that it requires continuous expansion and nurturing.
At this time in my career, my didactic lessons focus on the “neural basis for speech and language.” It is not unusual for beginning graduate students to express aversion, apprehension, and, even more worrisome, apathy for the subject. At the course conclusion, these same students acknowledge a conversion of perspective and a new appreciation for the topic. It’s at this moment that I am rewarded by the realization that these future clinicians soon will be providing clinical services guided by principles and insights that emerged in my presence—and perhaps through my efforts.
Tell us about a memorable moment in your career
After 45 years of professional work, it is so very difficult to comment on specific inspiring instances. Yet, when I reflect back, there is one particular patient, a self-described curmudgeon, who made a lasting impression. A veteran of WWII with a 40-year history of dysphagia and fear of swallowing, he reluctantly arrived in my clinic at the insistence of an otolaryngologist. He immediately announced that there was no cure for what ailed him; he was only here because the “good doctor insisted.” During the war he had suffered shrapnel wounds to his neck and several peripheral nerves were traumatized. By his report, he coped with his swallowing impairment by avoiding the embarrassment of eating and drinking around others. He indicated that he did not enjoy eating and was in constant fear of choking.
Before grudgingly allowing me to conduct an examination, he insisted on demonstrating his swallowing difficulties. His attempt to swallow a sip of water set up an immediate and prolonged coughing episode. “Hopeless,” he pronounced.
After my inspection and observation of his “swallowing behavior,” I encouraged him to turn his head slightly toward his weaker side and dip his chin slightly forward when swallowing. Expressing little optimism for success, he gave it a try. The result was positive and well beyond my wildest expectations—no choking, no coughing, and not even a hint of difficulty. After numerous additional successful trials, he began to tear and then broke down into full-out crying. The long-term outcome for this patient was entirely triumphant. He was able to resume an active social life that included eating and drinking without fear of embarrassment.
What is the most rewarding part of being a Speech-Language Pathologist?
At the beginning of my career our profession was in its infancy with regard to practicing in a medical environment. I was fortunate to work with a true pioneer, Dr. George Larsen. During this time, I was able to observe–and sometimes contribute–to his innovative projects. Our clinic may have been the first to conduct “video” fluoroscopic swallowing examinations, where we set up a camera to directly film a fluoroscopic image and record it on a reel-to-reel recorder.
Beginning in the mid-1970s, Larsen was organizing regional VA workshops on the topic of dysphagia and enlisted my assistance in teaching the therapeutic processes that he originally described—most of which are still utilized today. In 1977, Dr. Michael Groher (another Larsonite) and I presented the first ASHA mini-seminar on dysphagia. And, beginning in 1980, I created and taught graduate level courses in medical speech pathology and dysphagia at the University of Washington.
What many clinicians may not fully appreciate is that originally our profession–as represented by both ASHA and many academic programs–did not accept dysphagia as a clinical condition that could or should be addressed by SLPs. In 1983, I was asked by the association to debate this question with a prominent academician at ASHA’s Western Regional Conference in Honolulu. Given where we are today, perhaps I did in fact win that debate!
What excites you the most about working with MedBridge?
MedBridge is not just another vendor of continuing education products. They have a mission and vision to ultimately improve the outcomes for patients participating in rehabilitation. They are sincere in their efforts to assure quality in all of their products and their team is tireless in working toward this goal. Finally, while remaining dedicated, the team members with whom I have worked are fun! They maintain their individuality, explore their unique interests and engage instructors in a most cordial manner. They keep the atmosphere around course production relaxed, support one another to make the final product a true team effort, and express their appreciation and excitement about my work as a presenter.