Wen a head cold struck Drew Hirshfield while he was in Boston, the New York-based professional actor was left with subtle yet impactful changes to his voice—a voice that was already coping with the challenges of performing eight shows a week. He found himself at the Brigham and Women’s Voice Clinic seeking care. What he didn’t know was his initial visit would present medical professionals working in collaboration, all for the good of the singer. It is a model of care that he now describes as “unparalleled in benefit to vocal performers.”
Hirshfield is one of many performers in music and theater who receive care at the only clinic in Boston which provides this Interdisciplinary Collaborative Model of Care (ICMC) where at the initial appointment the doctor and the speech-language pathologist (SLP) assess the voice, talk through the issues, and develop a plan that will include the patient, their voice teacher, and any other medical professional they receive care from. “It was incredibly helpful to have both an MD and SLP present and collaborating to provide immediate care that was wonderfully thoughtful, detailed, and compassionate,” says Hirshfield.
It’s no accident that this model came together so successfully at Brigham and Women’s. Laryngologists Dr. Jayme Dowdall and Dr. Thomas Carroll and SLP Chandler Thompson all have strong backgrounds in singing and know what it is like to be too busy to take time off from work, battle traffic, and pay for parking to see the doctor—and then have to turn around to come back a second time to meet with the SLP.
Dr. Dowdall got her start in singing as a child in Kansas and knew she wanted to be a singer. As a teen, she wondered if Mariah Carey might one day need a doctor for her voice. While in her undergraduate program in voice at Boston University, she knew she had to choose between singing and medicine. Ultimately she leaned toward medicine and ended up attending Boston University’s medical school, where she discovered there was an emerging field called laryngology where she could fuse her passion for the voice with a love of medicine.
Dr. Carroll came from a musical family and grew up singing in choirs. He pursued an undergraduate degree in music theory and history from Oberlin College. After finishing medical school at Wright State University’s Boonshoft School of Medicine, he became a clinical and research fellow at the University of Pittsburgh Medical Center.
It was here that Carroll was trained in the ICMC, which inspired the way the team delivers care today at Brigham and Women’s Hospital in Boston. As a fellow, he saw firsthand the benefit to singers of the collaborative care model. Patients were more likely to return for follow-up therapy sessions and, therefore, have a better outcome in resolving their voice problem when both an MD and SLP were present at the initial visit.
The importance of the connection both doctors have to singing and the impact it has on their work with singers is captured by Dr. Carroll, who says, “There’s an aha moment where the [singer] realizes you really know what they are talking about.”
The third member of the team at Brigham and Women’s, Chandler Thompson CCC-SLP, coordinator of voice services, earned her DMA at Michigan State University and spent years teaching voice as well as directing and performing in operas. She returned to New York Medical College to obtain her master of science in speech-language pathology, where she won the Clinical Excellence Award. Now Thompson has over a decade of experience as an SLP working with Grammy and Oscar award-winning performers in addition to students, aspiring singers, actors, professors, teachers, and voice-over artists.
From the perspective of the SLP, Thompson indicates that the joint clinic visit allows the singer to leave with their first therapy appointment scheduled. “This means that the singer does not have to see a laryngologist,” she says, “then get a referral for a voice evaluation elsewhere, then wait for that appointment, then wait to see if therapy is recommended, then wait for therapy to be scheduled.”
Thompson also emphasizes the role communication plays in improving the patient’s experience. “This model allows me to hear exactly what the physician said to the singer/patient, so that if they see me for voice therapy, I can restate or reinforce what was said,” she says.
Research backs up both patient and clinician experiences.1 Several studies show that having an SLP present for the initial evaluation is linked to higher rates of attendance at subsequent therapy sessions as well as increases the likelihood of patients having successful therapeutic outcomes. The reason for this success is, in part, due to the ability of two medical providers to help patients better understand what is happening and to see at their very first visit that change in the voice is possible.
Improved communication in this innovative model is critical for the laryngologists as well. Dr. Dowdall credits this model with changing the way she practices medicine. She was not initially trained in the ICMC method, but cites three ways the model has improved her caregiving. The first, she says, is by simply being a better listener. With two providers in the room, the medical team is able to help each other to know when a patient does not understand the information presented, and together they move beyond focusing only on a correct diagnosis to understand exactly what the information means to the individual patient.
The second way is by simply checking her ego at the door. Dowdall has realized a level of humility and self-reflection through this model. The patient becomes the most important person in the room, and the laryngologist is a member of a team where surgery is only one possible outcome. And the third way is by leaving each evaluation with a better sense of what is possible for each singer’s instrument.
The wisdom of this care model lies in the understanding that these medical professionals have—that for a singer, the whole body is the instrument. Given the career demands of being a performer, they are often short on time. Maybe they are in town just for a few days for a show or have a recital coming up in a week. In those cases, they don’t have time to see a laryngologist and then wait several weeks to make an appointment to be seen by a speech-language pathologist to take the next step. They need a plan and they need it today! Because of that, the voice clinic tries as often as possible to see singers the same day they call for an appointment.
These initial visits take up to 45 minutes and include taking a history, completing a full voice evaluation and a visual examination of the vocal anatomy, and taking time to talk with the singer in terms they can understand about what is happening with the voice. “They had an understanding of the complex demands on a voice professional performing eight shows a week and a sensitivity for the difficulty that even the most relatively minor vocal issues can present,” Hirshfield reports of his experience.
It’s clear that the singer is at the center of care at Brigham and Women’s Voice Clinic, where the doctors and clinicians not only bring their own passion for singing but also their passion about the care they provide. In fact, they have been known to attend their patients’ performances, watching and offering feedback on subtle shifts the singers can make to improve their vocal function. From the beginning to the end of treatment, the Interdisciplinary Collaborative Model of Care practiced at Brigham and Women’s Voice Clinic pairs singers and other voice professionals with highly qualified professionals who are uniquely positioned to understand and empathize with their particular needs.
