The guidelines say to manage risk. But what if the guidelines are the problem? In this episode of Dysphagia Research Bites, Dr Shaun O'Keeffe and I unpack his critique of the Royal College of Physicians' guidance on eating and drinking difficulties, and we ask the question that too few clinicians are asking: is our fear of aspiration actually driving good practice, or just driving restriction?

In this episode we cover:

• The difference between aspiration and aspiration pneumonia, and why conflating them causes harm
• Why dietary modifications and thickened fluids are not evidence-based strategies for preventing pneumonia
• The BOLUS Framework and why Shaun takes issue with how it frames risk
• Why "unsafe swallow" is a term that needs to go
• The evidence, or lack of it, behind nil by mouth orders for dysphagic patients
• Informed consent, patient choice, and why quality of life has to be part of the conversation
• Why the profession is at a crossroads between risk-averse practice and evidence-based care

The article this episode is based on:

O'Keeffe, Shaun & Murray, Aoife & Leslie, Paula & Collins, Lindsey & Lazenby-Paterson, Tracy & Mccurtin, Arlene & Mulkerrin, Siofra & Smith, Alison. (2021). Aspiration, risk and risk feeding: A critique of the royal college of physicians guidance on care of people with eating and drinking difficulties. Advances in Communication and Swallowing. 1-10. 10.3233/ACS-210031.