Orders that make you go, "huh?"

We don't get very many head and neck cancer patients at my facility. With the arrival of a new ENT, we have been getting an increasing number, but we still don't have near the volume of some hospitals. Perhaps that's why some of our docs seem a little puzzled when it comes to some of our laryngectomees and other HANC patients, as evidenced by a couple of recent orders:

• On a patient several years post total laryngectomy: "Swallowing evaluation -- rule out aspiration". Unless you're pouring food and liquids into the patient's stoma (or have reason to suspect a tracheo-esophageal fistula), I doubt it!

• On a patient with a fresh TOTAL glossectomy and total laryngectomy: "Speech therapy for electrolarynx". While the electrolarynx will compensate for the absent vocal cords, it can't do a thing for the inability to articulate due to the glossectomy!

• My all time favorite, written by a first-year resident on a patient with a recent total laryngectomy: "Speech evaluation -- ? Passy-Muir Valve?" Uh, no! A tracheostomy valve to shunt air up through the vocal cords to enable vocalization will not work if those vocal cords (actually, the entire larynx) are surgically removed. Obviously. (Although, truthfully, I was really happy that facilitating communication was at least being considered!)