Do you think we need more swallowing therapies? Do you hand out a standard list of therapy worksheets for many of your patients with swallowing problems? Have you ever thought "Tell me what to do!" when faced with making decisions about treating patients? In this installment of Down the Hatch (The Swallowing Podcast), Alicia and Ianessa discuss the dilemma facing many SLPs who treat dysphagia. Alicia and I suggest focusing on the process of deciding whether therapy is needed and/or which therapy should be recommended, and we suspect that very little time is spent on clinical decision-making (rather just the execution of therapy). This is a skill that SLPs should possess and is required to actually provide the correct individualized treatment, rather than simply providing the same list of swallowing therapies for all of individuals with dysphagia.