Practice in dysphagia is evolving quickly. Rehabilitation is replacing compensation for nearly all patient populations. The evidence base for rehabilitative techniques is growing. The attitude that tubes are a treatment is in retreat. Patient desire and quality of life are as important, and sometimes more important than are an institution or practitioner’s assumed risk. These topics will be developed with patient examples and against the background of a realization that the speaker, like many members of the audience, will have clinical responsibilities on Monday a.m. after the conference.