The role of the speech pathologist in the acute hospital setting has changed remarkably over the last 10 to 15 years. The majority of the speech pathologist's caseload currently consists of individuals with dysphagia from a variety of causes, whereas previously the clinician's role focused on individuals with communication disorders. Although the assessment and treatment of dysphagia is of vital importance, its management has largely been at the expense of assessment and treatment of communication disorders. This article discusses possible reasons for the current situation, as well as implications of this for both individuals with communication problems and for the speech pathology profession. It also suggests ways of dealing with both swallowing and communication problems in the acute setting, while minimising increases in time and effort involved.