Medical Social Work
Explore the field of medical social work
Medicine is a complex and bewildering world for patients, an undecipherable morass of paperwork, procedures, and medical parlance, laced with the fear of financial devastation and worse. To minimize patient anxieties, many hospitals and clinics employ medical social workers who are the lifesaving interface between the patient and the medical bureaucracy.
Illness often overwhelms a family's emotional resources. At a time when families are least able to cope, they are often inundated with decisions. Medical social workers act as advocates for patients, assessing patients' strengths, abilities to cope, speaking their concerns, and helping them understand the many details.
Medical social workers' professional directive is to help facilitate the needs of patients as they maneuver the difficulties of the health care system. Social workers are typically responsible for the planning and discharge arrangements for patients, particularly the elderly or those for whom post-hospital treatment is vital. These tasks include everything from providing transportation and clothes to arranging for nursing homes, rehabilitation, or specialized in-home equipment or care.
Medical social workers must also be exceptionally skilled at communicating with medical staff, knowledgeable about medical diagnoses and treatment requirements, and have an ability to be engaging and responsive to patients of all walks of life. These workers make the intimidating medical world understandable for patients by working on their behalf.
Medical social workers assess conditions and establish cases for patients, documenting treatments, intervention plans, recuperative strategies, and providing the ongoing assessments that are fundamental to the social work process.
Genetics counselors are specialized health care counselors with graduate degrees in medical genetics. They are often scientifically trained social workers who are members of health care teams that work with individuals and families at risk of genetically based diseases.
Read more about genetics counseling...
Patient needs are determined by the information contained in these assessments. During the assessment, medical social workers examine the health status of various aspects of the patient's life – their medical prognosis, their psychological profile and mental health status, any cultural particularities that might affect their recovery, and spiritual influences that could affect their attitudes.
Typically, an assessment will be a comprehensive and culturally sensitive assessment that includes:
- past and current health status
- family's genetic history
- family's health history
- comprehensive description of the patient's health at discharge and the effect of illness and ongoing treatment on his or her psychological or physical functioning
- the effect of treatments on cognitive function and emotional state
- description of home environment
- description of work, school, or vocation
- age and related developmental issues
- cultural values and beliefs
- family structure and the patient’s position in the family
- social supports: friends, church, therapists, support group
- behavioral and mental health status
- mental health history, suicide risk, method of coping
- financial situation and resources
- health insurance
Patients are monitored through a case management system that keeps track of their care plans, and is continually updated through the assessment process. It is a collaborative process among physicians, therapists, and medical social workers that facilitates patients' post-hospital needs, and sets a course that includes discharge plans, lodging arrangements, counseling, transportation, and a myriad of other resources.
A crisis is a personal experience. Psychologists define it from the perspective of the person who experiences it rather than by an event. Causes vary, from natural disasters to personal abuse or mental or emotional instability. The crisis is typically a perception or an experience that exceeds an individual's coping mechanisms. It's a situation that can't be resolved using the individual's normal problem-solving skills.
Read more about Crisis Intervention...
In the course of managing the case, medical social workers often set goals and objectives for patients' care and ongoing recovery. These can include a variety of milestones, such as moving from a wheelchair to a walker for a joint-replacement case, a reduction in medication dose, an appointment with a specialist, or the removal of a cast. These goals document patients' progress and provide a structure that gives the patients a voice in their own recovery.
Patient advocacy, the social worker's obligation to speak on behalf of patients, is particularly important in caring for the psychosocial needs of both patients and their families. Caring for a family member can be stressful for both the caregiver and the patient. Medical social workers often make home visits specifically to assess the health and well-being of the caregivers.
A home assessment might reveal that the patient's medical condition has changed in some significant way. The medical social worker must report to the patient's doctor or healthcare provider to insure that progress is ongoing and that there haven't been any setbacks. Documentation must also show that the patient is complying with the medical directives, and that reactions or unforeseen circumstances have not occurred.
Home visits also give caregivers and patients the opportunity to interact with medical social service workers in the comfort and privacy of their own homes. This enables the workers to offer more individualized advice and, in these settings, social workers can more accurately assess the family's coping mechanisms.
Bridging the gap
A good example of case management is the situation of a 95-year-old woman. She is mentally alert and strong for her age - so strong that she has outlived her pacemaker. As the old pacemaker slowed, her general physical condition began to weaken, and she became susceptible to several bacterial infections causing her physician to hospitalize her. A lengthy hospital stay revived her general health and the pacemaker was replaced.
The extended bed rest weakened Marie and she can no longer use her walker, so her physician prescribed physical therapy to keep her active. The medical social worker who monitors Marie's case set to work finding a nursing home that would provide both the therapy and the medical management needed to dispense her medications.
Marie is Lebanese and speaks five languages, but not English. She lives with her daughter and although the daughter speaks English, they speak French in their home. It's important to Marie's welfare that when her daughter is not able to be at the nursing home, someone is available to communicate with her. And, as Marie transitions out of rehabilitation and returns to her daughter's home, her daughter will need multilingual in-home help.
Marie's medical social worker administers a special Medicaid program that helps Marie's daughter with the expense of in-home care. The social worker has found two French-speaking Sudanese women who are trained to work in Medicaid-assisted homes to help lift Marie in and out of bed, dress her, prepare her food and feed her. They also read to her in French and provide culturally familiar conversation.
When this medical social worker first interviewed Marie and her daughter, the language barrier as well as Marie's cultural attitude against non-family caregivers was challenging. The worker's assessment of this situation determined that cultural issues had to be accommodated to assure Marie's continued physical, psychological, and social improvement.
Medical social workers perform many services
Medical social workers are found in a variety of locations, but especially in clinics and hospitals where post-hospital interventions are common and where the patient population might be underprivileged or particularly vulnerable. Their days consist of working in the different wards consulting with nurses and physicians about patient care, checking on patients, and dealing with various crises that arise.
The importance of family genetics and medical history
Families are much more than just their members, they are a specific compilation of genes that tell researchers a great deal about the family's current and historic physiological and psychological makeup. Genes not only determine such things as hair and eye color, they tell us the part of the world our ancestors originated, and give us an understanding of the diseases we might encounter.
Read more about family genetics and medical history...
These social workers typically work as part of an interdisciplinary team that administers different aspects of health care. They are responsible for maintaining a therapeutic relationship with the patient and for providing information, linking with health care resources, and providing emotional support.
Their specific role encompasses a variety of responsibilities, all of which concern facilitating an easier transition from the care facility to the next stage of treatment.
Information, referral, and education. Patients and their families often need someone knowledgeable to take the time to give them answers. They may not understand the ramifications of the illness, or how to interpret the hospital's paperwork. They might also need someone to explain the role of a specialist or how their particular insurance or Medicare coverage works.
Some illnesses such as heart disease or diabetes require specific diets, medications, and close monitoring. Family members must be educated about the risks of the illness and possibly trained to administer shots and certain drugs.
The stress of illness and treatments is often as debilitating as the disease itself. Patient attitude is pivotal to recovery and social workers watch for signs that indicate the patient might be suffering from poor mental health. Intervention by a mental health counselor is a service medical social workers facilitate for the patient.
Counseling. Therapy and counseling bring understanding, comfort, and strength to families that have suffered trauma or have lost a loved one. Medical social workers counsel patients, helping them work through grief and fear. Specialized therapy, intended to encourage more beneficial behaviors to support change, is arranged when necessary.
Frequently, social workers connect individuals with support groups, such as those for breast cancer patients or for families of individuals with Alzheimer's. These and other support groups provide education and emotional structure to aid individuals and their families struggling with serious illness.
Crisis intervention. Many medical social workers contribute their skills to helping those who experience trauma by providing short and long-term counseling for suicide prevention, child abuse (see Child Abuse), rape, and domestic violence. They work closely with police and arrange resources such as safehouses, rehabilitation facilities, and help with mental health issues.
Documentation of care. Medical social workers must be meticulous record-keepers. Not only must they create care plans, interventions, and goals, their actions must include consultations with the patient and pertinent medical personnel. They are also responsible for knowing all applicable legal, ethical, and procedural concerns, confidentiality rights, and for securing medical and legal permissions for treatments and resources.
Financial counseling. Medical social workers must also understand financial considerations, government insurance programs and disbursements, and be able to perform the general administration of complex cases. Most medical facilities provide financial assistance and counseling because many patients suffer illnesses and disabling conditions that require the extra cost of medical equipment, medicines, in-home care, transportation and other expenses. Medical social workers are ethically bound to counsel patients about all financial considerations in their decision-making.
Medical social workers are the indispensable facilitators of health care services that help patients transition from hospitals to their homes or other facilities where they continue their healing. In a very real sense these workers are life-links for patients, visiting them, arranging services and treatments, monitoring their improvement, and managing their cases. Without them, many patients couldn't survive.