Medical Social Work
Medical Social Work
Medical Social Work
Medical social workers typically work in a hospital, skilled nursing facility or hospice, have
a graduate degree in the field, and work with patients and their families in need of
psychosocial help. Medical social workers assess the psychosocial functioning of patients
and families and intervene as necessary. Interventions may include connecting patients
and families to necessary resources and supports in the community; providing
psychotherapy, supportive counseling, or grief counseling; or helping a patient to expand
and strengthen their network of social supports.
In 1945, the Institute of Almoners in Britain was formed, which, in 1964, was renamed as
the Institute of Medical Social Workers. The Institute was one of the founder organizations
of the British Association of Social Workers, which was formed in 1970. In Britain, medical
social workers were transferred from the National Health Service (NHS) into local
authority Social Services Departments in 1974, and generally became known as hospital
social workers.
United States[edit]
The Massachusetts General Hospital was the first American hospital to have professional
social workers on site, in the early 1900s. The position was created by Richard Clarke
Cabot to help patients to deal with areas of their life that made treatment difficult. This was
important from an epidemiological point of view, as it made it easier to control and prevent
outbreaks of syphilis and tuberculosis.[2]
The medical social worker profession[edit]
For example, a medical provider informs the medical social worker that a patient will soon
be "cleared for discharge" and will need in-home services. Depending on the setting, it may
be the medical social worker's responsibility to arrange in-home services to coincide with
the patient's discharge date. If the home care service is not in place at time of discharge, the
patient may not be able to leave the hospital, resulting in a delay in discharge and the
patient being placed on alternate level of care status (that is, deemed no longer requiring
acute level of medical care, for which the hospital will receive a substantially lower rate of
payment) until the necessary services are arranged.
Another skill required of medical social workers is the ability to work cooperatively with
other members of the multidisciplinary treatment team who are directly involved in the
patient's care. Medical social workers also need to have excellent analytical and assessment
skills, an ability to communicate clearly with both patients and staff, and an ability to
quickly and effectively establish a therapeutic relationship with patients. But of paramount
importance, medical social workers must be willing to act as advocates for the patients,
especially in situations where the medical social worker has identified problems that may
compromise the discharge and put the patient at risk.
For example, a medical provider may report that a frail elderly patient, who lives alone, is
medically stable for discharge and plans to discharge the patient home with in-home
services. After assessing the patient's psychosocial needs, the medical social worker
determines that the patient does not have the ability to manage at home safely even with
the intervention of a home care worker. The medical social worker informs the medical
provider that the proposed discharge plan may place the patient at risk and the discharge
plan is deferred pending further assessment. The medical social worker can then
collaborate with multidisciplinary providers to develop a more appropriate discharge plan
even if that leads to discharge delays.
Medical social workers value the ethical concept of patient self-determination although this
value can conflict with the values and ethics of other disciplines in a medical setting.
Medical social workers strive to preserve the patient's right to make his or her own
decisions about goals of care, treatment planning, discharge, etc. as long as the patient is
capable of making those decisions him/herself. Patients often make decisions that medical
professionals disagree with but the medical social worker advocates for the patient's right
to self-determination. If the patient is not able to make his/her own decisions based on a
cognitive or other impairment, the right of self-determination can be superseded by
concern that a patient is a risk to self or others.
Challenges[edit]
As medical social workers often have large case-loads and have to meet tight deadlines for
arranging necessary services, medical social work is a demanding job. Medical social
workers often deal with highly complex cases involving patients who come into the
hospital with multiple psycho-social issues, all of which require assessment and treatment.
It is not uncommon for medical social workers to treat cases involving homelessness,
chronic unemployment, lack of income, lack of health insurance coverage, history of
incarceration, and substance abuse problems. Any of these problems, separately and
together, can impede timely discharge. Sometimes situations as seemingly mundane as the
patient needing bus fare or a decent pair of shoes can lead to delays in discharge, especially
if these needs are not identified quickly and early. This is why a complete and timely
assessment of the patient's psychosocial needs is critical.
Medical social workers coordinate services for and counsel patients and their families in a
variety of settings. You will find social workers in hospitals, schools, hospice, and anywhere
support and guidance is needed. Victims of crimes, trauma, or abuse also may especially
benefit from the services of a medical social worker.
To learn more about this versatile, demanding, and rewarding career, I consulted with a
fellow Guide at About.com, Elizabeth R. Rose, MSW.
Rose is a travel writer and Guide to Southwest for Visitors, and a former full time medical
social worker. She has over 30 years of experience in medical social work, including
management roles such as directing ethics and social services departments. Although
retired from the field, Elizabeth is still involved in supporting the efforts of social workers
via her websitesocialworkworld.org, which includes a variety of resources, information,
and articles for people who work in social work or who are planning a career in social
work.
Rose was kind enough to take time out of her busy schedule to answer some in-depth
questions regarding the ups and downs of a career in social work.
What are Some of the Roles and Jobs Available in Medical Social Work?
Discharge Planning
Crisis Intervention
Mental Health Evaluation
Chemical Dependency Evaluation
Short term decision making counseling
Facilitating support groups (ex. Cancer Support Group, Rehab Family Group)
Ethical decision-making counseling
Grief Counseling
Specialty evaluations and coordination such as on a Renal Transplant Team
Child Abuse investigations and reporting
A typical day in a hospital may begin with a review of new admissions to the facility,
current referrals and unresolved case issues from the previous day. The day will often
continue with rounds on the various nursing units to collaborate with the physicians and
nurses in planning for the patient.
Additionally, a social worker will spend part of his or her day implementing plans for
patients' discharge(release from the facility) or problem-resolution. This includes patient
and family meetings and, often, healthcare team meetings.
One of the big roles of the social worker is crisis intervention, so the social worker's day
never goes as expected. There may be a death on one unit, where the family needs grief
counseling, a suspected child abuse case on another unit, where an evaluation needs to be
made to assist the team in reporting to Child Protective Services.
And, of course there are always members of the healthcare team and patients who need to
"talk to the social worker right now!" Social work in health care requires a healthy dose of
patience, along with great skill in prioritizing cases and intervention.
The medical social worker's day may end with finishing charting and wrapping up
documentation, such as statistics paperwork or data entry and, in an ideal situation,
debriefing with colleagues.
What Did You Like Most About Your Career in Medical Social Work?
I thoroughly enjoyed being part of the medical team and providing a service that was
needed and appreciated. Often the social worker is the only one who sees things from a
systems perspective and can remove barriers that seem to be immobile. I also appreciated
the opportunity to be trained in Medical Ethics and to provide ethics consultations in very
difficult situations.
What Were Some of the Greatest Challenges Facing You as a Medical Social Worker?
Juggling an ever-increasing caseload and having to take a pager home on weekends was
difficult. I believe strongly in worklife-homelife balance and when you are working in a 24
hour, crisis-oriented environment, this is difficult to maintain.
What Advice Would You Give to Those Seeking a Career as a Medical Social Worker?
I always advise prospective social workers to make sure they have dealt with their own
issues and fears before trying to help others. They also need to have a strong family,
colleague or friend circle of support. It's not easy to lose a young cancer patient you have
been counseling for a year, for example, and not have someone to talk to about that
experience.
Medical social work is a stressful role, in general, and the social worker is often expected to
be the glue that keeps the discharge plan together (and, often the healthcare team.) That's a
big expectation and a role only for the most "together" and mature practitioners.