Social work is key to quality patient care

In 1927, Francis Peabody remarked that, “The secret of the care of the patient is in caring for the patient.”

Medicine has made much progress since those days, but some might argue that some of the humanitarian cornerstones of caring that concerned Peabody have been lost. Of course, there are many health professionals that still embody this caring ethic. And in today’s era, perhaps the group that best personifies this central caring ethic of medicine are medical social workers.

I know we should avoid generalizations, but isn’t it the case that all social workers are nice? Perhaps it is this niceness, combined with their knowledge and skills that makes them so indispensable. The social worker on the team that understands what is really going on with the patient and identifies the key details that make it possible to effectively care for them. They know what to ask, and patients and families are comfortable confiding in them.

Geriatrics practice would be impossible without social workers. I definitely see this in our geriatrics clinic. Many patients are referred to geriatrics because things seem to be falling apart in terms of their ability function independently at home. After I do an initial evaluation, I have to admit that I sometimes feel kind of bewildered. There is almost never a single underlying cause of the patient’s problems –as the Fiddler on the Roof song goes, it is a little bit of this, a little bit of that (or perhaps a lot of this and a lot that). There is always a complex interaction of medical, social, and environmental factors that can not be separated from each other.

So, after I do my initial evaluation, I politely excuse myself from the exam room and knock on the door of our social worker, Karen. She somehow always has time for my unannounced visit to discuss the patient, often even adding the patient that day to her overbooked schedule. After talking through the issues with her, what was bewildering starts to become clear, and we are able to start formulating a plan for the patient. I end up returning to the exam room more confident we will be able to come up with a plan that will help the patient.

Can you believe there are still doctors who will dismissively refer to some patient issues (usually psychosocial issues) with a comment such as, “that’s social work.” The tone often implies they think the issue is not their problem, or even worse, they think addressing the issue is beneath them. Perhaps we should continue to encourage physicians to remark, “that’s social work,” but train our students to know that means they are dealing with something of particular importance that will take great skill to manage.

I know very little about the structure of social work training. However, it seems efforts to improve medical education could learn something from social work training. Social workers tend to be better than most physicians at communicating with patients, and many patients are more comfortable talking to a social worker than their doctor. The ability of social workers to uncover key elements of the history that physicians fail to identify suggests we can learn some basic skills of physicianship from them. It sure seems we would be better doctors if more elements of social work training were included in our training.

Given the importance of the medical social worker, you would think this would be a well paid position. However, according to the Bureau of Labor Statistics, the median salary of medical social workers is only $46,000 per year. Only 10% earn over $70,000 per year. This seems strikingly low for a position that requires extensive education (many social workers have masters degrees), requires very high level skill and judgment, and is so indispensable.

Is this because social work tends to attract individuals committed to helping others and who are therefore less concerned with monetary rewards? Is it because social workers are so focused on others that they are less effective at negotiating their compensation? Or is this the legacy of workplace gender discrimination, as historically, woman have been more likely to enter social work than men?

March was Social Work Month 2010. This year’s theme was, “Social Workers Inspire Community Action.” But day in and day out, social workers make things better for our patients. In truth, every month is social work month.

Ken Covinsky is Professor of Medicine, University of California, San Francisco who blogs at GeriPal.

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