Although everyone on a multidisciplinary team can bring something to the discussion that makes the team work better, social workers and hospitalists collaborate well in painting a more comprehensive picture of the patient’s lifestyle, living habits, and needs.
“In many hospitals … there’s a pattern that develops [whereby at] some time in the morning the hospitalist and social worker will get together and talk,” says Dr. Flansbaum “The hospitalist speaks the language of the social worker and knows what to tell them and how to direct them rather than just saying, ‘the patient’s homeless or the patient needs help at home.’”
After working regularly with social workers and recognizing what they need to know, he says, “the hospitalist is more likely to say, ‘the patient has Medicaid,’ or ‘the patient has this insurance,’ [or] ‘the patient has a home-health [caregiver] four hours a day and needs six or eight hours a day,’ or ‘the patient’s going to need a subacute nursing facility.’ … I think our insights are different from voluntary physicians and our face-time with social workers is more efficient.”
Sylvia Krafcik, MSSA, LISW, with MetroHealth Medical Center, Cleveland, says hospitalists are “great to work with because they’re very dedicated to the population they’re caring for, because this is their whole responsibility; they don’t have a private caseload.”
But in her view most hospitalists are focused on patients’ medical conditions and some of them are not as tuned in to all the other aspects of the patient, such as all the psychosocial dynamics.
“A lot of them are, but some aren’t,” Krafcik says. “Especially at MetroHealth, we’re a county hospital. So many of the patients that come here are poor. A lot of them are alcoholics or drug abusers. They’re homeless. They live on the streets. They don’t have a primary doctor. They’re usually not compliant with their medications.”
“Here at Metro we have a lot of patients who have extreme social circumstances that affect their medical issues so much,” says Sara Dunson, MSW, LSW, who also works as a social worker at Metro-Health. “I think the hospitalist has greater insight into the person’s environment and all the social structures that they have at home and that are going on in their life [than other physicians might].”
But there is always room for improvement.
“We had one patient who wasn’t able to read, and he never told anybody this,” says Dunson. “And as social workers, we have more of a way of finding that kind of stuff out from patients than the doctors might. And he kept coming in and coming in and was noncompliant with his medication. We eventually determined that this was why he was noncompliant and was causing all these medical issues. The doctors finally [understood] why this gentleman kept coming in with the same problems and he wasn’t taking care of himself. It wasn’t that he didn’t want to, it was just that he was having problems reading all the medications and all the discharge paperwork, and he was too ashamed to tell anybody. [Once the social workers questioned him and got this] out in the open, we were able to get him help with that.”
The doctors focused on what he was or wasn’t doing, but they hadn’t looked at why he wasn’t adherent, explains Dunson. If hospitalists do that more often, she thinks, they could save time and get better outcomes sooner.
COMMUNICATING WITH PATIENTS AND FAMILIES
“I think where hospitalists are coming from is a whole different mindset than a physician who has mainly an office practice,” said Lingg. “The office practice comes first [for them]. Some of our physicians have huge practices in town. And they’ll visit the hospital very early in the morning or in the evening. … So if I need something in a case like that, if there was not a hospitalist involved, it would have been separate meetings for the family with the physician … and [with] me at another time.”