To hospitalists, a social worker can serve as an important adjunct in talking to the patient and family. “For example, if [social workers] are giving bad news, they warn the physician first,” says Dr. Rajan. “If they’re going to go in and tell the patient that they’re not going to qualify for any home services, they tell the physician as well so that [the hospitalist will not later be] meeting an angry patient.” In addition, she says, “for critically ill or long-term patients, social workers [can] help family members cope. Sometimes as physicians we don’t have the time or we don’t have the resources to do that.”
But this doesn’t let doctors off the hook in regard to addressing the whole person’s needs. Especially if someone has multiple medical problems, the social worker needs to know the availability and level of support for which the family can be counted.
“Social workers will ask questions such as: Are the families involved? or Is there any family?” says Krafcik. “Do they need to go in a nursing home or do they need 24-hour care at home? Is the family able to provide that? [E]very morning we meet to have team rounds. And the [team] go[es] over every patient on the floor, and then I will ask those questions if the doctor hasn’t given me that information.”
Social workers appreciate and would like hospitalists to do more listening to the patient and family for the aspects of the history and psychosocial status that the social worker will need to know.
In the course of their interactions, what do hospitalists and social workers teach each other that could lead to working a case more effectively and to the greater satisfaction of all involved?
Most of those we interviewed seem to think that the greatest service hospitalists provide is to teach the social worker the medical components that go along with what the social worker does every day.
“[Social workers] get a better understanding of [whether] someone comes in with heart failure or a fall or a stroke, just by repetition and also education; they get to understand after a while what’s needed for individual medical diagnoses,” says Dr. Flansbaum.
“When I know [better] what the medical condition is,” says Krafcik, “I have an idea of how much help [the patient] would need at home and their ability to function. And I would make sure that the patient gets physical therapy or occupational therapy referral or speech therapy.”
Again, perhaps the area where the social worker most teaches the hospitalist regards available resources to solve problems over and above the purely medical. “They know the social system and the needs of different forms and eligibility and what different patients are entitled to and what the system will provide,” says Dr. Flansbaum.
Dunson believes hospitalists are perceived as being more involved in a holistic way with the patient. “I always stress that it is so important to look at the whole person and not just the medical aspects,” she says. “It’s hard for the doctor sometimes to realize that this person might not be able to afford this medication and that’s why they’re noncompliant and all the other issues. So I think is important to open up to the other aspects of a person’s life and not just the medical aspects.”
Social workers’ knowledge of medical and nonmedical resources, both locally and nationally, offer hospitalists essential information that leads to designing more appropriate and effective post-discharge plans. Hospitalists can best team with social workers by consistently keeping in mind the patient’s overall circumstances and informing their colleagues of the medical information that can help social workers do their best work. TH