Medical social work is a sub-discipline of social work, also known as hospital 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.
Medical social workers typically work on an interdisciplinary team with professionals of other disciplines (such as medicine, nursing, physical, occupational, speech and recreational therapy, etc.)
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Medical social workers in Britain and Ireland were previously known as Almoners, or Hospital Almoners. In Ireland, the origins of medical social workers go back to Dr. Ella Webb, who, in 1918, established a dispensary for sick children in the Adelaide Hospital in Dublin, and to Winifred Alcock, who trained as an Almoner and worked with Dr. Webb in her dispensary.[1]
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.
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 plays a critical role in the area of discharge planning. It is the medical social worker's responsibility to develop a discharge plan that will meet the patient's needs and allow the patient to leave the hospital in a timely manner so as to prevent delays in discharge that could cost the hospital thousands of dollars per day in lost revenues from third-party payers.
For example, a medical doctor informs the medical social worker that a patient will soon be "cleared for discharge" and will need home care services. It is then medical social worker's responsibility to arrange for the home care service to be in place by the date the patient is scheduled to be discharged. 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. In such situations, the treating physician is ultimately held responsible for the delay. Nevertheless, the medical social worker may share the blame for the delay in discharge and in the process attract the attention of management.
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 doctor may report that a frail elderly patient, who lives alone, is medically cleared for discharge and plans to discharge the patient home with home care services. However, after assessing the patient's psychosocial needs, the medical social worker has determined that the patient does not have the requisite ability to direct a home care worker and recommends that the discharge be deferred pending further assessment of the problem and perhaps the development of an alternative discharge plan that will better ensure the patient's safety. In such cases, it is the medical social worker's ethical duty to inform the medical doctor that the discharge may place the patient at risk and advocate for another, more appropriate, discharge plan even if it means that the patient's discharge has to be delayed. It is precisely in such cases as these that the medical social workers prove their worth - by placing the needs of the patient ahead of all other considerations.
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.
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