Sunday, March 27, 2016
By Vickie Leff
March is Social Work Month – a great excuse to take a moment and celebrate the work that clinical social workers do in palliative care. But, hang on, perhaps we should be doing more than that. Can we adjust our lens settings and challenge ourselves to see clinical social work differently?
Palliative Care is a team sport; the standard model of practice includes an MD, NP and CSW. My challenge to all of you would be to make sure you are all equal partners in our unequal medical world. CSW’s can’t bill for in-patient visits, we can’t generate RVU’s for the hospital system, and it’s often hard to quantify data-driven results proving the impact of CSW interventions. I don’t know about you, but I work in a pretty physician-centric organization where there is a distinct pecking order. In fact, my hospital recently dissolved the CSW department in lieu of a Case Management Department. Medical social workers have been dealing with this for a long time (1920-30’s).
Much of the work done by your CSW is unseen, done in private with a patient or family member – needing to have conversations away from other providers due to the nature of the content and emotions. The work you may see us doing might look like “general support” but I can tell you it is quite deliberate and well thought out, founded in evidence based theories.
We choose our words very carefully. In fact, CSW has been having the “conversation” with patients and families for decades about goals of care, end of life and other difficult subjects. You may not know that the theory that grounds most of the communication skill and psychosocial protocols you use every day relies on the most fundamental social work tenant: start where the patient is. CSW developed the person-in-environment theory way back in the 1920’s and has served our profession well- understanding our clients in the context of their situation – which is now fundamental to all palliative care providers.
What’s the big deal, you ask? It is important to recognize the significant contribution of Clinical Social Work to Palliative Care. Communication is the heart of palliative care, without that we are nothing. Before there was SPIKES, NURSE, VitalTalk, OncoTalk there was Clinical Social Work – communicating with patients and families and other providers about these difficult subjects.
CSW also brings the concept of countertransference to the communication table. We don’t call it that when we are helping providers look at how their reactions impact the patient directly, (we call it self-awareness) but those are the theories we are using.
So, thank your team clinical social worker today; treat them as your equal in this work we do with patients and families. We might not be able to bill, or add to the financial bottom line of the hospital, but we are the backbone of the communication and psychosocial skills you use everyday.
Vickie Leff, LCSW, ACHP-SW, is a clinical social work in Palliative Care at Duke University Hospital. She won first place in her age division of her first marathon because she was the only person in her age division (40-45) at the marathon many years ago. And she still runs...