The Role of Social Work in Patient-Centered Rheumatology Care

Chronic rheumatologic diseases such as lupus and rheumatoid arthritis are characterized by extreme fatigue, pain, and unpredictability, often causing major disruptions in emotional, social, and physical well-being. Social workers in healthcare are experts on the impact of a health crisis on individual and family functioning. Their skills include the ability to assess disruption, mobilize problem solving, and help return the patient to an adaptive level of functioning.¹ Caring for the whole person is integral to the concept of patient centered care; these concepts are the cornerstone of the social work role on the interdisciplinary team.

Relationships

Patients are often challenged by the complexity of chronic illnesses. They can find themselves paralyzed by unpredictability, frustrated by symptoms, and overwhelmed by the many dimensions of management. The disruption and fragmentation that a chronic illness brings can touch every aspect of their life. Patients may be unprepared to cope with the intrusion and feelings of loss that a chronic illness can engender. Social workers work in the emotionally turbulent space in the lives of patients and their families to help make sense of this, using relationship building as the fundamental medium for intervention.² They expand upon the symptoms of a disease model to identify and address emotional, social, economic, cultural, and spiritual issues, as well as sources of patient and family resilience.¹

Relationships are the invaluable currency of optimizing patient care and helping patients, faced with a shattered reality, to visualize what is possible. The social worker, based on a skill set of “being where the patient is,” is often the team member the patient feels can be trusted with sensitive personal information. Patients turn to the social worker to seek out guidance and share vulnerable moments without the fear of being judged. This helps to engage patients in their own care, motivating them to become active partners in the process as they seek to enhance their quality of life. Monica Richey, MSN, ANP-BC/GNP, Lupus Center nurse coordinator at the Hospital for Special Surgery in New York City, summarizes the benefits to both nurses and patients. “The rewarding part of working with social workers is not just how they uncomplicate my life as a nurse,” she says, “but how they make a friend out of every patient.”

In the current healthcare environment, medical providers have limited time with patients, making it difficult to build and nurture such relationships. Time constraints are a major barrier to patient care, resulting in an increasing need for care coordination for patients with chronic illnesses. Coordination of care for patients takes time, time that is typically not reimbursed.³ Social workers spend that time assessing the patient’s biopsychosocial condition, getting to know him or her outside of the constraints of the medical appointment. These interactions build trusted relationships between the patient and the social worker, allowing for enhanced care coordination with the team and targeted interventions to address the patient’s needs.