“The medical part of the care of our rheumatic disease patients is often the easy part. What is difficult, and the reason we doctors stand in awe of our social work department, is the finding of access to medications, solving of social problems, the support systems, the immense paperwork, the outreach programs, and sometimes just being a friend to our patients,” says Michael D. Lockshin, MD, director of the Barbara Volcker Center for Women and Rheumatic Disease and co-director of the Mary Kirkland Center for Lupus Research, both at the Hospital for Special Surgery.
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Explore This IssueDecember 2013
Communication is a vital component of patient-centered care. Social workers help optimize physician–patient communication, and communication with the entire medical team; in turn, this can minimize patient and family concerns. They are the lynchpin between family, healthcare systems, and community resources, helping families navigate an increasingly overwhelming and depersonalized system.1 Social workers can help patients be true partners in their care by empowering them to engage in active dialogue with their physicians and other care providers. Patients can then collaborate with the team in the healing process. By providing education and support to patients, social workers encourage informed decision making in the face of unavoidable choices and tasks.
It is well documented that patients with chronic disorders are more likely to be nonadherent to treatment than those with other diseases. Evidence suggests that nonadherence contributes to poor long-term outcomes, as well as increased utilization cost.4,5 Social workers assess the social determinants of health, such as financial resources, insurance status, health beliefs, and health literacy issues that can contribute to nonadherence, medication mismanagement, and coping with illness. These challenges can lead to expensive emergency room visits, increase disease damage, and illness complications.3
The literature also suggests that better communication between the healthcare provider and the patient is key to improve adherence.6 Cultivating trusted relationships with patients can open the lines of communication, allowing the social worker to expand the care plan by activating relevant community resources that are readily accessible to the patient. This contributes to a more comprehensive and continuous team to engage and address patient and family needs.7 If basic needs are not met, this can undermine the care plan and leave patients feeling helpless. To uncover these barriers to care, communication with patients needs to be optimal.
“I’ve found our social work staff to be incredibly experienced and resourceful, finding clever solutions to problems that I would never have thought of myself. Between time constraints placed on doctors and gaps in medical school teaching when it comes to some practical issues of taking care of the ‘whole’ patient, our social workers have really provided an extra level of care and support that I am sometimes not capable of,” notes Alana B. Levine, MD, assistant attending physician and clinical associate at the Barbara Volcker Center for Women and Rheumatic Diseases at the Hospital for Special Surgery.
Addressing the Emotional Components of Care
The emotional dimensions of a chronic illness are often overlooked in the context of a medically centered care plan.8 For example, fatigue, a feature of many rheumatologic illnesses, can lead to frustration and a sense of helplessness, anger, fear, hopelessness, and defeat.9 This can often lead to low self-efficacy, compromising a patient’s competence to manage their illness. Medications that treat the illness can affect mood, as well as overall disease burden.8 It’s important that a patient’s risk factors for mental illness, such as depression, be assessed on a continuous basis. Even mild depression may reduce a person’s motivation to access medical care or to follow treatment plans.8 Through comprehensive assessments, a social worker identifies and addresses these issues to make appropriate referrals to community agencies or other members of the team, ensuring that these confounding concerns don’t jeopardize the success of the treatment plan or affect the patient’s medical outcome.