We clinical social workers know the impact of the work we do with clients; it drives us forward and gives us satisfaction as we help to change people’s lives. But even as we advocate for our clients, we often fail to advocate for ourselves and our profession. We can (and should!) because we know why it matters.
Working on a medical interdisciplinary team for many years has taught me, among other things, that other providers in the medical setting generally do not know what clinical social workers do or know what our skill-set is. And it has taught me that we clinical social workers need to make the effort, over and over, to teach others about our capabilities. As it turns out, they want to know and they need to know.
In addition to our expertise in psychotherapeutic techniques, we are exceptional at diagnosing and intervening in systems issues, a competence that is vastly underrated not only by us, but by our medical colleagues. Often this skill is applied to what I like to call “Clean Up In Aisle Nine”: as a clinical social worker in an acute care hospital, I often meet with patients/families after a medical provider has been in the room and, despite good intentions, has made a mess of the situation.
With all due respect to my medical colleagues, many of whom are excellent communicators: Some of you need help!
Here is one example of why our work matters AND why it is so important that we speak up for ourselves. I was working with a family (mother, sister and brother) of a man in his early forties. He had multi-organ system failure and was not likely to survive his acute hospitalization despite valiant efforts by his medical team. His physicians had tried to prepare the family for “the worst”. As might be expected, the family struggled with this and with the onrush of very complex medical facts. For days the primary team, and my palliative care team, worked with the family (the patient was too weak to participate) and devised a compassionate plan for terminating ventilator support and providing comfort care.
As often happens in an academic medical setting, physicians rotate in and out of cases. One day after the patient-care plan was implemented, a physician new to the case spoke to the mother about how hopeful he was that the patient could not only survive but get back home. The mother, and then the family, were left confused and angry, and flabbergasted by the physician whom they had never met before—it was so different from what others were telling them.
Enter the providers who could help, and who had come to know the family well. We met with them, comforted them, talked about an uncertain prognosis, and normalized their reaction to this unexpected encounter and its take-away, all without creating a split with the new attending physician. Because of the trusting relationship and our family-systems skills, we were able torestore some equilibrium—and we worked with the attending physician to improve communication. This work we do—re-establishing trust; explaining complex medical situations; outlining choices; and supporting families as they struggle to do what is best for their loved one—may be invisible at times, but it is integral and necessary to the care of patients and families.
Knowing that clinical social workers are often under-rated and misunderstood as to the breadth of our skill set, my team and I debriefed about this case, and highlighted how we worked together to intervene. I spoke about the impact on the family system, and how we could help this family with anticipatory grieving. I also debriefed with several of the other medical providers involved in the case and took the opportunity to talk about how communication impacts families and their decisions and guilt, as well as our own issues (countertransference) in complex settings. To a person, my interlocutors appreciated the insight and context to help them come to terms with a difficult situation.
We must be our own best marketers—we need to showcase our abilities, and remind others about our value! We need to use our expert clinical skills with other medical providers: they want to know what we can do. Formal education is wonderful, but I challenge you to use moments, relationships, and shared experiences as times to let others know how we can help and how we are different than other specialties.
ACSWA—the online American Clinical Social Work Association—is now here for all of us, a place of refuge and understanding. Working in a host institution (medical hospital) is quite fulfilling, but I look to ACSWA, and you, for my professional support and encourage all of you to do the same.
Vickie Leff, BCD, LCSW,
Clinical Social Work, Palliative Care, Duke University Hospital Durham, NC; national board member of the Center for Clinical Social Work.