Thursday, June 1, 2017

A Day in the Life of a Medical Social Worker

Medical Social Work
One of the problems of being a medical social worker in a hospital is that my work is so varied that people get confused as to what I actually do! To give you a better idea of my job functions, here's a rundown of a typical day at work. At some point, I may write different versions based on what unit I'm working on and what model of social work the hospital uses. For a comprehensive overview of the medical social work profession, please go here: About Social Services at a Hospital

A Typical Day in the Life of a (not so) Cheap Medical Social Worker

 6:20am: Alarm clock goes off. I hit the snooze button.

6:30am: I drag myself out of bed, wash up, throw some clothes on, and slap my makeup on my face.

7:00am: I run out the door and proceed to sit in traffic for the next hour.

8:00am: I arrive at work, clock in, and head to my desk to print out the hospital census. After figuring out who all the new patients are, I go through each one to determine if they need to be "triggered" for a discharge planning and/or social services assessment.

Most common discharge planning triggers include:
  • High fall risk
  • Chronic illnesses prone to hospital readmission (i.e. congestive heart failure)
  • Patients discharged and readmitted within the past 30 days
  • Difficulties with activities of daily living (i.e. bathing and toileting)
  • Patients likely to have medical discharge planning needs such as skilled nursing placement, durable medical equipment, and/or home health 
Most common social services triggers include:
  • Financial issues (i.e. uninsured, homeless)
  • Mental health problems (i.e. depression, anxiety, 5150)
  • Substance abuse
  • End of life concerns (i.e. hospice, comfort care, advance healthcare directive education)
  • Lack of family support
  • Abuse (child or elder)
  • Domestic violence
8:30am: After identifying my triggers, I start putting together my to-do list for the day. I usually divide my list into the following categories:
  • Discharge planning assessments
  • Social services assessments
  • Social services follow-up visits (i.e. support needs, community resources/referrals
  • Patients being discharged and needing skilled nursing placement, home health, or durable medical equipment
  • Patients needing a copy of the Important Message from Medicare Letter reissued (must be done within 48 hours of discharge)
8:45am: Time for rounds with the charge nurse and nurse case manager! Here, we go through every patient on the floor with a focus on barriers to discharge. The charge nurse gives updates on the patient's medical condition and whether they are medically stable for discharge. The case manager provides leadership on what needs to be done from a multidisciplinary standpoint to address barriers to discharge. I (the social worker) give input on potential social barriers to discharge and take note of potential discharges to add to my to-do list.

9:00am: I start working on my to-do list by prioritizing cases in the following order:
  1. Any crisis situation that may arise during the day (i.e. code situation, sudden death, etc.)
  2. Patients needing immediate placement (specifically those under involuntary psychiatric hold)
  3. Patients with acute safety concerns (i.e. abuse, domestic violence)
  4. Patients with discharge orders who have immediate needs (i.e. skilled nursing transfer, home health care, hospice, durable medical equipment, transportation assistance, homeless shelter placement, follow-up doctor's appointments for high risk patients)
  5. Reissuing Important Message from Medicare Letters to patients with discharge orders
  6. Social services assessments of new patients
  7. Discharge planning assessments of new patients
  8. Reissuing Important Message from Medicare Letters to patients who may discharge in the next 48 hours
Typically, I spend my mornings working on assessments while waiting for physicians to come in to write discharge orders. As I start getting orders, the assessments get set aside for later. If you are to survive in hospital social work, the ability to multitask and set priorities is key!

1:30pm: Lunch (if I have time)! By this time of day, I should have everything set up for my patients with discharge orders. This includes transportation for patients transferring to other facilities, home health orders faxed to the appropriate agencies, and durable medical equipment issued to patients needing it.

2:00pm: I come back from lunch and start working on the rest of my to-do list.

3:30pm: Around this time of day I start getting physician orders for the next day's discharges. Typically this involves arranging nursing home placement, home health care, or hospice. My role is to inform patients of the discharge plan, see if they have a preference for a facility/agency, and make arrangements.

4:00pm: If I'm having a particularly bad day, I'll get last-minute orders to transfer a patient to another facility or arrange post-hospital care. Otherwise, around this time I start typing up a "handoff" for the next day's social worker, which includes a summary of what I did for each patient and a list of what still needs to be done.

4:30pm: Barring a crisis or super last-minute orders, I can clock out and go home!

5:30pm-8pm: Arrive home, eat dinner, clean up, watch baseball, play video games, blog, etc. To be honest, I don't do much on weekdays because I'm too drained after work.

10:30pm: Bedtime! Usually I end up going to bed much later because I lose track of time. I know, it's something I need to work on!

Hope this gives everyone a better idea of what I do at work. Please feel to ask questions in the comments section.

Sunday, January 29, 2017

Discrimination Against Patients by Healthcare Providers

Recently, I was speaking to a nurse (whose identity will remain anonymous for her sake) regarding President Donald Trump's travel ban on seven Muslim majority countries. This nurse is an immigrant from another country and has been working in the United States for roughly 30 years.

This nurse expressed her support for the travel ban against Muslims, saying that it's "for the better". Her support was not based on any fear of terrorists. She stated that having been a nurse for 30 years, she's encountered a number of people who come to America and "mooch" off the system. With regards to the seven banned countries, she stated that she's had a number of "birth tourist" patients whose purpose is to give birth to American citizen babies and take advantage of the system. She described the patients as "demanding", "knowledgeable of the system", and not knowing how to speak English. In her opinion, banning Muslims would prevent these "birth tourists" from entering the United States and stealing our tax dollars and free money given away by hospitals.

Obviously, I questioned the logic of her arguments, specifically the "free money" given away by hospitals (because that would make my job so much easier) and the "birth tourists" being mostly from Muslim countries. Her response is that she's been a nurse for 30 years and I've only been a social worker for 7 years, therefore she knows more about social services than I do. I promptly ended my discussion, as I knew it was not going to get anywhere.

There were a number of things that bothered me about my conversation with this nurse, but I for the sake of this post I will focus on one. What really bugged me is that this nurse works for a hospital in one of the most socioeconomically diverse places in the United States. If this nurse has such views of Muslim immigrants in general being demanding and out to take advantage of the system, then how does this affect how she cares of them?

Reflecting on my limited 7 years experience in the social work field, I have observed numerous instances of both overt and veiled discrimination in the hospital setting. Here are some examples:
  • Nurses complaining about having "another African-American/Mexican/Middle Eastern/Medicaid/non-English speaking/etc." patient. This is not limited to Caucasian nurses. Knowing a second language, I have heard the same complaints from nurses speaking to each other in their native language in the break room.
  • Patients with too many questions or requests being labeled "demanding" during morning rounds. At times, I've been sent in to talk to families because doctors "don't want to deal with them anymore".
  • Complete scorn for families not wanting their loved ones to enter hospice care due to cultural or religious reasons.
  • Healthcare providers attributing their problem patient's behavior to ethnicity or culture.
I realize that when it comes to challenging patients, there is going to be some grey area. Perhaps that "demanding" patient is indeed a narcotics addict hopping emergency rooms for more meds. Maybe that nurse is being treated like a personal servant by her patient. Abuse of hospital staff happens all the time.

However, the patients we see represent a small fraction of the entire population. It's certainly easy allow frustrating patients to reinforce our personal prejudices, but we must remind ourselves that one person should not represent an entire culture. Our patients come to the hospital because they need help, and otherwise would not be there if they didn't have any problems.

My social work education emphasized the need to check our biases at the door so we can provide optimal care to our clients or patients. While I hope that non-social work healthcare workers do the same thing, a study by the Agency of Healthcare Research and Quality reflects the following:
  • Blacks and AI/ANs received worse care than Whites for about 40% of measures.
  • Asians received worse care than Whites for about 20% of measures.
  • Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
  • Poor people received worse care than high-income people for about 80% of core measures.
As healthcare providers, we are in this field to help all people. I will not deny that our jobs are emotionally draining, physically taxing, and often thankless. However, if we healthcare providers cherry pick who we are able to provide quality, compassionate care to, then what does this say about our society as a whole? As the cliché goes, we are a reflection of how we treat our most vulnerable populations.

Saturday, January 7, 2017

How to Plan a Wedding and Stay Sane

wedding self care
In my previous post, I discussed the various cost saving measures my husband and I used during our wedding planning process. This was by far the easiest part of planning our wedding!

Today, reflect on our wedding again and provide tips on how you can survive with your sanity intact! My husband and I made it, so you can too!


Tip #1: While wedding planning, insignificant details suddenly become significant. In the end, they really don't matter.
When we started planning this wedding, I was well aware that it would be lots of work. What I failed to realize was the amount of detail involved. Right from the start I was told that I "needed" things from floor length tablecloths, wooden dance floor, uplighting, Chiavari chairs, knee length or floor length bridesmaids dresses (depending on who I was talking to), matching bridesmaid accessories, Catholic Ceremony, etc. Such advice was often accompanied with warnings if I didn't listen (i.e. "Your pictures will look bad!" "You decorations will look cheap!" "You'll look ugly/fat/old/young/90s/tacky/dated!" "Your guests will be bored/angry/hungry/confused/annoyed/hot/cold/sober/drunk/thirsty/etc!" "People will judge you!" "You'll convert to another religion!" "You'll regret it!")

Thinking back, there were so many hours wasted debating people on and researching insignificant details like tablecloth colors, napkin folds, decorations, makeup colors, uplighting, and seating arrangements. These are certainly hours of my life I certainly would like back, as in the end I'm sure 95% of the people at our wedding didn't notice/care about these things.


Tip #2: When you're told, "It's your wedding, do what you want," there's always going to be with a caveat. Ignore the caveat and trust your abilities.
While I was frequently told, "It's your wedding, do what you want," I often feel like people were really telling me, "Do what you want as long as I personally find it aesthetically pleasing." For instance, I was told that my wedding dress of choice was too simple and looked like a "bridesmaid dress", then asked to try on a gaudy sequin covered gown 10 sizes too large for me and being told it was a perfect fit. Later, I was told my attire looked "dated".

Keeping our wedding true to us was certainly a big challenge, and never in my life have I felt so insecure because everything from my decision making abilities down to my looks seemed to be under the magnifying glass at all times. At one point, I was even told that my demeanor was "too calm". It really felt like the world had their doubts and wanted us to fail.

In the end, my husband and I dealt by taking an "us against the world" approach to our wedding and not allowing unwanted opinions to change what we wanted. If anything, the doubt motivated us even more to throw the most enjoyable event possible for our loved ones. I learned to confident in my decisions and ignore any person, forum, or blog that told me that my tastes were tacky, ugly, and/or dated. While our wedding isn't exactly Pinterest worthy, I'm happy with how everything looked and felt great in my wedding outfit. Yes, I'm some people did have nitpicks (with other probably still waiting to tell me their "feedback") about the wedding, food, and my looks/attire, but so what? In the end, I'm glad my husband and I didn't cave to trends and conventions and can proudly say that we had a wedding that was true to ourselves.


Tip #3: Find support from different sources
Weddings certainly have the ability to teach you about the people in your social circles. While there were a few outlying incidents, I was generally wowed by the positivity and support from many of my family members and friends.

I also found support through online forums like Weddingwire.Com, which allowed me to ask questions and commiserate with fellow brides. What I liked best about the site was that most brides there provided honest and constructive feedback in a manner that was supportive, understanding, and non-judgmental. This extra outlet kept me from overwhelming my own social circles, as their lives are busy enough without me burdening them with my wedding woes.


Tip #4: Treat your wedding party and vendors with respect
Just because someone is your bridesmaid/groomsman does not mean that you own them until after your wedding day. Most likely, there are people you've selected because they're you're closest family/friends, so I find it just wrong to treat them like personal assistants. While our wedding party did offer to help out, my husband and I tried to keep their tasks to a minimum so they could enjoy the day. Ultimately, this wedding is just one day our of the (hopefully) many we will spend together in our lifetimes.

Similarly, while providing paid services, don't forget that vendors are people too. Treat them well from the start and they will return the favor. Also, don't forget gratuity always and positive online reviews for good service! My husband and I were lucky enough to work with wonderful vendors over the course of a year, and one of the saddest parts of this wedding being over is no longer getting to interact with them regularly.


Tip #5: Something will go wrong on your wedding day, but it will be okay!
My coworker relayed these words of wisdom to me on my last day of work before the wedding. Indeed, despite months of painstaking planning, there were still things that went wrong! While there were no major disasters, there were definitely a few near misses and rough patches throughout the day. However, our wedding day didn't fall apart, plenty of things went right, and I haven't heard too many complaints.


Tip #6: Don't expect your wedding day to be the best day of your life
Not only is there so much expectation for weddings to be "perfect", but there's the myth that it's supposed to be the "happiest day of your life". At this point, it's safe to say that the week leading up to the wedding was miserable and exhausting. While our wedding day was great, it was far from the happiest day of our lives as there was so much organized chaos happening around us. In fact, it took several weeks and the arrival of wedding photos for the adrenaline to fully wear down, though these series of blog posts has caused some of those old feelings to resurface.

It's okay if your wedding day isn't the best day ever! If fact, that was my expectation going into this event, as how sad would it be if my life reached its peak on my wedding day? Now that I'm married, my desire is to make even happier memories together with the hope that our best days are yet to come.


Tip #7: Don't forget your relationship...and yourself!
With all the work surrounding weddings, it's sometimes easy to forget the reason for having one! From the beginning, I knew that my husband didn't care as much about "the convention of marriage" as in his mind, we were already committed to each other. I accepted this and hence did most of the planning work. However, as the work increased and the wedding date approached, our lives and free time became consumed with everything wedding related.

Realizing that we were increasingly exhausted and miserable, we made changes like evening walks where no wedding talk was allowed and date nights at our favorite restaurants. Feeling my body start to to break down between the stress of work and wedding planning, I made concerted efforts to sleep early, stay hydrated, and relax when I could. While I'm already familiar with the importance of self-care thanks to my career, I had to be even more mindful of my physical and emotional health during this taxing wedding process. No wedding is worth sacrificing health.


For those who had relaxing wedding experiences, I congratulate you on being extremely lucky! For everyone else, please remember to stay true to yourself, trust your abilities, and that this is only one day out of an entire lifetime! While I'm thankful to have had a wonderful wedding, my husband and I are ecstatic and relieved to have moved on from that part of our lives, and mostly to have some free time again!