Beyond Medical Basics: Hospital Social Workers Blend Compassion and Counseling

Jim Carrigan was in shock. Three thousand miles across the country, his son Andrew was lying comatose at Stanford Hospital, bones broken up and down the left side of his body. And, a few hours after he’d been hit by a car while riding his motorcycle on Highway 9, he also suffered a stroke that disabled his uninjured right side. Carrigan and his wife Sue were overwhelmed.

Andrew Carrigan practices his guitar.
Before his accident, Andrew Carrigan
loved making music.  After many months
of therapy, he's regaining his skills on
the guitar.

Even before the Carrigans arrived at Stanford to be with their son, hospital social worker Tim Chamberlain had phoned them, ready to help them cope not only with the emotional impact of what had happened but with practical issues as well. Among those was the question of recovering Andrew’s motorcycle. A local towing company had it and the charges were mounting. Chamberlain was ready to take care of the paperwork to get the bike released.

“He went above and beyond the call to solve a problem, relieving us of some stress in the middle of everything else that was going on,” said Jim Carrigan. As the days passed, and Andrew slowly defied an initially poor prognosis, Chamberlain continued to be someone whose compassion and understanding was crucial. Not only was Chamberlain willing to let Carrigan vent his frustration, but he remained a proactive champion even after Andrew was discharged.

What the Carrigans discovered at Stanford was that pivotal element of care supplied by a particular group of professionals. “Social workers are the cement that binds all the disciplines,” said Will Gressman, interim director of the Hospital’s Social Work and Case Management Department. Whether a patient is waiting for an organ transplant, or receiving treatment for cancer or recovering from an accidental trauma, Stanford’s care team includes a social worker.

Seeing the Whole Picture

Every day, social workers gather with nurses and physicians to talk about their patients, reviewing their progress, working together to make sure that the non-medical needs of each are considered and addressed. For one patient, a social worker might be helping with insurance issues; for another, the most important service might be to arrange for a family visit.

John and Andrew Carrigan look at x-rays.
Andrew Carrigan and his brother John look at x-rays of Carrigan's leg injuries, still awed by the damage done by the accident.

“We’re problem solvers,” said social worker manager Michael Thomas. “We answer all manner of questions and all sorts of non-medical problems come to us. We fill that role of being an emotional support to patients and families, identifying things that might be obstacles to doing well here in the hospital and to a smooth transition out of the hospital.”

How Hospital Social Workers Can Help:

Stanford Hospital's Department of Social Work and Case Management provides a wide array of services and information.  They include:
- discharge planning
- assistance and referrals to lodging resources
- supportive and adjustment counseling
- crisis intervention
- financial assistance
- insurance, Medicare, Medi-Cal, state disability and Social Security
- psychosocial evaluations
- support groups
- education and consultative services
- medical care preference documents
- other Hospital resources include:
   *  Stanford Health Library -- 650.723.9863
   *  Hospital Guest Services -- 650.498.3333
   *  Farewell to Falls -- 650.724.9369
   *  Aging Adult Services -- 650.498.3333
   *  Stanford Cancer Supportive Care Program -- 650.725.9481
   * Art for Health, massage therapy, Pet Assisted Wellness, music, smoking cessation -- 650.498.3333

“People go to a hospital and can be pretty clueless,” said Jim Carrigan. “When something catastrophic happens, you need to ask as many questions as possible. You’re dealing with so many people and then there are shift changes. You would be lost unless you really get a handle on it.”

“He went above and beyond the call to solve a problem, relieving us of some stress in the middle of everything else that was going on."
-Jim Carrigan, father of Stanford Hospital patient Andrew Carrigan

Someone like Chamberlain is that person “you can go to and say, ‘This is what I need,’” Carrigan said. And in situations where the lives of a patient and family have been turned upside down in a second, a social worker is the person who helps a family get organized to cope.

In his first meeting with the Carrigan family, Chamberlain said, “We talked about what had happened and we talked about the feeling of being afraid he might not survive. Part of my reward is being able to offer support, to say, ‘It’s appropriate for you to be afraid.’ But we also talked about how it was okay to maintain hope. There is nothing wrong with hope.”

As Andrew’s family rallied, Chamberlain continued his work. For many families, he is the person who educates them about practical matters, including disability insurance. But he’s always checking in, asking, “How are you coping?”

Handling Difficult Realities

“It’s a very subtle science,” said Thomas. “We have to tell people things they really don’t want to hear and tell them in a way so there can be a productive outcome for the family. It can be very challenging, especially when there’s a lot of emotion and a lot of anger.”

“Social workers are the cement that binds all the disciplines."
-Will Gressman, Interim Director, Stanford Hospital Social Work and Case Management Department

In the most difficult circumstances, social workers must find a way to quickly address issues of life and death. “We see a wide variety of situations that have an emotional impact on a patient and patient’s family. For instance, a patient may have been in a car with their best friend and maybe they lived and their best friend didn’t,” said Thomas. “We want to respond to those issues from as close to the onset as we can, with education and support because that can have a positive influence on the immediate and long-term well-being of a patient.”

Sometimes, the impact of a social worker’s words is not obvious during a patient’s stay in the hospital, Thomas said. “Sometimes we are planting seeds we hope will grow at some point in the future.” Recently, he received a voicemail message from a former patient who said she still had his card and that she had stopped drinking after he had talked with her while she had been hospitalized five years earlier. She didn’t leave her last name, but she’d wanted to thank him.

Stanford Hospital social workers find ways
to help patients and their families cope with
the stress and challenge of illness and
hospitalization.  Clockwise from the top left are: Evonne David, Michael Thomas,
Tim Chamberlain and Sandy Chen.

Thoughtful Guidance

The better a social worker understands a patient, the better medical treatment plans can be implemented. Social worker Evonne David, who works with transplant patients and their families, has become expert in analysis of key psychosocial elements in order “to develop a therapeutic alliance that keeps everyone engaged,” she said, including a patient’s support person. She also arranges conversations between transplant candidates and transplant recipients as another way of educating those candidates about the change they face, focusing on coping skills and the lifelong need to follow a medical regimen that protects their health. “I can yack away at them, but there’s nothing like hearing it from a person who’s walked the walk,” David said.

“We're problem solvers.  We answer all manner of questions and all sorts of non-medical problems come to us."
-Stanford Hospital social worker Michael Thomas

With her cancer patients, Sandy Chan makes sure that they have the chance to talk about their feelings. “Doctors can be busy, and patients have these things they want to say, but they’re not always able to tell them. They hold these things in, feeling as though they shouldn’t be feeling them. But the deeper you can get in, the more you can find out, the more you can do.”

“Our goal is to make sure patients have all the information they need to make good decisions,” she said.


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