Table Of ContentFOUR PHYSICIANS * RESPONSE TO INTERPRETATION
OF MEDICAL SOCIAL CASEWORK
A Thesis
Presented to
the Faculty of the School of Social Work
The University of Southern California
In Partial Fulfillment
of the Requirements for the Degree
Master of Social Work
by
Miriam Purcell
June 1950
UMI Number: EP66359
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This thesis, written under the direction of the
candidate’s Faculty Committee and approved
hy all its members, has been presented to and
accepted by the Faculty of the Graduate School
of Social W ork in partial fulfilment of the re
quirements for the degree of
MASTER OF SOCIAL WORK
^ j Dean
(&_
)
7
'
Thesis o/.-. MISIAM-PURCELL.
Faculty Committee
TABLE OF CONTENTS
CHAFER FACE
I* PROBLEM OF INTEGRATION OF MEDICAL SOCIAL
WORK IN MEDICAL CARE . . . .'................ 1
Interpretation of medical social work to
physicians . . . . . . . . . . . . . . . . . 10
Purpose of this s t u d y ............• . • • . 13
Setting of this study* • ......... 14
Case selection • 17
Method of this study . • • • . . ♦ • • • • • . 19
II. CASES UNDER CARE OF THE PARTICIPATING PHYSICIANS
AND THE MEDICAL SOCIAL WORKER. . . . . . . . . 22
Mr. Adams. 22
Mr. Burrows . • « • . . . • . • . • • • • . * 24
Mr. Curran . • • • . . . . • • • • • » » . • » 27
Mr. Downs 29
III. INTERVIEWS WITH THE FOUR PHYSICIANS ABOUT
MEDICAL SOCIAL WORK. . . . . . . . . . . . . . 34
General considerations of all four
physicians 34
Interview with Mr. Adams* physician . . . . . 37
Comments on the interview with
Mr. Adams* physician . . • • • • • • • • . . 44
Interview with Mr. Burrows* physician « . . . 46
ill
CHAPTER PAGE
Comments on the interview with
Mr. Burrows 1 physician......... . 52
Interview with Mr. Curran’s physician • • . • . 54
Comments on the interview with
Mr. Curran’s physician • • • • • • • • • . . 62
Interview with Mr. Downs1 physician . . . . « • 65
Comments on the interview with
Mr. Downs’ physician ........... 70
IV. REACTIONS OF THE FOUR PHYSICIANS PARTICIPATING
IN THIS STUDY ......... 75
Some considerations regarding the validity
of the following interpretation 73
To being interviewed • • • • • • • • • • • • • 75
To their experience with medical social
workers . . . . . . • • • • • . 77
To their concept of medicine • • • • • * • • • 78
To their understanding and acceptance of
medical social work • • • • • • • • • . . • • 80
To the definition of medical social work
in the Statement • • • . . . . . • • • • . . 82
To the Summaries of the cases • • • • • • • • • 84
V. CONCLUSIONS. 86
BIBLIOGRAPHY . . ......................... 92
IV
CHAPTER PAGE
APPENDIX A. The Statement......................... 96
APPENDIX B. Case Summaries......... 99
INTRODUCTION
PROBLEM OF INTEGRATION OF MEDICAL SOCIAL WORK
IN MEDICAL CARE
Since medical social work has joined with medicine in
giving medical care and functions in a setting in which
physicians are primarily responsible, it can develop into
Its fullest maturity only with the cooperation of medical
men who see Its contribution as important to the care of
their patients* The profession of medical social work Is
continuously working toward achieving this goal* As the
physician’s understanding of medical social work is neces
sary to a realization of its function, study and evaluation
of the physician’s reactions to medical social work is an
essential step in improving that understanding*
"The major function of medical social work is the
practice of social casework in a medical setting**'3- Case
work. is not easy to define because It has been developed
over the years as a dynamic process, having amassed a body
of knowledge applied from the findings of various disci
plines such as sociology, biology, psychology, psychiatry
^■Harriett Bartlett, Some Aspects of Social Casework
(Chicago: American Association of Medical Social Workers,
1940)•
and anthropology, because of their common concern with human
relationships. Gordon Hamilton says that "Social casework
has always proved elusive in definition because the social
sciences and civilization are, themselves, fluid and
elusive#”2 Social casework is concerned with helping the
individual to mobilize his personality strengths and his
personal resources, and helping him to use what he needs of
the services and resources of the community to solve a
problem in his reality*
Medical social work retains the function and methods
basic to social casework practice# In joining its purposes
with those of medicine, its primary objective is that of
medicine: the most effective medical care for the individu
als served by the medical institution of which it is a part#
Because sick people are so often more helpless than those
who have retained their health, because, in a hospital, they
cannot function as they do in their normal environment,
because medical care is often complex and disturbing to
vital adjustments, patients tend to have problems with which
they need the help of the social worker# fhe illness,
itself, often produces problems and may be influenced or
motivated by social, emotional and environmental factors,
all of which may keep the individual from making the fullest
^Gordon Hamilton, Principles of Social Case Record
ings (Hew York: Columbia University Press, 1946) , p# 1#
3
use of his medical care* Social case work, then, with sick
people Is a significant part of medical care*
In a recent publication sponsored by a committee of
physicians and medical social workers, Antoinette Gannon and
Harriett Bartlett, eminent in the field of medical social
work, are responsible for the following partial statement
about medical social caseworkt "Medical social casework has
been called upon to further the doctor fs purpose of cure or
rehabilitation and also to bring in a knowledge of social
causes*® Also, "The medical social worker is prepared to
help the patient in regard to those psycho-social and
environmental problems that arise in the course of the
medical care and interfere with its successful proseeution*w^
Since medical care is the objective of medical social
work, integration of social work with the care offered by
physicians and other clinicians and practitioners in the
medical setting is essential* This integration can only be
possible if all the participants offering service to the
patient, in this setting, act as a team* Teamwork implies
an understanding and acceptance by all the teammates of the
contribution of each member of the team— not necessarily
3fjhe Hew York Academy of Medicine Committee on Medi
cine and the Changing Order, Medical Addenda: Related Essays
on Medicine and the Changing Order (Hew Yorks She Common-
wealth Fund , 1947 ), p* 40 *
4Ibid.. p. 45.
joint and concurrent action of all.
The concept of the "clinical team11 in medical care is
not new. Physicians have always depended to some extent
upon the services of other practitioners, such as midwives,
nurses and attendants, with whom they shared responsibility.
With the development of the large institutions for medical
care, which made necessary a large and complicated system of
staff for service to the patient, more and more sharing of
responsibility became necessary. But the clinical team is
now developing into its greatest potential, in most instan
ces, only as skills in interpersonal relationships are being
learned. The clinical team is dependent upon the ability of
each member of the team to find and maintain his appropriate
role, in relation to his function, his responsibility and the
degree of his skills. This ability to find his characteris
tic contribution depends upon the underlying assumption that
the contribution of each team member is needed and this
assumption finds verification in the appreciation of the
full truth and implications of the social component in
medicine.
The really great physicians, even in the very early
days of medicine, realized the importance of the social and
emotional factors in the patient’s life in relation to his
physical symptoms. The old adage, lfA healthy mind in a
healthy body," implies this relationship. "Psychosomatic
