New research suggests adolescents and young adults (AYAs) with leukemias and lymphomas are living longer than such patients did 2 decades ago.

However, their survival still lags behind survival in children. It even lags behind survival in older adults in the case of acute myeloblastic leukemia (AML).

Investigators reported these findings online August 24 ahead of the November 1 print edition of Cancer.

Dianne Pulte, MD, of the University of Medicine and Dentistry of New Jersey, and colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) database to determine survival rates of young people with Hodgkin lymphoma, non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), AML, and chronic myelocytic leukemia (CML).

They compared data from 1981–1985 with data from 2001–2005.

The investigators found that survival had improved significantly in each of the 5 malignancies. For AYAs with Hodgkin’s lymphoma, 10-year survival increased from 80.4% to 93.4%. For those with NHL, it increased from 55.6% to 76.2%; for those with ALL, from 30.5% to 52.1%; for those with AML, from 15.2% to 45.1%; and for those with CML, from 0% to 74.5%.

They analyzed the data further and found that the survival rate for young people with the lymphomas or CML had improved steadily over the 2 decades. And the survival rate was stable for patients with the acute leukemias during the late 1990s and early 21st century.

However, they found that survival in AYAs is still not as good as the survival rate for children with these hematologic malignancies, with the exception of patients with Hodgkin lymphoma. And survival in AYAs with AML lags behind survival in older adults.

The investigators acknowledge that improving survival rates for the AYA population is a major challenge. Dr Pulte suggests that “more research into how to treat these diseases and how to make sure that all patients have access to the best treatment is needed.”

New research suggests adolescents and young adults (AYAs) with leukemias and lymphomas are living longer than such patients did 2 decades ago.

However, their survival still lags behind survival in children. It even lags behind survival in older adults in the case of acute myeloblastic leukemia (AML).

Investigators reported these findings online August 24 ahead of the November 1 print edition of Cancer.

Dianne Pulte, MD, of the University of Medicine and Dentistry of New Jersey, and colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) database to determine survival rates of young people with Hodgkin lymphoma, non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), AML, and chronic myelocytic leukemia (CML).

They compared data from 1981–1985 with data from 2001–2005.

The investigators found that survival had improved significantly in each of the 5 malignancies. For AYAs with Hodgkin’s lymphoma, 10-year survival increased from 80.4% to 93.4%. For those with NHL, it increased from 55.6% to 76.2%; for those with ALL, from 30.5% to 52.1%; for those with AML, from 15.2% to 45.1%; and for those with CML, from 0% to 74.5%.

They analyzed the data further and found that the survival rate for young people with the lymphomas or CML had improved steadily over the 2 decades. And the survival rate was stable for patients with the acute leukemias during the late 1990s and early 21st century.

However, they found that survival in AYAs is still not as good as the survival rate for children with these hematologic malignancies, with the exception of patients with Hodgkin lymphoma. And survival in AYAs with AML lags behind survival in older adults.

The investigators acknowledge that improving survival rates for the AYA population is a major challenge. Dr Pulte suggests that “more research into how to treat these diseases and how to make sure that all patients have access to the best treatment is needed.”

New research suggests adolescents and young adults (AYAs) with leukemias and lymphomas are living longer than such patients did 2 decades ago.

However, their survival still lags behind survival in children. It even lags behind survival in older adults in the case of acute myeloblastic leukemia (AML).

Investigators reported these findings online August 24 ahead of the November 1 print edition of Cancer.

Dianne Pulte, MD, of the University of Medicine and Dentistry of New Jersey, and colleagues analyzed data from the Surveillance, Epidemiology and End Results (SEER) database to determine survival rates of young people with Hodgkin lymphoma, non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), AML, and chronic myelocytic leukemia (CML).

They compared data from 1981–1985 with data from 2001–2005.

The investigators found that survival had improved significantly in each of the 5 malignancies. For AYAs with Hodgkin’s lymphoma, 10-year survival increased from 80.4% to 93.4%. For those with NHL, it increased from 55.6% to 76.2%; for those with ALL, from 30.5% to 52.1%; for those with AML, from 15.2% to 45.1%; and for those with CML, from 0% to 74.5%.

They analyzed the data further and found that the survival rate for young people with the lymphomas or CML had improved steadily over the 2 decades. And the survival rate was stable for patients with the acute leukemias during the late 1990s and early 21st century.

However, they found that survival in AYAs is still not as good as the survival rate for children with these hematologic malignancies, with the exception of patients with Hodgkin lymphoma. And survival in AYAs with AML lags behind survival in older adults.

The investigators acknowledge that improving survival rates for the AYA population is a major challenge. Dr Pulte suggests that “more research into how to treat these diseases and how to make sure that all patients have access to the best treatment is needed.”

Dr. Joel Gelfand discusses research concerning the use of biologics and lymphoma risk. Kerri Wachter of the Global Medical News Network (GMNN) reports from the American Academy of Dermatology's Academy 2009 meeting in Boston.

Dr. Joel Gelfand discusses research concerning the use of biologics and lymphoma risk. Kerri Wachter of the Global Medical News Network (GMNN) reports from the American Academy of Dermatology's Academy 2009 meeting in Boston.

Dr. Joel Gelfand discusses research concerning the use of biologics and lymphoma risk. Kerri Wachter of the Global Medical News Network (GMNN) reports from the American Academy of Dermatology's Academy 2009 meeting in Boston.

Endobronchial dysplasia significantly improved in former smokees who received oral iloprost during a phase II trial, says study investigator Dr. Robert Keith. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

Endobronchial dysplasia significantly improved in former smokees who received oral iloprost during a phase II trial, says study investigator Dr. Robert Keith. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

Endobronchial dysplasia significantly improved in former smokees who received oral iloprost during a phase II trial, says study investigator Dr. Robert Keith. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

Dr. Roy S. Herbst reflects on the most clinically relevant studies presented at the world conference of the International Association for the Study of Lung Cancer. Dr. Herbst is chief of Thoracic Head and Neck Medical Oncology at M. D. Anderson Cancer Center. He is also associate editor of the Oncology Report, an Elsevier publication. GMNN's Bob Finn reports.

Dr. Roy S. Herbst reflects on the most clinically relevant studies presented at the world conference of the International Association for the Study of Lung Cancer. Dr. Herbst is chief of Thoracic Head and Neck Medical Oncology at M. D. Anderson Cancer Center. He is also associate editor of the Oncology Report, an Elsevier publication. GMNN's Bob Finn reports.

Dr. Roy S. Herbst reflects on the most clinically relevant studies presented at the world conference of the International Association for the Study of Lung Cancer. Dr. Herbst is chief of Thoracic Head and Neck Medical Oncology at M. D. Anderson Cancer Center. He is also associate editor of the Oncology Report, an Elsevier publication. GMNN's Bob Finn reports.

An investigational device can discriminate normal cells from cancerous cells in sputum with 90% sensitivity and near 100% specificity, according to its manufacturer, VisionGate, Inc. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

An investigational device can discriminate normal cells from cancerous cells in sputum with 90% sensitivity and near 100% specificity, according to its manufacturer, VisionGate, Inc. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

An investigational device can discriminate normal cells from cancerous cells in sputum with 90% sensitivity and near 100% specificity, according to its manufacturer, VisionGate, Inc. Bob Finn of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

A hospitalist-orthopedic comanagement model at Loyola University Medical Center in Maywood, Ill., improves both patient care and satisfaction, according to a study published in the July issue of Orthopedics (2009;32:495).

The approach, which dedicates two hospitalists to work with the orthopedists, was the culmination of a joint effort that began in 2005 to address communication issues between the hospitalist consultation service and the orthopedic surgery team, says Edward Gurza, MD, associate professor of medicine and director of the Division of General Internal Medicine at Loyola's Stritch School of Medicine in Chicago. “The idea was to have the same group of people to take care of patients pre-operatively, peri-operatively, and post-operatively,” Dr. Gurza says. “That’s absolutely critical. With orthopedics, one of the big issues is lack of continuity in the coordination of care.”

The study reports that the length of hospital stays was 0.693 days for 86 high-risk, comanaged patients with multiple comorbidities compared with 0.862 days for 54 patients in the control group. The severity of illness and risk of mortality scores were higher in the study group. The analysis found little effect on costs of care, but patient satisfaction scores for the test groups rose by 5% and 14%, respectively, in the categories of “communication with doctors” and “doctors treated you with respect.”

Dr. Gurza says the program needed no new funding, just a commitment from HM group leaders to dedicate staff to the concept. Hospitalists breed familiarity that cements a bond between physician and patient. “It flows naturally,” he says. “You’re not going out to specifically charm a patient. Hopefully, if you’re doing your job as an internist delivering proper care, patients understand that.”

A hospitalist-orthopedic comanagement model at Loyola University Medical Center in Maywood, Ill., improves both patient care and satisfaction, according to a study published in the July issue of Orthopedics (2009;32:495).

The approach, which dedicates two hospitalists to work with the orthopedists, was the culmination of a joint effort that began in 2005 to address communication issues between the hospitalist consultation service and the orthopedic surgery team, says Edward Gurza, MD, associate professor of medicine and director of the Division of General Internal Medicine at Loyola's Stritch School of Medicine in Chicago. “The idea was to have the same group of people to take care of patients pre-operatively, peri-operatively, and post-operatively,” Dr. Gurza says. “That’s absolutely critical. With orthopedics, one of the big issues is lack of continuity in the coordination of care.”

The study reports that the length of hospital stays was 0.693 days for 86 high-risk, comanaged patients with multiple comorbidities compared with 0.862 days for 54 patients in the control group. The severity of illness and risk of mortality scores were higher in the study group. The analysis found little effect on costs of care, but patient satisfaction scores for the test groups rose by 5% and 14%, respectively, in the categories of “communication with doctors” and “doctors treated you with respect.”

Dr. Gurza says the program needed no new funding, just a commitment from HM group leaders to dedicate staff to the concept. Hospitalists breed familiarity that cements a bond between physician and patient. “It flows naturally,” he says. “You’re not going out to specifically charm a patient. Hopefully, if you’re doing your job as an internist delivering proper care, patients understand that.”

A hospitalist-orthopedic comanagement model at Loyola University Medical Center in Maywood, Ill., improves both patient care and satisfaction, according to a study published in the July issue of Orthopedics (2009;32:495).

The approach, which dedicates two hospitalists to work with the orthopedists, was the culmination of a joint effort that began in 2005 to address communication issues between the hospitalist consultation service and the orthopedic surgery team, says Edward Gurza, MD, associate professor of medicine and director of the Division of General Internal Medicine at Loyola's Stritch School of Medicine in Chicago. “The idea was to have the same group of people to take care of patients pre-operatively, peri-operatively, and post-operatively,” Dr. Gurza says. “That’s absolutely critical. With orthopedics, one of the big issues is lack of continuity in the coordination of care.”

The study reports that the length of hospital stays was 0.693 days for 86 high-risk, comanaged patients with multiple comorbidities compared with 0.862 days for 54 patients in the control group. The severity of illness and risk of mortality scores were higher in the study group. The analysis found little effect on costs of care, but patient satisfaction scores for the test groups rose by 5% and 14%, respectively, in the categories of “communication with doctors” and “doctors treated you with respect.”

Dr. Gurza says the program needed no new funding, just a commitment from HM group leaders to dedicate staff to the concept. Hospitalists breed familiarity that cements a bond between physician and patient. “It flows naturally,” he says. “You’re not going out to specifically charm a patient. Hopefully, if you’re doing your job as an internist delivering proper care, patients understand that.”

Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.

"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."

Lea Booker, right, a nurse practitioner at Hamot Hospital in Erie, Pa., listens to a presentation by Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, at the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, gives a presentation on congestive heart failure.

Robert Bowden, left, of South Dartmouth, Mass., and Sally Figueiredo, right, of North Dighton, Mass., physician assistants at St. Luke's Hospital in New Bedford, chat during a break.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Over 200 NPPs attended the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week.

"Everyone was there to learn, to network, and to share their own knowledge and experiences, whether they were brand new to the field of hospital medicine or had been practicing for 10 years in the field," said course instructor Lynne Allen, MN, MRNP.

The Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp was meant to be an intense study of routine topics in adult HM practice.

Photo credit: Jay Westcott

Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.

"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."

Lea Booker, right, a nurse practitioner at Hamot Hospital in Erie, Pa., listens to a presentation by Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, at the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, gives a presentation on congestive heart failure.

Robert Bowden, left, of South Dartmouth, Mass., and Sally Figueiredo, right, of North Dighton, Mass., physician assistants at St. Luke's Hospital in New Bedford, chat during a break.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Over 200 NPPs attended the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week.

"Everyone was there to learn, to network, and to share their own knowledge and experiences, whether they were brand new to the field of hospital medicine or had been practicing for 10 years in the field," said course instructor Lynne Allen, MN, MRNP.

The Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp was meant to be an intense study of routine topics in adult HM practice.

Photo credit: Jay Westcott

Nurse practitioners (NPs) and physician assistants (PAs) are expected to help fill the HM ranks in the coming years, and more than 200 of them showed their dedication to the field by attending the first Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Sponsored by SHM, the American Academy of Physician Assistants, and the American Academy of Nurse Practitioners, the soldout event provided intense training in such clinical areas as cardiac neurologic care, as well as infection control. Attendees also learned valuable practice management tips and learned how to report Physician Quality Reporting Initiative (PQRI) measures.

"The NPP bootcamp was a success; participants were happy with the content," says Jeanette Kalupa, MSN, ACNP-BC, APNP, an acute-care NP with Cogent Healthcare of Wisconsin in Milwaukee. "The faculty, who were a mix of MDs, NPs, and PAs, were terrific. The NPs and PAs who attended were a mix of experience levels and knowledge levels, in regards to hospital medicine."

Lea Booker, right, a nurse practitioner at Hamot Hospital in Erie, Pa., listens to a presentation by Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, at the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week in Chantilly, Va.

Lorenzo Di Francesco, MD, of Emory University Hospital in Atlanta, gives a presentation on congestive heart failure.

Robert Bowden, left, of South Dartmouth, Mass., and Sally Figueiredo, right, of North Dighton, Mass., physician assistants at St. Luke's Hospital in New Bedford, chat during a break.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Attendees listen to a presentation by Chad Whelan, MD, associate professor and director of the hospital medicine program at Loyola University in Chicago.

Over 200 NPPs attended the Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp last week.

"Everyone was there to learn, to network, and to share their own knowledge and experiences, whether they were brand new to the field of hospital medicine or had been practicing for 10 years in the field," said course instructor Lynne Allen, MN, MRNP.

The Adult Hospitalist Physician Assistant and Nurse Practitioner Boot Camp was meant to be an intense study of routine topics in adult HM practice.

Photo credit: Jay Westcott

A revolutionary new staging system for lung cancer will unite clinicians from different specialties and nations in characterizing tumor characteristics, node involvement, and metastasis, says Dr. Peter Goldstraw. Betsy Bates of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

A revolutionary new staging system for lung cancer will unite clinicians from different specialties and nations in characterizing tumor characteristics, node involvement, and metastasis, says Dr. Peter Goldstraw. Betsy Bates of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

A revolutionary new staging system for lung cancer will unite clinicians from different specialties and nations in characterizing tumor characteristics, node involvement, and metastasis, says Dr. Peter Goldstraw. Betsy Bates of the Global Medical News Network (GMNN) reports from the World Conference on Lung Cancer in San Francisco.

Editors’ note: “Alliances” is a new series written about the relationships that hospitalists have with members of the clinical care team—from the team members’ points of view. It’s our hope that each installment of “Alliances” will provide valuable, revealing feedback that hospitalists can use to continually improve their intrateam relationships and, ultimately, patient care.

Social workers are a natural fit with hospitalists and the hospitalist’s strongest allies and staunchest supporters, wrote Bradley Flansbaum, DO, MPH, in his Nov./Dec. 2003 article in The Hospitalist. What makes this collaboration such a positive one and what can members of these two professions learn from each other?

Dr. Flansbaum, a hospitalist and internist with the Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y., and a former SHM board member, recently reiterated the benefits of the hospitalist-social worker relationship. In general, he believes that hospitalists provide a unique history-taking perspective that is useful to social workers in their work. Foremost, social workers bring a rich understanding of the available resources that patients need after discharge and a view of the patient’s nonmedical circumstances. Together, the two professionals’ daily interactions generate more effective discharge planning as a part of the multidisciplinary team.

ALWAYS THERE

Amy Lingg, MS, MPA, works on the general medicine unit at Greenwich Hospital (Conn). She says the role of the hospitalist is fairly new at Greenwich. In fact Sabitha Rajan, MD, MS, was the first one at Greenwich Hospital.

In Lingg’s view, nothing can replace the availability of the hospitalist to discuss patient cases, not only with the social worker but also as a team with the patient and family.

“[Attendings] are not there for the moment-by-moment events that happen on the unit, including availability when families are here,” says Lingg. “If I need to speak with a family and the physician’s input is important there, I can just page the hospitalist, she’s here. Whereas with an attending you have to make an appointment; you have to schedule around them. It can become difficult.”

Lingg, who works with hospitalist Dr. Rajan, director of hospitalist services at Greenwich Hospital, cites an example of the benefits of hospitalists’ 24/7 availability: “We had a fairly young woman in her mid-40s who was the divorced mother of a 17-year-old son. The father was not in the picture, and the woman was dying of alcoholic cirrhosis and liver failure. She was Dr. Rajan’s patient. One of the issues was the fact that there was no adult guardian for the son although he was going to be 18 in two months.

“So it involved a lot of talking with friends of the woman, who were sort of stepping in as surrogate guardians to him,” Lingg continues. “There were a lot of logistics [regarding] what would happen with him. We were trying to call the grandfather who was estranged. It was a very, very sensitive, very, very tricky case. It went on for days and days. … Dr. Rajan and I could work on this together on a dayto-day basis, [including] … the counseling, relaying medical knowledge to the family, what was going on clinically, trying to deal with that in a way where she was talking in one way to [the] adults and in a different, more appropriate [for the boy’s age] way to the 17-yearold son. And I can be there to help with that process.”

The situation was resolved to the satisfaction of the mother, the son, the friends, and the providers. “It was really pretty extraordinary,” she said. “I’ve talked about that a couple of times, including at a staff meetings when we were talking about getting new hospitalists. That is something I’ve described because, really, it was very special.”

TRUE TEAMWORK

Although everyone on a multidisciplinary team can bring something to the discussion that makes the team work better, social workers and hospitalists collaborate well in painting a more comprehensive picture of the patient’s lifestyle, living habits, and needs.

“In many hospitals … there’s a pattern that develops [whereby at] some time in the morning the hospitalist and social worker will get together and talk,” says Dr. Flansbaum “The hospitalist speaks the language of the social worker and knows what to tell them and how to direct them rather than just saying, ‘the patient’s homeless or the patient needs help at home.’”

After working regularly with social workers and recognizing what they need to know, he says, “the hospitalist is more likely to say, ‘the patient has Medicaid,’ or ‘the patient has this insurance,’ [or] ‘the patient has a home-health [caregiver] four hours a day and needs six or eight hours a day,’ or ‘the patient’s going to need a subacute nursing facility.’ … I think our insights are different from voluntary physicians and our face-time with social workers is more efficient.”

Sylvia Krafcik, MSSA, LISW, with MetroHealth Medical Center, Cleveland, says hospitalists are “great to work with because they’re very dedicated to the population they’re caring for, because this is their whole responsibility; they don’t have a private caseload.”

But in her view most hospitalists are focused on patients’ medical conditions and some of them are not as tuned in to all the other aspects of the patient, such as all the psychosocial dynamics.

“A lot of them are, but some aren’t,” Krafcik says. “Especially at MetroHealth, we’re a county hospital. So many of the patients that come here are poor. A lot of them are alcoholics or drug abusers. They’re homeless. They live on the streets. They don’t have a primary doctor. They’re usually not compliant with their medications.”

“Here at Metro we have a lot of patients who have extreme social circumstances that affect their medical issues so much,” says Sara Dunson, MSW, LSW, who also works as a social worker at Metro-Health. “I think the hospitalist has greater insight into the person’s environment and all the social structures that they have at home and that are going on in their life [than other physicians might].”

But there is always room for improvement.

“We had one patient who wasn’t able to read, and he never told anybody this,” says Dunson. “And as social workers, we have more of a way of finding that kind of stuff out from patients than the doctors might. And he kept coming in and coming in and was noncompliant with his medication. We eventually determined that this was why he was noncompliant and was causing all these medical issues. The doctors finally [understood] why this gentleman kept coming in with the same problems and he wasn’t taking care of himself. It wasn’t that he didn’t want to, it was just that he was having problems reading all the medications and all the discharge paperwork, and he was too ashamed to tell anybody. [Once the social workers questioned him and got this] out in the open, we were able to get him help with that.”

The doctors focused on what he was or wasn’t doing, but they hadn’t looked at why he wasn’t adherent, explains Dunson. If hospitalists do that more often, she thinks, they could save time and get better outcomes sooner.

COMMUNICATING WITH PATIENTS AND FAMILIES

“I think where hospitalists are coming from is a whole different mindset than a physician who has mainly an office practice,” said Lingg. “The office practice comes first [for them]. Some of our physicians have huge practices in town. And they’ll visit the hospital very early in the morning or in the evening. ... So if I need something in a case like that, if there was not a hospitalist involved, it would have been separate meetings for the family with the physician … and [with] me at another time.”

To hospitalists, a social worker can serve as an important adjunct in talking to the patient and family. “For example, if [social workers] are giving bad news, they warn the physician first,” says Dr. Rajan. “If they’re going to go in and tell the patient that they’re not going to qualify for any home services, they tell the physician as well so that [the hospitalist will not later be] meeting an angry patient.” In addition, she says, “for critically ill or long-term patients, social workers [can] help family members cope. Sometimes as physicians we don’t have the time or we don’t have the resources to do that.”

But this doesn’t let doctors off the hook in regard to addressing the whole person’s needs. Especially if someone has multiple medical problems, the social worker needs to know the availability and level of support for which the family can be counted.

“Social workers will ask questions such as: Are the families involved? or Is there any family?” says Krafcik. “Do they need to go in a nursing home or do they need 24-hour care at home? Is the family able to provide that? [E]very morning we meet to have team rounds. And the [team] go[es] over every patient on the floor, and then I will ask those questions if the doctor hasn’t given me that information.”

Social workers appreciate and would like hospitalists to do more listening to the patient and family for the aspects of the history and psychosocial status that the social worker will need to know.

TEACHING POINTS

In the course of their interactions, what do hospitalists and social workers teach each other that could lead to working a case more effectively and to the greater satisfaction of all involved?

Most of those we interviewed seem to think that the greatest service hospitalists provide is to teach the social worker the medical components that go along with what the social worker does every day.

“[Social workers] get a better understanding of [whether] someone comes in with heart failure or a fall or a stroke, just by repetition and also education; they get to understand after a while what’s needed for individual medical diagnoses,” says Dr. Flansbaum.

“When I know [better] what the medical condition is,” says Krafcik, “I have an idea of how much help [the patient] would need at home and their ability to function. And I would make sure that the patient gets physical therapy or occupational therapy referral or speech therapy.”

Again, perhaps the area where the social worker most teaches the hospitalist regards available resources to solve problems over and above the purely medical. “They know the social system and the needs of different forms and eligibility and what different patients are entitled to and what the system will provide,” says Dr. Flansbaum.

Dunson believes hospitalists are perceived as being more involved in a holistic way with the patient. “I always stress that it is so important to look at the whole person and not just the medical aspects,” she says. “It’s hard for the doctor sometimes to realize that this person might not be able to afford this medication and that’s why they’re noncompliant and all the other issues. So I think is important to open up to the other aspects of a person’s life and not just the medical aspects.”

CONCLUSION

Social workers’ knowledge of medical and nonmedical resources, both locally and nationally, offer hospitalists essential information that leads to designing more appropriate and effective post-discharge plans. Hospitalists can best team with social workers by consistently keeping in mind the patient’s overall circumstances and informing their colleagues of the medical information that can help social workers do their best work. TH

Writer Andrea Sattinger will write about the effect of poor communication skills in the November issue of The Hospitalist.

HOSPITALISTS AND SOCIAL WORKERS

Both sides of the clinical care team discuss the pros and cons of working together

Bradley Flansbaum, DO, MPH, Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y.

In these … fractious healthcare times when resources are not plentiful and the expectations of patients might be higher, like getting 24-hour care at home, sometimes it might appear that the hospitalist or [another] physician is always the bringer of bad news. A good social worker can work well with the hospitalist in … letting the patient know the realistic expectations of what the system can provide [so that] we’re not in this alone. You know, ‘the world is a nail, the hospitalist is always the hammer’ kind of thing. Social workers can be very helpful in delivering information. … A good social worker can also add some “salve” to the wounds that the patient comes in with.

Some [patients] are borderline functioning or kind of on the precipice already. They come in with this problem and all of a sudden they can’t go back to the situation they were operating in prior. Social workers’ knowledge of the social safety net … is terrific, and they help us in directing what would be the best discharge plan for this patient, [including] knowing what the insurance status is, … what resources they have in place already, what else is available. … [I]t has a lot to do with discharge and recovery and functionality, and [to find out what’s the best place for the patient. They can help us with that.

Sabitha Rajan, MD, MS, director of hospitalist services at Greenwich Hospital, Conn.

Perhaps the greatest value social workers provide for all concerned is having the storehouse of knowledge of the available resources of the community. This is probably one of the most vital things to me; they can get a patient into services or programs that I didn’t even know exist. And the resources are very different in Connecticut than … in New York [where I practiced previously]. In New York there are many resources geared toward the Hispanic community, which I haven’t seen so far in Connecticut. But Connecticut has some other great resources; the local area clinic is a fantastic one.

Patients with end-of-life situations are dealt with differently in different states, too, and I wouldn’t have known about all this if it had not been for the social worker with whom I work. I also found out that there is a free program for alcohol rehabilitation in Connecticut; that does not exist in New York. We’ve sent a lot of our patients [to that]; you know they have to be the ones to initiate the call, but if they do, then that’s actually a resource for them. I wasn’t aware of that until I worked with the social workers here.

Editors’ note: “Alliances” is a new series written about the relationships that hospitalists have with members of the clinical care team—from the team members’ points of view. It’s our hope that each installment of “Alliances” will provide valuable, revealing feedback that hospitalists can use to continually improve their intrateam relationships and, ultimately, patient care.

Social workers are a natural fit with hospitalists and the hospitalist’s strongest allies and staunchest supporters, wrote Bradley Flansbaum, DO, MPH, in his Nov./Dec. 2003 article in The Hospitalist. What makes this collaboration such a positive one and what can members of these two professions learn from each other?

Dr. Flansbaum, a hospitalist and internist with the Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y., and a former SHM board member, recently reiterated the benefits of the hospitalist-social worker relationship. In general, he believes that hospitalists provide a unique history-taking perspective that is useful to social workers in their work. Foremost, social workers bring a rich understanding of the available resources that patients need after discharge and a view of the patient’s nonmedical circumstances. Together, the two professionals’ daily interactions generate more effective discharge planning as a part of the multidisciplinary team.

ALWAYS THERE

Amy Lingg, MS, MPA, works on the general medicine unit at Greenwich Hospital (Conn). She says the role of the hospitalist is fairly new at Greenwich. In fact Sabitha Rajan, MD, MS, was the first one at Greenwich Hospital.

In Lingg’s view, nothing can replace the availability of the hospitalist to discuss patient cases, not only with the social worker but also as a team with the patient and family.

“[Attendings] are not there for the moment-by-moment events that happen on the unit, including availability when families are here,” says Lingg. “If I need to speak with a family and the physician’s input is important there, I can just page the hospitalist, she’s here. Whereas with an attending you have to make an appointment; you have to schedule around them. It can become difficult.”

Lingg, who works with hospitalist Dr. Rajan, director of hospitalist services at Greenwich Hospital, cites an example of the benefits of hospitalists’ 24/7 availability: “We had a fairly young woman in her mid-40s who was the divorced mother of a 17-year-old son. The father was not in the picture, and the woman was dying of alcoholic cirrhosis and liver failure. She was Dr. Rajan’s patient. One of the issues was the fact that there was no adult guardian for the son although he was going to be 18 in two months.

“So it involved a lot of talking with friends of the woman, who were sort of stepping in as surrogate guardians to him,” Lingg continues. “There were a lot of logistics [regarding] what would happen with him. We were trying to call the grandfather who was estranged. It was a very, very sensitive, very, very tricky case. It went on for days and days. … Dr. Rajan and I could work on this together on a dayto-day basis, [including] … the counseling, relaying medical knowledge to the family, what was going on clinically, trying to deal with that in a way where she was talking in one way to [the] adults and in a different, more appropriate [for the boy’s age] way to the 17-yearold son. And I can be there to help with that process.”

The situation was resolved to the satisfaction of the mother, the son, the friends, and the providers. “It was really pretty extraordinary,” she said. “I’ve talked about that a couple of times, including at a staff meetings when we were talking about getting new hospitalists. That is something I’ve described because, really, it was very special.”

TRUE TEAMWORK

Although everyone on a multidisciplinary team can bring something to the discussion that makes the team work better, social workers and hospitalists collaborate well in painting a more comprehensive picture of the patient’s lifestyle, living habits, and needs.

“In many hospitals … there’s a pattern that develops [whereby at] some time in the morning the hospitalist and social worker will get together and talk,” says Dr. Flansbaum “The hospitalist speaks the language of the social worker and knows what to tell them and how to direct them rather than just saying, ‘the patient’s homeless or the patient needs help at home.’”

After working regularly with social workers and recognizing what they need to know, he says, “the hospitalist is more likely to say, ‘the patient has Medicaid,’ or ‘the patient has this insurance,’ [or] ‘the patient has a home-health [caregiver] four hours a day and needs six or eight hours a day,’ or ‘the patient’s going to need a subacute nursing facility.’ … I think our insights are different from voluntary physicians and our face-time with social workers is more efficient.”

Sylvia Krafcik, MSSA, LISW, with MetroHealth Medical Center, Cleveland, says hospitalists are “great to work with because they’re very dedicated to the population they’re caring for, because this is their whole responsibility; they don’t have a private caseload.”

But in her view most hospitalists are focused on patients’ medical conditions and some of them are not as tuned in to all the other aspects of the patient, such as all the psychosocial dynamics.

“A lot of them are, but some aren’t,” Krafcik says. “Especially at MetroHealth, we’re a county hospital. So many of the patients that come here are poor. A lot of them are alcoholics or drug abusers. They’re homeless. They live on the streets. They don’t have a primary doctor. They’re usually not compliant with their medications.”

“Here at Metro we have a lot of patients who have extreme social circumstances that affect their medical issues so much,” says Sara Dunson, MSW, LSW, who also works as a social worker at Metro-Health. “I think the hospitalist has greater insight into the person’s environment and all the social structures that they have at home and that are going on in their life [than other physicians might].”

But there is always room for improvement.

“We had one patient who wasn’t able to read, and he never told anybody this,” says Dunson. “And as social workers, we have more of a way of finding that kind of stuff out from patients than the doctors might. And he kept coming in and coming in and was noncompliant with his medication. We eventually determined that this was why he was noncompliant and was causing all these medical issues. The doctors finally [understood] why this gentleman kept coming in with the same problems and he wasn’t taking care of himself. It wasn’t that he didn’t want to, it was just that he was having problems reading all the medications and all the discharge paperwork, and he was too ashamed to tell anybody. [Once the social workers questioned him and got this] out in the open, we were able to get him help with that.”

The doctors focused on what he was or wasn’t doing, but they hadn’t looked at why he wasn’t adherent, explains Dunson. If hospitalists do that more often, she thinks, they could save time and get better outcomes sooner.

COMMUNICATING WITH PATIENTS AND FAMILIES

“I think where hospitalists are coming from is a whole different mindset than a physician who has mainly an office practice,” said Lingg. “The office practice comes first [for them]. Some of our physicians have huge practices in town. And they’ll visit the hospital very early in the morning or in the evening. ... So if I need something in a case like that, if there was not a hospitalist involved, it would have been separate meetings for the family with the physician … and [with] me at another time.”

To hospitalists, a social worker can serve as an important adjunct in talking to the patient and family. “For example, if [social workers] are giving bad news, they warn the physician first,” says Dr. Rajan. “If they’re going to go in and tell the patient that they’re not going to qualify for any home services, they tell the physician as well so that [the hospitalist will not later be] meeting an angry patient.” In addition, she says, “for critically ill or long-term patients, social workers [can] help family members cope. Sometimes as physicians we don’t have the time or we don’t have the resources to do that.”

But this doesn’t let doctors off the hook in regard to addressing the whole person’s needs. Especially if someone has multiple medical problems, the social worker needs to know the availability and level of support for which the family can be counted.

“Social workers will ask questions such as: Are the families involved? or Is there any family?” says Krafcik. “Do they need to go in a nursing home or do they need 24-hour care at home? Is the family able to provide that? [E]very morning we meet to have team rounds. And the [team] go[es] over every patient on the floor, and then I will ask those questions if the doctor hasn’t given me that information.”

Social workers appreciate and would like hospitalists to do more listening to the patient and family for the aspects of the history and psychosocial status that the social worker will need to know.

TEACHING POINTS

In the course of their interactions, what do hospitalists and social workers teach each other that could lead to working a case more effectively and to the greater satisfaction of all involved?

Most of those we interviewed seem to think that the greatest service hospitalists provide is to teach the social worker the medical components that go along with what the social worker does every day.

“[Social workers] get a better understanding of [whether] someone comes in with heart failure or a fall or a stroke, just by repetition and also education; they get to understand after a while what’s needed for individual medical diagnoses,” says Dr. Flansbaum.

“When I know [better] what the medical condition is,” says Krafcik, “I have an idea of how much help [the patient] would need at home and their ability to function. And I would make sure that the patient gets physical therapy or occupational therapy referral or speech therapy.”

Again, perhaps the area where the social worker most teaches the hospitalist regards available resources to solve problems over and above the purely medical. “They know the social system and the needs of different forms and eligibility and what different patients are entitled to and what the system will provide,” says Dr. Flansbaum.

Dunson believes hospitalists are perceived as being more involved in a holistic way with the patient. “I always stress that it is so important to look at the whole person and not just the medical aspects,” she says. “It’s hard for the doctor sometimes to realize that this person might not be able to afford this medication and that’s why they’re noncompliant and all the other issues. So I think is important to open up to the other aspects of a person’s life and not just the medical aspects.”

CONCLUSION

Social workers’ knowledge of medical and nonmedical resources, both locally and nationally, offer hospitalists essential information that leads to designing more appropriate and effective post-discharge plans. Hospitalists can best team with social workers by consistently keeping in mind the patient’s overall circumstances and informing their colleagues of the medical information that can help social workers do their best work. TH

Writer Andrea Sattinger will write about the effect of poor communication skills in the November issue of The Hospitalist.

HOSPITALISTS AND SOCIAL WORKERS

Both sides of the clinical care team discuss the pros and cons of working together

Bradley Flansbaum, DO, MPH, Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y.

In these … fractious healthcare times when resources are not plentiful and the expectations of patients might be higher, like getting 24-hour care at home, sometimes it might appear that the hospitalist or [another] physician is always the bringer of bad news. A good social worker can work well with the hospitalist in … letting the patient know the realistic expectations of what the system can provide [so that] we’re not in this alone. You know, ‘the world is a nail, the hospitalist is always the hammer’ kind of thing. Social workers can be very helpful in delivering information. … A good social worker can also add some “salve” to the wounds that the patient comes in with.

Some [patients] are borderline functioning or kind of on the precipice already. They come in with this problem and all of a sudden they can’t go back to the situation they were operating in prior. Social workers’ knowledge of the social safety net … is terrific, and they help us in directing what would be the best discharge plan for this patient, [including] knowing what the insurance status is, … what resources they have in place already, what else is available. … [I]t has a lot to do with discharge and recovery and functionality, and [to find out what’s the best place for the patient. They can help us with that.

Sabitha Rajan, MD, MS, director of hospitalist services at Greenwich Hospital, Conn.

Perhaps the greatest value social workers provide for all concerned is having the storehouse of knowledge of the available resources of the community. This is probably one of the most vital things to me; they can get a patient into services or programs that I didn’t even know exist. And the resources are very different in Connecticut than … in New York [where I practiced previously]. In New York there are many resources geared toward the Hispanic community, which I haven’t seen so far in Connecticut. But Connecticut has some other great resources; the local area clinic is a fantastic one.

Patients with end-of-life situations are dealt with differently in different states, too, and I wouldn’t have known about all this if it had not been for the social worker with whom I work. I also found out that there is a free program for alcohol rehabilitation in Connecticut; that does not exist in New York. We’ve sent a lot of our patients [to that]; you know they have to be the ones to initiate the call, but if they do, then that’s actually a resource for them. I wasn’t aware of that until I worked with the social workers here.

Editors’ note: “Alliances” is a new series written about the relationships that hospitalists have with members of the clinical care team—from the team members’ points of view. It’s our hope that each installment of “Alliances” will provide valuable, revealing feedback that hospitalists can use to continually improve their intrateam relationships and, ultimately, patient care.

Social workers are a natural fit with hospitalists and the hospitalist’s strongest allies and staunchest supporters, wrote Bradley Flansbaum, DO, MPH, in his Nov./Dec. 2003 article in The Hospitalist. What makes this collaboration such a positive one and what can members of these two professions learn from each other?

Dr. Flansbaum, a hospitalist and internist with the Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y., and a former SHM board member, recently reiterated the benefits of the hospitalist-social worker relationship. In general, he believes that hospitalists provide a unique history-taking perspective that is useful to social workers in their work. Foremost, social workers bring a rich understanding of the available resources that patients need after discharge and a view of the patient’s nonmedical circumstances. Together, the two professionals’ daily interactions generate more effective discharge planning as a part of the multidisciplinary team.

ALWAYS THERE

Amy Lingg, MS, MPA, works on the general medicine unit at Greenwich Hospital (Conn). She says the role of the hospitalist is fairly new at Greenwich. In fact Sabitha Rajan, MD, MS, was the first one at Greenwich Hospital.

In Lingg’s view, nothing can replace the availability of the hospitalist to discuss patient cases, not only with the social worker but also as a team with the patient and family.

“[Attendings] are not there for the moment-by-moment events that happen on the unit, including availability when families are here,” says Lingg. “If I need to speak with a family and the physician’s input is important there, I can just page the hospitalist, she’s here. Whereas with an attending you have to make an appointment; you have to schedule around them. It can become difficult.”

Lingg, who works with hospitalist Dr. Rajan, director of hospitalist services at Greenwich Hospital, cites an example of the benefits of hospitalists’ 24/7 availability: “We had a fairly young woman in her mid-40s who was the divorced mother of a 17-year-old son. The father was not in the picture, and the woman was dying of alcoholic cirrhosis and liver failure. She was Dr. Rajan’s patient. One of the issues was the fact that there was no adult guardian for the son although he was going to be 18 in two months.

“So it involved a lot of talking with friends of the woman, who were sort of stepping in as surrogate guardians to him,” Lingg continues. “There were a lot of logistics [regarding] what would happen with him. We were trying to call the grandfather who was estranged. It was a very, very sensitive, very, very tricky case. It went on for days and days. … Dr. Rajan and I could work on this together on a dayto-day basis, [including] … the counseling, relaying medical knowledge to the family, what was going on clinically, trying to deal with that in a way where she was talking in one way to [the] adults and in a different, more appropriate [for the boy’s age] way to the 17-yearold son. And I can be there to help with that process.”

The situation was resolved to the satisfaction of the mother, the son, the friends, and the providers. “It was really pretty extraordinary,” she said. “I’ve talked about that a couple of times, including at a staff meetings when we were talking about getting new hospitalists. That is something I’ve described because, really, it was very special.”

TRUE TEAMWORK

Although everyone on a multidisciplinary team can bring something to the discussion that makes the team work better, social workers and hospitalists collaborate well in painting a more comprehensive picture of the patient’s lifestyle, living habits, and needs.

“In many hospitals … there’s a pattern that develops [whereby at] some time in the morning the hospitalist and social worker will get together and talk,” says Dr. Flansbaum “The hospitalist speaks the language of the social worker and knows what to tell them and how to direct them rather than just saying, ‘the patient’s homeless or the patient needs help at home.’”

After working regularly with social workers and recognizing what they need to know, he says, “the hospitalist is more likely to say, ‘the patient has Medicaid,’ or ‘the patient has this insurance,’ [or] ‘the patient has a home-health [caregiver] four hours a day and needs six or eight hours a day,’ or ‘the patient’s going to need a subacute nursing facility.’ … I think our insights are different from voluntary physicians and our face-time with social workers is more efficient.”

Sylvia Krafcik, MSSA, LISW, with MetroHealth Medical Center, Cleveland, says hospitalists are “great to work with because they’re very dedicated to the population they’re caring for, because this is their whole responsibility; they don’t have a private caseload.”

But in her view most hospitalists are focused on patients’ medical conditions and some of them are not as tuned in to all the other aspects of the patient, such as all the psychosocial dynamics.

“A lot of them are, but some aren’t,” Krafcik says. “Especially at MetroHealth, we’re a county hospital. So many of the patients that come here are poor. A lot of them are alcoholics or drug abusers. They’re homeless. They live on the streets. They don’t have a primary doctor. They’re usually not compliant with their medications.”

“Here at Metro we have a lot of patients who have extreme social circumstances that affect their medical issues so much,” says Sara Dunson, MSW, LSW, who also works as a social worker at Metro-Health. “I think the hospitalist has greater insight into the person’s environment and all the social structures that they have at home and that are going on in their life [than other physicians might].”

But there is always room for improvement.

“We had one patient who wasn’t able to read, and he never told anybody this,” says Dunson. “And as social workers, we have more of a way of finding that kind of stuff out from patients than the doctors might. And he kept coming in and coming in and was noncompliant with his medication. We eventually determined that this was why he was noncompliant and was causing all these medical issues. The doctors finally [understood] why this gentleman kept coming in with the same problems and he wasn’t taking care of himself. It wasn’t that he didn’t want to, it was just that he was having problems reading all the medications and all the discharge paperwork, and he was too ashamed to tell anybody. [Once the social workers questioned him and got this] out in the open, we were able to get him help with that.”

The doctors focused on what he was or wasn’t doing, but they hadn’t looked at why he wasn’t adherent, explains Dunson. If hospitalists do that more often, she thinks, they could save time and get better outcomes sooner.

COMMUNICATING WITH PATIENTS AND FAMILIES

“I think where hospitalists are coming from is a whole different mindset than a physician who has mainly an office practice,” said Lingg. “The office practice comes first [for them]. Some of our physicians have huge practices in town. And they’ll visit the hospital very early in the morning or in the evening. ... So if I need something in a case like that, if there was not a hospitalist involved, it would have been separate meetings for the family with the physician … and [with] me at another time.”

To hospitalists, a social worker can serve as an important adjunct in talking to the patient and family. “For example, if [social workers] are giving bad news, they warn the physician first,” says Dr. Rajan. “If they’re going to go in and tell the patient that they’re not going to qualify for any home services, they tell the physician as well so that [the hospitalist will not later be] meeting an angry patient.” In addition, she says, “for critically ill or long-term patients, social workers [can] help family members cope. Sometimes as physicians we don’t have the time or we don’t have the resources to do that.”

But this doesn’t let doctors off the hook in regard to addressing the whole person’s needs. Especially if someone has multiple medical problems, the social worker needs to know the availability and level of support for which the family can be counted.

“Social workers will ask questions such as: Are the families involved? or Is there any family?” says Krafcik. “Do they need to go in a nursing home or do they need 24-hour care at home? Is the family able to provide that? [E]very morning we meet to have team rounds. And the [team] go[es] over every patient on the floor, and then I will ask those questions if the doctor hasn’t given me that information.”

Social workers appreciate and would like hospitalists to do more listening to the patient and family for the aspects of the history and psychosocial status that the social worker will need to know.

TEACHING POINTS

In the course of their interactions, what do hospitalists and social workers teach each other that could lead to working a case more effectively and to the greater satisfaction of all involved?

Most of those we interviewed seem to think that the greatest service hospitalists provide is to teach the social worker the medical components that go along with what the social worker does every day.

“[Social workers] get a better understanding of [whether] someone comes in with heart failure or a fall or a stroke, just by repetition and also education; they get to understand after a while what’s needed for individual medical diagnoses,” says Dr. Flansbaum.

“When I know [better] what the medical condition is,” says Krafcik, “I have an idea of how much help [the patient] would need at home and their ability to function. And I would make sure that the patient gets physical therapy or occupational therapy referral or speech therapy.”

Again, perhaps the area where the social worker most teaches the hospitalist regards available resources to solve problems over and above the purely medical. “They know the social system and the needs of different forms and eligibility and what different patients are entitled to and what the system will provide,” says Dr. Flansbaum.

Dunson believes hospitalists are perceived as being more involved in a holistic way with the patient. “I always stress that it is so important to look at the whole person and not just the medical aspects,” she says. “It’s hard for the doctor sometimes to realize that this person might not be able to afford this medication and that’s why they’re noncompliant and all the other issues. So I think is important to open up to the other aspects of a person’s life and not just the medical aspects.”

CONCLUSION

Social workers’ knowledge of medical and nonmedical resources, both locally and nationally, offer hospitalists essential information that leads to designing more appropriate and effective post-discharge plans. Hospitalists can best team with social workers by consistently keeping in mind the patient’s overall circumstances and informing their colleagues of the medical information that can help social workers do their best work. TH

Writer Andrea Sattinger will write about the effect of poor communication skills in the November issue of The Hospitalist.

HOSPITALISTS AND SOCIAL WORKERS

Both sides of the clinical care team discuss the pros and cons of working together

Bradley Flansbaum, DO, MPH, Division of Internal Medicine/Primary Care at Lenox Hill Hospital, Bronx, N.Y.

In these … fractious healthcare times when resources are not plentiful and the expectations of patients might be higher, like getting 24-hour care at home, sometimes it might appear that the hospitalist or [another] physician is always the bringer of bad news. A good social worker can work well with the hospitalist in … letting the patient know the realistic expectations of what the system can provide [so that] we’re not in this alone. You know, ‘the world is a nail, the hospitalist is always the hammer’ kind of thing. Social workers can be very helpful in delivering information. … A good social worker can also add some “salve” to the wounds that the patient comes in with.

Some [patients] are borderline functioning or kind of on the precipice already. They come in with this problem and all of a sudden they can’t go back to the situation they were operating in prior. Social workers’ knowledge of the social safety net … is terrific, and they help us in directing what would be the best discharge plan for this patient, [including] knowing what the insurance status is, … what resources they have in place already, what else is available. … [I]t has a lot to do with discharge and recovery and functionality, and [to find out what’s the best place for the patient. They can help us with that.

Sabitha Rajan, MD, MS, director of hospitalist services at Greenwich Hospital, Conn.

Perhaps the greatest value social workers provide for all concerned is having the storehouse of knowledge of the available resources of the community. This is probably one of the most vital things to me; they can get a patient into services or programs that I didn’t even know exist. And the resources are very different in Connecticut than … in New York [where I practiced previously]. In New York there are many resources geared toward the Hispanic community, which I haven’t seen so far in Connecticut. But Connecticut has some other great resources; the local area clinic is a fantastic one.

Patients with end-of-life situations are dealt with differently in different states, too, and I wouldn’t have known about all this if it had not been for the social worker with whom I work. I also found out that there is a free program for alcohol rehabilitation in Connecticut; that does not exist in New York. We’ve sent a lot of our patients [to that]; you know they have to be the ones to initiate the call, but if they do, then that’s actually a resource for them. I wasn’t aware of that until I worked with the social workers here.

In more than 30 years as a healthcare industry consultant, Jack Silversin, DMD, DrPH, has watched as hospitals have evolved into complex organizations that emphasize efficiency, teamwork, and cost-effectiveness—three things absent from most medical training programs, he says.

“Doctors have been trained to be autonomous, but the new organizational structure is to be collective,” says Dr. Silversin, CEO of the Boston-based consulting firm Amicus Inc.

The changes doctors and HM groups are being asked to make are challenging their way of life and their work, Dr. Silversin says, and leading a group of independent-thinking hospitalists is no easy task.

“It’s a very challenging thing to be a leader. … It’s having the confidence and mind-set to engage people and make decisions,” says Dr. Silversin, who plans to address such issues during his daylong seminar at SHM’s Leadership Academy Sept. 14-17 in Miami.

Part of an expert faculty that teaches skills and concepts on beginner and advanced tracks, Dr. Silversin says Leadership Academy attendees learn how to define their roles and how to present their expectations to their groups.

“You go back to your hospital and see things in a different light,” he says. “You need to have the answers, but you need to balance that with relationships.”

The next Leadership Academy is Jan. 25-28 in Scottsdale, Ariz. For complete faculty bios and more information on participating, visit SHM’s events Web site.

In more than 30 years as a healthcare industry consultant, Jack Silversin, DMD, DrPH, has watched as hospitals have evolved into complex organizations that emphasize efficiency, teamwork, and cost-effectiveness—three things absent from most medical training programs, he says.

“Doctors have been trained to be autonomous, but the new organizational structure is to be collective,” says Dr. Silversin, CEO of the Boston-based consulting firm Amicus Inc.

The changes doctors and HM groups are being asked to make are challenging their way of life and their work, Dr. Silversin says, and leading a group of independent-thinking hospitalists is no easy task.

“It’s a very challenging thing to be a leader. … It’s having the confidence and mind-set to engage people and make decisions,” says Dr. Silversin, who plans to address such issues during his daylong seminar at SHM’s Leadership Academy Sept. 14-17 in Miami.

Part of an expert faculty that teaches skills and concepts on beginner and advanced tracks, Dr. Silversin says Leadership Academy attendees learn how to define their roles and how to present their expectations to their groups.

“You go back to your hospital and see things in a different light,” he says. “You need to have the answers, but you need to balance that with relationships.”

The next Leadership Academy is Jan. 25-28 in Scottsdale, Ariz. For complete faculty bios and more information on participating, visit SHM’s events Web site.

In more than 30 years as a healthcare industry consultant, Jack Silversin, DMD, DrPH, has watched as hospitals have evolved into complex organizations that emphasize efficiency, teamwork, and cost-effectiveness—three things absent from most medical training programs, he says.

“Doctors have been trained to be autonomous, but the new organizational structure is to be collective,” says Dr. Silversin, CEO of the Boston-based consulting firm Amicus Inc.

The changes doctors and HM groups are being asked to make are challenging their way of life and their work, Dr. Silversin says, and leading a group of independent-thinking hospitalists is no easy task.

“It’s a very challenging thing to be a leader. … It’s having the confidence and mind-set to engage people and make decisions,” says Dr. Silversin, who plans to address such issues during his daylong seminar at SHM’s Leadership Academy Sept. 14-17 in Miami.

Part of an expert faculty that teaches skills and concepts on beginner and advanced tracks, Dr. Silversin says Leadership Academy attendees learn how to define their roles and how to present their expectations to their groups.

“You go back to your hospital and see things in a different light,” he says. “You need to have the answers, but you need to balance that with relationships.”

The next Leadership Academy is Jan. 25-28 in Scottsdale, Ariz. For complete faculty bios and more information on participating, visit SHM’s events Web site.