I am not a social worker. No training, no classes in medical school on being a social worker, and no formal training in residency. Yet probably 35% of my time working as an emergency physician is spent ACTING like a social worker. Our society has issues, to say it simply. When these issues come to a head, or when a person needs medical attention they come to the ER. Once in my ER, whatever problem they have, whether medical, personal, family, or financial, it then becomes my problem. Often what starts as a simple complaint of ‘dizziness’ in an 80 year old, quickly becomes: “80 year old female, who lives alone with 2 cats that has no family in the area, no social support, that can’t remember the last time she ate, and refused to go to a nursing home or assisted living facility in the past.” Wow, suddenly “dizziness” is a welcome complaint compared to the rest of the story. This sad but true situation happens daily in every ER in the country. So thus I start to practice social work, without a license.
    I propose that for every ER, it be mandatory to have a 24 hour social worker. Some major medical centers already have social workers in the ER, but rarely do the smaller community hospitals. Even the big medical meccas often do not have 24 hour ER coverage. Mostly there is a social work service that works 9-5 and are on call for extreme situations. They are great at what they do, but many times they are most needed when not available. Like physicians they too spend a lot of their day buried under paperwork and performing tasks better suited for clerical employees than their own talents. When called at home after hours, the kind social worker usually responds with, “There is nothing I can do until morning” or “Just admit the patient and we can work on it tomorrow. Admit I often do, a patient that has no acute medical condition, but must be admitted for 3 days to an inpatient hospital bed before they “qualify” for placement in a facility that can help take care of them long term. Another beautifully wasteful aspect of medical care spending.
    Maybe the “there is nothing we can do tonight answer clues us in that social problems are SOCIETY problems, not ER problems. And if we had more social responsibility for ourselves and our families, we would have so many situations where someone else has to take the burden.
    Still having a Nancy Pando (a Licensed Independent Clinical Social Worker) around at all times of my shift would let me spend more time on the things I know how to do...like clinical medicine.