Geriatrician or Social Worker?

It’s the second week of geriatrics. And my first impression of this specialty is – it’s a lot of social work! In fact, I would say it accounts for the majority of the work by everyone from the resident up to the consultant. The ward I am attached to is mainly for elderly amputees to go through rehabilitation after their amputation so they can go home with the skills to live as normally as possible.

Although the patients are mostly elderly people who have multiple co-mobidities like diabetes, heart failure, COPD, peripheral vascular diseases, etc., which make them very interesting patients as far as pathology is concerned, their conditions have largely stabilized by the time they are ready to go to the geriatric and rehab ward. So the main focus on the ward is their rehabilitation; their medical conditions have almost become a secondary issue. As they go through the process of going to the gym to gain their strength back and learn to use the wheelchair with help from physiotherapists, the doctors are busy coordinating the allied health team to work on their discharge – home visits to assess access issues in and around their houses, arranging Meals on Wheels for them, booking the Blue Nurses to care for them post-discharge, arranging house-cleaning, and for those not fit enough to live in their own homes, plan for discharge to nursing homes. A meeting is held weekly for doctors and allied health professional to discuss each patient on the ward and to assess their progress and the progress of the work being done to address the patient’s living situation.

While it’s great to see that patients get such thorough treatment to make sure their transition from hospital to home go as smoothly as possible, it appears that this specialty involves more social work than the practice of medicine. Is this the result of the break down in the social fabric of Western societies? Traditionally, people go to the hospital when they are sick; and when they go home, their immediate or extended families take on the role of care takers. Now that role has been assumed by the health care system and, at least in Australia, largely by the government. From a rational point of view, it makes sense – the patients’ family, now unburdened with the work of caring for them, is free to devote their time on work and, by extension, contribute to the national economy. But from the humanistic point of view, the care the patients receive from the various government agencies and professionals, however great, cannot make up for the feeling of being cared for by someone close to them. Of course, many of these patients are fortunately enough to get the best of both worlds: they are under the care of a family member, with help and subsidies from the government. Their main carers can get various benefits like pensions from the government and carer respite to prevent burn-outs. It is reassuring to see that, under the generous welfare state and the social safety net in Australia, people can age with dignity, even with debilitating illnesses.