Sunday, April 14, 2013

Zimmerman & Dabelko, Collaborative models of patient care - summary critique

Zimmerman, J., & Dabelko, H. I. (2007). Collaborative models of patient care: new opportunities for hospital social workers. Social Work in Health Care, 44(4), 33-47.

A shift to patient and family centered care is oiccurring in the medical field, and medical social workers are in a position to provide an eased transition. PFCC is an alternative to the more hierarchical medical model. Patients and families are more engaged in their treatment planning. Social workers have are trained in a strengths-based and consumer-focused perspective, which coincides perfectly with PFCC.

Studies are cited by Zimmerman & Dabelko (2007) showing how patient satisfaction has been low due to the hierarchical model of care with physicians on top and patients on bottom. Improved patient satisfaction can lead to better outcomes and better treatment compliance. This poor customer service has created a push to do a biopsychosocial assessment instead of traditional physical symptom assessment. Biopsychosocial assessment in the medical environment often leads to earlier identification of high risk social or medical conditions, which are cheaper and less painful to treat. Additionally patients report feeling more valued which this creates a longer-term connection as a consumer of a particular brand of healthcare services.

A primary component of PFCC is a shift to healthcare staff respecting and supporting patients’ rights and letting them make decisions for themselves. Many other facets of PFCC provide opportunities for social workers to play an important role in treatment. Social workers can assist patients and their families in understanding treatments and making decisions in line with their values and wishes. Social workers can engage families in the treatment process. With numerous medications, a second set of eyes might catch errors such as the wrong medication, dosage, or allergies. This is highly beneficial to both patients and healthcare systems. Social workers can identify gaps in continuity of medical care. Social workers are better trained than other healthcare workers to facilitate groups and peer counseling programs for struggling patients and their families.  Comprehensive medical treatments require adherence to guidelines, and social workers can be more effective in difficult cases where psychological or social barriers impede life-saving treatments. Finally, collaborative models of patient care, encouraged by medical social workers and PFCC, have been shown to decrease hospital stays and increase treatment compliance.

The inclusion of patients and professional advocates into medical treatment planning is an exciting and necessary turning point in the healthcare field. It is unfortunate that it has taken this long for the medical community to include patients more in their treatment. Even this inclusion is done with reluctance, however, and with impure motives, at least from a social work standpoint. The article makes it clear that this shift is taking place for the utility of healthcare systems, not for the well-being of patients. The fundamental goal of the healthcare industry appears to be making money and treating people in the most efficient and cost effective ways. Things have evolved in a way which now necessitates giving patients more choice and care because it builds a better customer base and encourages longterm customer relationships. In this model, better healthcare is a byproduct of lucrative business practices. As a social worker, I am occasionally willing to accept progress over stagnation, even if the motivation is not in line with my ethics. At some point, however, healthcare as a whole must be motivated by a higher purpose than profit.

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