Social Workers: Making Health Care More Effective

In the early 1900s, Richard Cabot, MD, concluded that he didn’t have enough information to make exact diagnoses of his patients at the Massachusetts General Hospital clinics. He didn’t know where they lived or worked, what they worried about or ate for dinner.

“My diagnosis remained slipshod and superficial in many cases … I found myself constantly baffled when it came to treatment,” Dr. Cabot wrote. He believed it was important to understand his patients’ economic situation, what toxins they may have been exposed to and how they were handling the stress of daily life.

A Mass General Milestone

Dr. Cabot sought the advice of friends in social service agencies in Boston about getting an assistant. In 1905, with his own money, he hired a nurse, Garnet Pelton, to serve as Mass General’s first social worker. Then, in 1907, Dr. Cabot hired Ida Cannon as the first chief, and together, they led the development and growth of the first social services department in a hospital in the United States.

Society changes; our basic problems do not. Some of the same factors that strained our ancestors in the early 1900s still challenge us today: poverty; abuse of alcohol and drugs; epidemics of highly contagious diseases and families with inadequate support systems.

Dr. Cabot’s goal was “to make medical care effective” by addressing patients’ basic needs.

Through the years, Mass General has continued to reach out into the community and beyond. In 1917, ammunition ships exploded in Halifax Harbor, Nova Scotia, resulting in about 1,900 deaths and, thousands of injuries and leaving 6,000 people without shelter. MGH social workers Ruth Emerson and Edith Baker rode the first relief trains there. They helped secure clothing and shelter, arranged special care for injured children and provided psychological assistance. Ms. Emerson stayed to help establish the field of medical social services in Halifax.

An Integral Part of Patient Care

After the 1942 fire at the Boston nightclub Cocoanut Grove — a tragedy that killed 492 — Mass General social workers responded. They worked to identify victims and served as a liaison with the American Red Cross to counsel the injured and families.

Today, social workers are integral members of the Mass General patient care team. They help cancer, pediatric, obstetric, emergency and mental health patients. The department operates housing facilities for patients and families who travel to Mass General for treatment. Its HAVEN (Hospitals Helping Abuse and Violence End Now) program, cares for domestic abuse victims. Social workers are also members of the MGH disaster response team and, in recent years, been deployed to the U.S. Gulf Coast, Indonesia and Haiti.

Ann Daniels, PhD, executive director of MGH Social Services, says social workers help families and patients work through illness, grief and other issues by understanding patients in the context of their families, communities and culture. They often also provide a vital link between the care team, the family and community resources such as support groups and transportation to appointments, she says.

“We are mental health counselors, facilitators, educators and advocates,” Dr. Daniels says. “We really do accompany patients on their journeys.”


Accompanying Patients on Their Journeys

With the pressure for healthcare reform, Dr. Daniels sees social workers becoming even more valuable. Just as Dr. Cabot envisioned, social workers are continuing to make their voices heard about health and social concerns. Addressing many of these issues will help people live better and create healthier communities.

“From the beginning, hospital social workers have been part of making health care more effective,” Dr. Daniels says.