Social Workers Leading the Way to a Major Paradigm
Shift in Health Care
by Marilyn Gough, MSW RSW
Fraser Health Authority
Although the World Health Organization has a very broad definition
of health, the actual practice of medicine has gradually shifted
from a more holistic approach to one which views the more critical
aspects of assessment and treatment to be those that focus on
the physical over the psychological and on ‘curing over
caring’. This has happened over time and appears to be rooted
in the late 19th and early 20th centuries when the greatest threat
to health was pathogens, which caused widespread epidemics. The
response to this threat led to a greater dependence on science
and technology, which has been and continues to be, responsible
for many critical advancements, such as the development of antibiotics,
inoculation and the field of organ transplantation.
This dependence, however, has lead to separation within medicine
on several different levels, the most important being mind from
body, individual from context and practitioner from patient. The
‘hero (health practitioner), victim (patient)’ approach,
whichdeveloped as a result, minimizes the potential curative powers
that can be gained from establishing trusting and caring partnerships
between professionals and patients and from mobilizing the internal
healing powers of patients and their families/communities. Rather
the primary goals in health care have tended to evolve into a
‘find it, fix it’ mode that focuses on finding the
cause of disease and then proceeding to treat by removing, reversing,
replacing or bypassing the ‘enemy’.
Over the past few decades, populations in general have been aging.
As a result of this, the greatest threat to health care has become
chronic illness. Upward of 80% of all patients now suffer from
some form of chronic illness. The responses of the past no longer
work as well. In fact, the ‘hero:victim’ approach is woefully
inadequate in the face of this threat. It can not only inadvertently
cause greater suffering for patients, but can also cause health practitioners
to feel a profound sense of failure in their work.
In spite of an abundance of academic literature that has appeared
in medical journals for years, highlighting the importance of
giving the psychological, emotional, spiritual and social aspects
of health equal time in the practice of medicine, minimal gains
have been made in this area. Practitioners have been so overwhelmed
with day to day medicine that few have taken the time to read
the literature and respond accordingly. Many health care organizations
have adopted a broader approach to health on paper, by way of
mission statements and policies, however, when the ‘rubber
hits the road’, mainstream medicine remains very physically
focused and the psychosocial continues to be considered as peripheral
in nature.
By virtue of the core values and practice principles of Social
Work as a profession, Social Workers in healthcare are well positioned
to take on a leadership role in tipping the scales toward an inevitable
shift in medical practice. This paradigm shift, I believe, has
been building for years and what is most needed at this point
is strong leadership from a profession that understands and practices
from a systems approach. This will require Social Work to make
their work more visible to others whenever possible. It will also
require Social Workers to be very clear about why they practice
the way they do and to demonstrate how the application of theoretical
concepts can produce improved health outcomes at the front line.
There are a number of ways that this can be achieved at the individual,
team, supervisory, organizational and professional levels. For
more information about some of the possibilities from my perspective,
you may go to the BCASW
website to view the power point slides from a recent presentation
on this material at the BCASW Fall conference.
“We must be the change that we see” (Gandhi)
