Worlds Apart by Dias Patrick

Author:Dias, Patrick.
Language: eng
Format: epub
ISBN: 978-1-135-69140-0
Publisher: Taylor & Francis Ltd

Accountability to Medicine

Social work genres in a hospital must produce activities, including texts, that support the efforts of the medical staff. It was widely agreed that the doctors and nurses were not reading social work records before the genre changes, because they were too long. Narrative is often considered an occupational hazard of social work; when you deal in people’s lives, stories are what you get. The changes were designed to correct that situation. As the director said, “we don’t want biographical information ad nauseam.” Nor do doctors or nurses want the “balderdash” or “psychobabble” found in social work’s traditional “psychodynamic interpretations,” because they are too long and technical and “have no business in a medical chart.” She summed up social work’s position:

And I think that’s an important thing: this is a medical chart that we’re writing in. We’re invited to give our opinion. We should give it and thank them…. More than that, I don’t think is expected.

As with other areas of accountability, workers were not always in agreement with managers on this question of responding to the social motives of medicine. The speed at which the medical staff worked, and the resulting need for brevity in record-keeping, alarmed some writers: “I find … that in talking to medical people, especially now when everybody’s so pressed, that if I can’t give it to them in 25 words or less, then they tune out.” Social work discourse, if such an independent discourse can be said to exist, frequently occurs in conjunction with, and at the service of, other more powerful discourses: legal, psychological, medical, bureaucratic (Paré, 1993; in press). For many, this service to medicine represented a conflict of interests, as these workers explain:

I find the new recording system is useful for a doctor who may be ready to discharge someone. It’s useful for the organization. I don’t find it useful for social workers. So, so I guess I kind of feel like I do the hospital recording for the hospital; that helps the doctors clear the bed or make appropriate discharge plans…. I feel that my role is much more than that, and I require extra things, and it’s almost like the recording doesn’t fit into that.

*****

We have the chart, and that’s very much medically-based; and I find for social work purposes, there are things that I like to have a record of that I don’t believe should be in the chart. So I do the recording, but it’s almost like something I have to do that’s not central to my work.

*****

We have a policy in this hospital that we just have one chart, and it’s the medical chart. So it means that if a social worker is careful about what they put in the chart, which they should be, in fact there is nothing there of value to me.

The social motive of accountability to medicine shaped particular texts, texts that were brief and helpful to doctors. As members of a department of social work in a hospital, the

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