Medical clinic referrals to psychiatric social work: Review of 100 cases

This study examines 100 consecutive patient referrals from a general medical clinic to psychiatric social work. While much has been written from a theoretical or anecdotal perspective on the contribution of social work to medical care, there have been relatively few attempts to look in detail at actual practices. Of the 100 patients, 52 were referred for "concrete services," 30 for evaluation of a psychiatric disorder (such as depression or somatoform disorder), 20 for counseling, and 11 for assistance for a drug or alcohol problem. Although the most frequent referral to psychiatric social work by the medical clinic staff was for concrete services, half of these cases actually involved overlooked psychiatric problems, and no concrete service of any sort was perceived as necessary by the psychiatric social worker in 30% of these cases. Referring medical staff tended to view patient distress in terms of concrete needs and chose to refer to social work even when significant psychiatric diagnostic problems were identified. Analysis of the differences in reasons for referral versus actual clinical problems has implications not only for the training needs of social work in this setting, but also for the relationship between social work and psychiatry, and for the organizational and educational needs of ambulatory medical services.