Wednesday, December 12, 2007


I have certain things I am required to do in my job as a social worker. Along with all of the ethical practices (i.e. no dual relationships with clients, no sleeping with clients, not accepting gifts, etc.), there are laws that require that I break confidentiality.

There are sometimes funny contradictions, for example, I have to report to the police if someone is threatening someone's life, but if someone has already committed the crime and is telling me about it, rules of confidentiality require that I not share that info (unless it is subpoenaed, yadayada...and no confidentiality does not end when someone dies regardless of what they show on all the police dramas).

Sometimes it is a hard call about whether something is considered abuse or neglect, or whether someone is a danger to themselves or others. And sometimes, my opinions of these things differs from the helping professionals that I call on to follow-up on these things. But what always clues me in that I need to take action is the raising of the hackles on the back of my head. And when that happens, I know I need to act, sometimes if only to save my own license.

Today I had a situation that I needed to report and it's a touchy one that leaves me worried about consequences, etc. I've spent most of my day feeling lightheaded from the adrenaline my body keeps releasing. It's hard to concentrate and think sometimes in the aftermath. But I've done what I'm mandated to do...and now I find I need to do a little education.

You see, being a social worker in a medical setting, I have the experience crop up in which a nurse will tell me something - either in passing as just information or as a "this is something you need to report!" The first type of information sharing scares the living daylight out of me. Here's this professional that is aware of something in a patient's (or their family's) life that is a clear mandate to report, and she does not even seem aware that she should consider reporting it. And the second type of message infuriates me. Here's why:

Under the laws of the state of CA and licensed medical professional is held to the same mandates as I am regarding suspected abuse or neglect, or potential for self-harm or harm to others. But in many medical settings, the accepted practice is for the nursing staff to report it to the social worker to report...sometimes days later. Not only is it too late, in some cases, to act effectively, but if something had happened in the intervening time, they are liable both civilly and criminally.

It feels like a contiual uphill battle to help people to understand that this is not just something that the social worker can and should do. And, then I get to face the questions that come up from the person I make the report to, like today, "Why isn't the nurse calling us?"


Well, at least I'm not talking about money anymore.


Planet Me said...

no dual relationships? what does that actually mean?

spinsterwitch said...

That means, basically, that I should not be my friend's therapist. Or my plumber's therapist.

In some smaller communities, this is a pretty significant issue of how to handle it. I'm privileged to live in a big place where I have lots of options and where potential clients have lots of options.

Aravis said...

Such a coincidence... as my Intro to Human Services class wraps up, we've been discussing the code of ethics, confidentiality, mandates and the law. Now I'm seeing it play out in this situation of yours. I wish you the best with this, and send my deepest empathy.

The same regarding money.