朝闻天 : 医疗社工课上的提问

一直想把这个翻译出来，今天终于做到了，趁我对当年实习的情况记忆犹新。虽然这是老年社会工作、医疗社工相关，而实际上，这几个问题，可能与我们的生活和工作都不无关联吧。...





一直想把这个翻译出来，今天终于做到了，趁我对当年实习的情况记忆犹新。虽然这是与社会工作，尤其是老年社会工作、医疗社工相关，而实际上，这几个问题，可能与我们的生活和工作都不无关联吧。

时光回到2011年，悉尼大学社工专业四年级的老年护理课程，我的实习导师高级社工Francis被邀请来做一次讲座。Francis提早几日就给我发来电子邮件，询问我有没有兴趣在课上与他来个互动，向他提出几个我在实习当中遇到的主要难题，由他来解答。我很喜欢这个主意，就答应了，当晚就起草出四个问题，后来如实用到了他的课上。

问题1：（社工评估）

我时有察觉病人及其家属的期望值与他们的真实需求之间，有条鸿沟。例如，一位先见到病人的健康辅助专业人士，告诉了病人有关的老年护理计划，并转介给社工。但是当你去给病人做评估时，却得到完全不同的印象。您在实际工作中是怎样从相关的病人、护理者以及其他专业人士等各方面着手评估，从而确立客户的真实需求的呢？

问题2：（道德困境）

在医院老年病房，我遇到过一个这样的道德困境案例：一位病人被转移到养老院2天后就去世了。我真的感到很痛心。他都快90岁了，是一位DVA金卡持有者（荣誉老兵）。他被转移之前，已经很少进食了，他应当被转去临终关怀医院，但是那时没有床位。作为资深高级社工，您怎么看待这个案例？

问题3：（老年服务的工作性质：不确定性）

另一个有趣的案例。有一次，我们领着一位有老年痴呆症的病人出门，结果成了一场“灾难”。我们去到Surry Hills一带找一间适合他的小型养老机构。他起先不喜欢那一家，后来又说喜欢。我们开车带他到了他的家，但他根本不认得了，直说那不是他的家。我们最终找到一家更好的养老机构，可他拒绝配合，并且不愿意同我们一道回医院。Francis，您可以把这故事替我说下去吗？

问题4：（医疗模式下的跨学科团队合作）

医院系统常常被指等级制度森严。在老年病房，老年病医生特别是高级专家，享有安排病人出院去处的资源和权力，但是我们社工，怎样就做出对病人有益影响的决定，以及在这个系统里工作，做到游刃有余呢？

这节课上的效果从师生们的课堂反应就能看出。课后，有几位同学过来给我反馈，表示有了这些问与答，课堂变得更为生动（vivid）。真没想到，两千多年前中西方圣人们常用的提问法用在现今的课堂上，仍旧不失为一种互动的、引发积极思考的好方法。

附：

Questionsto ask in lecture of hospital social work

Question1: social work assessment

I often found that there’s a gap between patients’ or their family’s expectations and their real needs. For example, an allied health professional had seen patient first and told him or her there’s some aged care package and referred to social work. But when you went to assess the patient, you just found a different story. How do you work towards establishing realistic expectations on the part of patients, their carers and professionals involved?

Question2: ethical dilemma

One case of ethical dilemma I experienced in aged care ward was that we were informed the patient died just 2 days after moving to a nursing home. I really felt sorry for him. He’s in his late 80s, a DVA Gold card holder. He already had limited eating and drinking, and should have been sent to a hospice, but there’s no vacancy then. What do you think about this case?

Question3: Nature of work in aged care (working under uncertainty)

Another interesting case. One outing with a patient with dementia became a nightmare. We went to look around a small hostel in Surry Hills. He initially didn’t like it, but later wanted to take it. We drove him to his home, but he couldn’t recognise it by telling us this was where he used to live. We finally sorted it out and moved on to visit a nicer hostel where he refused to cooperate and didn’t wanna come back to the hospital with us. Francis, can you finish this story for me? …

Question4: interdisciplinary teamwork and working within the medical model

The hospital system is often referred to as hierarchy. And in aged care ward, geriatricians, particular consultants, have the resources and power to decide where patients can be discharged. But how can we influence on decisions about patient care and work well in the system?

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