MARTHA BURKE Interviewed by Ann Conway, PhD [I m] Martha Burke, Director of Social Work and Clinical Services at Brigham and Women s Hospital. OK. I was hired as a primary care social worker in 1978 and was very fortunate to be part of an interdisciplinary team in that ambulatory setting. And within a year I also had other ambulatory clinics to cover. One of the areas was hematology. So within a year I became the dedicated both inpatient and outpatient hematology oncology social worker, caring for patients and families who had leukemia, lymphoma, Hodgkin s disease, etc. And this is at the Peter Bent Brigham? Working at the Peter Bent Brigham, working in a very interdisciplinary, multi- interdisciplinary team approach, where you dealt with the medical, nursing, and psychosocial issues of these patients at that time had life threatening illnesses, and many of them died within a couple years of treatment. And what did you do next? Well, I did that for 11 years. And then I did half of hematology and began taking on administrative skills. I became chief of the graduate student training program, and then I did the graduate student training program and chief of med- surg, the medical surgical social workers in the inpatient setting. Then I became assistant director, program manager for care coordination and then director of social work. What have been some of the highlights for you, of your work here? 1
Well, I think first and foremost that the best highlights have been the patients and families that you came in contact with. In many ways they were our teachers. As we got to know them in their psychosocial situation, as we cared for them through just horrendous medical events and illnesses and treatment, I think they were awe- inspiring with their perseverance, their courage, and their resiliency in coping with illness and treatment, recovery, or end- of- life issues. So I think first and foremost, patients and families have been awe- inspiring. I think second of all interdisciplinary collaboration and the collegial relationships you develop with staff. And I think third of all, developing and building upon the strong history of social work practice at both the Peter Bent, Robert Breck Brigham, Boston Hospital for Women and the Brigham and Women s Hospital. And just to backtrack for a moment, could you also tell me a little bit about where students have come to study at the Brigham, social work students, you alluded to that, the graduate education. I know some of the interviews have covered medical education and nursing but we haven t talked too much about social work. Sure, well I recently learned in reading about the Peter Bent history that our first students came in 1923 from Simmons College School of Social Work, which was the first hospital social work training program in the country. And they started in 1923 accepting students and since then and more recently we have very strong relationships with Simmons College School of Social Work, Boston College School of Social Work, BU School of Social Work, Smith College School of Social Work, and Salem State School of Social Work. So we take second- year students and our mission is training the next generation of social work professionals. And what would you say have you enjoyed most? What are your fondest memories, if there s things you haven t elaborated about before? I think my fondest memories are caring for patients. And being part of that journey within an interdisciplinary team approach. I think working in this great institution. They talk a lot in the early days, they talk currently about Brigham family, Brigham spirit. We truly are Brigham family and we truly are honored and privileged to be part of this great institution. So I think my fondest memories first and foremost are the patients and families we care for. Second of all the wonderful interdisciplinary physicians, nurses, chaplains, physical therapists, dieticians that we ve worked with throughout the years. And third of all I think my fondest memories are watching the skill and competence of a growing social work practice and watching staff grow in their own learning and their own care of patients and families. Have you had a mentor in your work? I ve had a smorgasbord of mentors, and I think first and foremost I think my parents were wonderful mentors because they taught me service - - my dad was a physician, my mother was 2
a teacher. And we were taught to serve at a early age. I think other mentors have been Barbara Hewitt, who was the director that hired me, was just a skillful compassionate woman. Florence Slepian, who brought the business aspect of social work in a hospital in the 80s. I think Anne Gross was another wonderful mentor who s just a brilliant clinician. And folks like Joanne Hogan, who really helped me understand the economic, the utilization review, the insurance world that was so crucial for a social worker to know both your clinical competence and expertise but the business aspect of health care. I think other mentors have been physicians like Dr. Richard Nesson who started primary care in 1977. Dr. William Maloney who started hematology and Dr. David Rosenthal. That s quite a list. I wonder, because you refer to care coordination and to Joanne Hogan s role and that world, can you explain a little bit about how social work intersects or is part of care coordination? Sure, I think many years ago Joanne and I worked together to create a team of staff, both nursing care coordinators and social workers to deal with both the psychosocial issues but [also] the utilization management, the discharge planning issues and what s the next step for patients once they enter our system. And I think care coordination is the wave of the future. It s looking right now at patients in an ambulatory setting and following them through the continuum of care. And I think as a group we have worked very closely with community partnerships whether they re social service agencies, skilled nursing facilities or VNA. But that we re looking at patients and families as a whole in helping them in their next care delivery system. I have been very privileged to read many of the annual reports by social work directors and I have to give due credence to Alice Cheney, who was a nurse and the first social work director appointed in 1914 at the Peter Bent Brigham. And what she did for 25 years was just miraculous. She had the vision and mission of looking at the patient within their environment, in the social, emotional, financial, familial and barriers to care that those decades provided. And she was just awe inspiring. But I also felt for her because she had primarily a volunteer staff. But she realized the critical need of developing standards of practice and educating social workers from a clinical standpoint so their overall contributions to patient care were taken into consideration. Barbara Hewitt took over in the mid 60s when we had federal programs like Medicare and Medicaid come into play and that s when social work really I think took off and became a bona fide professional group, where you need a master s prepared clinical rigorous program to work at the Brigham. And aren t we fortunate that they want us part of the health care team. True. How have demographics of the patient population changed over the years since you ve been here; how has that affected your work? 3
I think in many ways they are the same. There are economic barriers that are, there s tremendous violence, psychiatric issues, financial issues, employment issues. In many ways the hospital mirrors what s going on in society, and I think to care for patients, we have to work very closely with community partners on dealing with some of the psychosocial mental health, economic problems that exist within society. You know those patients come to us for care. Yes. What would you say are the strengths of social work here and what are some of the challenges that remain for you? I think the strengths are that all our social workers are clinically sophisticated in caring for not only the psychosocial, but behavioral needs of patients and families that come to us for care. That we are integrated, embedded within teams, whether it be inpatient teams or ambulatory teams. The shift, if you stay here long enough you ll see the pendulum swing back. I started my career where the focus was ambulatory and the pendulum is swinging back to primary care and ambulatory practices. And I think that s crucial for the prevention and identification of problems that impact patients before they hit an inpatient setting. That s why [the] link to patient centered medical home[s]? Patient centered medical home, patient centered family care. We have a very strong component with Maureen Fagan s initiatives in developing a patient family centered care programs, where our patients and families sit on major committees and are part of the decision- making process of the hospital. And are there challenges that you haven t identified? I think immigration is a challenge, psychiatric bed availability continues to be a challenge, unemployment, economic concerns appropriate, detox for patients. But I think we re gifted to have partners within our network to gather to really look at some of the issues we struggle with and as a system address them. You had eluded a little bit earlier, Martha, to the culture of the Brigham and the community here. How is it changed and remained the same since you ve been here, would you say? Well, it s much bigger than it was when I started. It was smaller. I think the mission of serving patients, serving our community, teaching, and research continue to be the core of what the Brigham is all about. We re both local, national, and international facility now caring for patients, and we have a very strong relationship with Dana Farber/Brigham and Women s Cancer Center. And it has just grown so tremendously. I feel like I ve lived through medical miracles. That I have witnessed the advancement of science. And if you take oncology alone when I started, many of my patients, I still have a handful of patients that survived 30 years 4
when they weren t supposed to survive. Seeing the tremendous growth and people living with disease and not dying. It s been an honor and a privilege to be a social worker here to be part of the Brigham and to have such a remarkable staff that come in each and every day just wanting to make a difference in the lives of the patients and families we serve. 5