The Responsibility to Heal: Dr. Richard Clarke Cabot and the Creation of Medical Social Work in the United States

How can a society best care for its sick and indigent clients? Dr. Richard Clarke Cabot (1868-1939), a physician and social ethicist, formulated an efficient and socially just solution to this question by creating the field of medical social work. This model ensured competent and humane patient care through socially responsible policy and administrative practices. Cabot asserted that effective medical practice must consider adverse environmental conditions that contributed to illness. Yet most physicians lacked the training to recognize, let alone attend to, these social aspects of medicine. As an outpatient doctor at Massachusetts General Hospital, Cabot treated immigrants and other urban poor with tuberculosis, venereal disease, and other conditions exacerbated by poverty, ignorance, or a lack of safety and health standards. Cabot discerned that some patients remained ill because of unaddressed psychosocial factors, and were often unable to understand or afford the treatments prescribed. With Ida Cannon (1877-1960), a social worker and nurse, Cabot established the first hospital-based social service department in the U.S. Social workers acted as advocates in the hospital, and provided advice and resources related to work, housing, education, or family life. Despite opposition from many administrators, nurses and doctors, they created this new field of hospital social service through political savvy, diplomacy, and an advisory committee comprised of influential public figures. They educated health care professionals about practicing medicine in its social context, and fostered teamwork in patient care. Their administrative innovations were soon borrowed by other institutions, ensuring that social service became an essential part of every hospital in the U.S. and abroad. Cabot came from a background of great wealth and privilege. Yet his Progressive spirit of reform, alongside deeply-held religious and philosophical convictions, resulted in a keen sense of ethical responsibility towards the nation’s poorest, sickest, and most vulnerable. This resulted in his creation of a medical social work model that embraced systemic and far-reaching reforms, in its attempt to address complex social barriers that prevented healing. Cabot's model provides inspiration and guidance as we attempt to meet the needs of indigent clients in our own time.