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COPE_PC Vignette #4

Read Vignette #4

Gabriela and Dr. Cheng

Gabriela is a 75-year-old, single woman living in her own home. In her twenties, she immigrated to Canada from Columbia in search of a brighter future. She worked hard and climbed the ladder of success becoming the Chief Finance Officer for an insurance company. Now she is retired but is financially stable. She has worsening macular degeneration and has controlled hypertension.

Because of her worsening eye sight, her family physician, Dr. Cheng made the difficult decision to have Gabriela’s driver’s license revoked. This has made her feel very old and dependent. She doesn’t want to be a burden on anyone and therefore feels very lonely – especially when missing her great-nieces back home. She is able to stay connected with great-nieces through social media. To navigate her feelings of isolation, she draws strength from her deep spiritual connection with God, which has been a guiding light through her life’s challenges. She no longer attends church services because she has no way to get to them. Dr. Cheng has not asked about Gabriela’s spirituality but has suggested large print books and in-home care.

After reading Vignette # 4, use your clinical expertise to reflect on what part of patient’s situation resulted in them experiencing social isolation.

When you have finished your reflection, click on the REVEAL button. This button reveals colour coded phrases to share the research evidence suggesting why the patient might be experiencing social isolation and their family physician’s perspective.





The following colour-coded phrases reveal the research evidence suggesting why this patient might be experiencing social isolation.

Self-perceived mental health: Feeling old and dependent, not wanting to be a burden on anyone, and feeling lonely may indicate poor mental health which can be associated with social isolation.

Community belonging: Missing nieces back home can indicate a lower sense of belonging which has been associated with social isolation. Having had her driver’s license revoked makes it more difficult for Gabriela to engage in activities that promote community belonging.

Religiosity: Drawing strength from deep spiritual connection with God has been associated with less social isolation.

Organizations and activities No longer attending church services means that Gabriela engages in fewer activities which can be associated with increased social isolation.

Use of social networking sites: Connecting through social media with her great-nieces has been helpful for Gabriela in reducing her feeling of isolation. It helps her stay connected with her loved ones back home.

Family physician’s response: The family physician’s focus on practical solutions, without considering her spiritual needs, may miss an important part of her well-being.

Consider if what you see in the REVEAL supports your clinical assessment. Did you identify other factors? Did Dr. Cheng’s response resonate with you? Did the REVEAL suggest new factors you had not considered? Did the family physician’s reponse resonate with you?

Click on the COPE_PC TOOL Simulation button. This button provides the COPE_PC Tool questions you may discuss with the patient to facilitate a discussion about social isolation.

Instructions for Vignette COPE_PC Tool Simulation


Imagine Gabriela is your patient and is visiting today for routine checkup. You have noticed changes in Gabriela and are concerned that she may be experiencing social isolation. You wonder how you might help Gabriela. You ask Gabriela if you can try the COPE_PC Tool, saying something perhaps like:

  • If Gabriela agrees, think about how you might use the COPE_PC website:
    • Consider sharing the COPE_PC website computer screen with Gabriela.
    • Would you start by showing Gabriela the Infographic? the Resources pages? You find these webpages on the left-side navigation bar.
  • Now consider how you will use the COPE_PC Tool (provided below):
    • Will you go through all the questions?
    • Will you ask Gabriela which questions she wants to answer? Will you decide to ask only some questions?
    • Will you share the research evidence that supports asking these questions?
    • Will you use the COPE_PC Tool just today or might you follow up at Gabriela’s next appointment?
  • Answer the questions as a simulation exercise, choosing the answer that you see reflected in Gabriela’s vignette.
    • Questions are colour-coded to indicate answers that reflect factors that protect someone from social isolation (orange colour) to items that may put someone at risk for social isolation (purple).
    • You can use the COPE_PC Tool to see if there are patterns of one colour which might indicate a longer conversation with Gabriela – perhaps over multiple visits. Or you may see just a few questions that indicate a risk that you and Gabriela decide to explore.
  • Once you have used the COPE_PC Tool for this vignette, please click on the “Go to the Next Vignette” button or use the left-side navigation bar at the top of this webpage to move to another vignette. Once you have reviewed the five vignettes, please click on the “Proceed to Finish COPE_PC Family Physician Education Module button found on the left-side navigation bar at the top of this webpage.

    • COPE_PC Tool Simulation


    In general, how is your mental health?

    Research indicates those who rate their self-rated mental health as ‘excellent’, ‘very good’ or ‘good’ are less likely to report experiencing social isolation than those who rate their mental health as ‘fair’ or ‘poor’.

    To what level do you consider yourself to be spiritual?

    Research indicates those who identify as ‘very spiritual’ or ‘moderately spiritual’ are less likely to report experiencing social isolation than those who identify as ‘not spiritual’ or ‘slightly spiritual’.

    Resilience #1 – I am able to adapt when changes occur

    Research indicates that the more resilient a person is, the less likely to report experiencing social isolation.

    Resilience #2 – I tend to bounce back after illness, injury, or other hardships.

    Research indicates the more resilient a person is, the less likely to report experiencing social isolation.

    How would you describe your sense of belonging to your local community?

    Research indicates those who identify as having a ‘very strong’ or “somewhat strong’ sense of community belonging are less likely to report experiencing social isolation than those who identify as ‘somewhat weak’ or ‘very weak’.

    How many places such as organizations, activities or clubs do you participate in or visit? Examples: Health care, clubs, community or senior centres, exercise facilities, restaurants, stores, places of worship, parks

    Research indicates the more places a person participates in or visits, the less likely they are to report experiencing social isolation.

    Do you use any social networking websites (e.g. Facebook) or apps (e.g. Zoom or Face Time) to communicate with friends and family?

    Research indicates those who use social networking websites are less likely to report experiencing social isolation than those who do not use social networking websites.