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COPE_PC Vignette #5

Read Vignette #5

Marlene and Dr. Anderson

Marlene, 54, lives alone in a small apartment. She struggles with arthritis and asthma and can barely afford her bills and groceries on her part-time cashier’s salary. Recently some of her close friends have moved away, leaving her feeling lonely.

When she meets with her family physician, Dr. Anderson, Marlene avoids eye contact with her shoulders slumped and her hands fidgeting. She looks tired and tries to hide her struggles, often forcing a smile that doesn’t reflect how she truly feels. Not wanting to burden Dr. Anderson, she keeps her troubles to herself.

As Marlene lays down in bed each night, the stress of unpaid bills and an empty pantry feels overwhelming, and the silence in her apartment weighs on her like a burden.

As Dr. Anderson looks back over her day, she keeps coming back to her encounter with Marlene. She feels like she is missing something that is troubling Marlene. She resolves to talk to Marlene about this when she sees her at her appointment next month.

After reading Vignette # 5, 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 lonely can be associated with social isolation. Marlene looks tired is hiding her struggles from her family physician. She may be feeling isolated but is keeping her troubles to herself .

Resilience: Marlene is struggling to cope with the stress of unpaid bills , an empty pantry , and this weighs on her like a burden .

Family physician’s response: Marlene’s reluctance to share her problems with her family physician reflects how people sometimes hide their struggles from their health care providers. After the encounter, the family physician reflected on Marlene’s situation and will use future visits to explore Marlene’s emotional struggles, which Dr. Anderson thinks she might have missed.

Consider if what you see in the REVEAL supports your clinical assessment. Did you identify other factors? Did Dr. Anderson’s response resonate with you? Did the REVEAL suggest new factors you had not considered? Did the family physician’s response 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 Marlene is your patient and is visiting today for routine checkup. You have noticed changes in Marlene and are concerned that she may be experiencing social isolation. You wonder how you might help Marlene. You ask Marlene if you can try the COPE_PC Tool, saying something perhaps like:

  • If Marlene agrees, think about how you might use the COPE_PC website:
    • Consider sharing the COPE_PC website computer screen with Marlene.
    • Would you start by showing Marlene 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 Marlene 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 Marlene’s next appointment?
  • Answer the questions as a simulation exercise, choosing the answer that you see reflected in Marlene’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 Marlene – perhaps over multiple visits. Or you may see just a few questions that indicate a risk that you and Marlene 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.