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COPE_PC Vignette #1

Read Vignette #1

John and Dr. Lam

John is an 82-year-old retired schoolteacher living in a retirement home; he is financially secure. He has arthritis and diabetes. Once an active community member, he is now withdrawn and isolated after the death of his wife two years ago. Despite a close-knit group of friends and family, John feels disconnected and hesitates to reach out, fearing he may burden others with his grief. To support his physical health, he goes out for walks.

John has been under the care of Dr. Lam, his family physician, for the past ten years. She knows him well as a patient. Over the years, Dr. Lam has witnessed John’s transformation from a happy individual to someone struggling with isolation. During their appointments, she frequently checks on his overall health, including his diabetes and arthritis. Occasionally, she inquiries about his emotional wellbeing, yet John still feels lost and unsupported in navigating his grief. He often looks down during conversations, rarely makes eye contact, and hesitates to engage in conversation with Dr. Lam. He continues to struggle with finding ways to reconnect with the community in and outside his retirement home, leaving him to face his loneliness largely on his own. Dr. Lam wonders how else she might help John.

After reading Vignette # 1, 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: Struggling, feeling lost and unsupported, and navigating grief may reflect mental health concerns, with social isolation exacerbating these feelings and hindering the healing process.

Community belonging: Feeling disconnected, hesitating to reach out and struggling with finding ways to reconnect with the community can represent a lack of community belonging, which is associated with social isolation.

Organizations and activities: Going out for walks is an example of engaging in an activity which is associated with reducing social isolation.

Family physician’s response: Dr. Lam has been attentive to John’s physical health but is unsure how to better support his emotional wellbeing. He continues to struggle with isolation. Dr. Lam wonders how else she could support him to navigate his isolation? Possibly, she may refer John to counselor or group sessions

Consider if what you see in the REVEAL supports your clinical assessment. Did you identify other factors? Did Dr. Lam’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 John is your patient and is visiting today for routine diabetes care. You have noticed changes in John and are concerned that he may be experiencing social isolation. You wonder how you might help John. You ask John if you can try the COPE_PC Tool.

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