Disconnected
Morning Doc,
It’s been a while.
How are you?
Good to see you smile.
Actually,
It’s been tough,
This year’s been really rough.
Oh I see,
Why don’t you share with me?
Okay well here goes,
You see,
My minds in disarray
I feel anxious all the time
I never want to go out and play
It always feels like bedtime
I’ve got no one to talk to
I’m all alone
I feel so ashamed
I…
I’m so sorry,
I’ve got internet trouble,
Could you repeat that last part?
Speak up, try not to mumble.
Sure thing, doc.
So as I was saying,
My loneliness and confusion
Is what I was conveying
My friends feel so distant
They don’t seem to notice
This internal struggle
That’s got me at my lowest
Do you have any solution?
I want to break this cycle,
Get rid of this mind pollution.
You’re already on medication,
I can increase the dosage,
Is there anything else you want to talk about?
I’m here for you,
You know that.
Thanks Doc,
I really appreciate it.
I just wish-
It’s hard to feel heard
When all I see is a screen
This is hopeless,
I hate talking to a machine.
Hey doc,
The connections really bad.
This isn’t working out.
We’ll speak another time?
So its bye for now.
Alright, I’ll see you
Please, take care.
Our project ‘Disconnection’ was inspired primarily by our experiences during virtual teaching and GP placements. With online consultations comes the removal of many subtle yet fundamental elements of communication and non-verbal body language. Forming connections with patients and truly empathising with them is an art form in itself, and we therefore wanted to reflect on the added complexities when these layers of communication are stripped away.
To encapsulate this, we have used a variety of art forms, combining these in a film to present an online consultation alongside the internal monologue of a patient feeling unheard and undervalued due to these barriers.
Karissa reflected on what inspired her to write the poem which forms the foundation of our film: ‘I was inspired to write this poem after an Effective Consulting session where we had to role-play in pairs. Taking on the role of a troubled patient participating in an online consultation allowed me to reflect on the obstacles that patients may face. Mental health has become an increasingly prevalent topic of conversation, especially in the times that we live in. Feelings of isolation are amplified, leaving those that struggle with mental health illnesses more vulnerable than ever. The portrayal of bad connection can be taken literally and figuratively. The patient struggles with bad internet connectivity, but also finds it tough to communicate effectively with the doctor. At the end of the day, both patient and doctor understand that they must work within the constraints of restrictions, both hoping for an improvement in time.’
We created vibrant and colourful paintings within the internal monologue sections to portray the full complexity and array of emotions the patient experiences. These were contrasted with black and white drawings to reflect the doctor’s clinical perspective; the dissonance between the two colour palettes conveying their lack of mutual understanding and contrasting agendas. Furthermore, we incorporated a black buffering screen to almost reflect back at the audience, putting them in the position of the patient who has lost this connection and is now left feeling isolated and unheard.
Overall, we feel the process of making this film has allowed us to empathise further with the patients we have been seeing during online placements. Given the growing use of technology, we appreciate that many of our consultations in the future may be online. We therefore hope that undergoing this project will enable us to better support and build rapport with our patients in the future.
Exhibited as part of the Art of Medicine Student Conference, December 2020
Izzy Saunders, Karissa Chia, Katy Cutler, Isabella Kwiecinski, Damisi Dare, Matthew Pierce Ionides, Jacob Lynn, Ellie Marsh, Sri Movva, Aleena Philip, Louise Carter, James Nicholson
Foundations of Medicine student conference 2020
This project is a really nice depiction of an online consultation. I think this does a great job of highlighting the subtle but fundamental elements of communication that are lost online. I really enjoyed the artwork, especially how it was contrasted with the black writing and drawings over the top of it. Overall a very moving project.
This highlighted the importance of non-verbal communication, a crucial aspect of healthcare, that is so easy to lose when providing healthcare online. Communication is so much more than just verbal, it can be easy to take for granted quite how significantly non verbal communication shapes consultations. I really enjoyed the presentation of this film, the bold stand out key words working well when contrasting against the pallid colour scheme of the pictures conveying the feeling of being lost and overwhelmed by the move to virtual healthcare. Conveys the need for human contact, both for the patient and doctor.
I think that this project really accurately shows some of the negatives patients feel about online consultations, which have been a major part of healthcare throughout the Covid-19 pandemic. The poem highlights how patients feel disconnected when ‘talking to a machine’, and the loss in internet connection represents both the practical problems with online communication and the lack of communication between the doctor and patient, and this is similar to how a patient in my GP placement felt that she ‘wasn’t being properly seen’ when consulted over the phone. This illustrates how important non verbal communication is in building a rapport with patients, which allows them to feel more comfortable and open up more to doctors, which in turn improves patient outcomes. The contrasting coloured paintings of the patient and black and white paintings of the doctor in the video further displays the disconnection between doctor and patient, and conveys the confusion and sadness the patient feels.
I think this project highlights how online consultations can make it harder for the patient to convey exactly how they’re feeling, and the negative impact that the lack of non-verbal communication can have on an effective consultation. The poem shows how isolated patients can feel and how they can feel frustrated/ hopeless when talking to a screen and not being able to discuss their issues/concerns properly. The contrast between the black and white of the doctor’s perspective and the colour of the patient’s perspective shows that they are not on the same page and shows the struggle for the doctor to understand the patient’s concerns because they can’t pick up on non-verbal signs.
This project represents the struggles of effective communication and connection during the covid-19 pandemic. Face to face consultations and actually any interactions in person are crucial for the most effective conversation. During the pandemic many people, especially the more isolated, suffered without human interaction that we all know is necessary for maintaining our mental well being. The poem highlights the disconnection felt between patients and doctors during the pandemic and highlights the difficulties of online consultations. For example, the barriers of communication and non-verbal cues. These crucial parts of a doctor-patient relationship are important for the patient to feel listened to and at ease and for the doctor to interpret and therefore figure out how their patient is actually feeling. All of these factors contribute to an effective and trusting relationship between a patient and their doctor. I really like the use pencil and watercolor, the pieces well represent the emotions that patients must have felt, the use of somewhat dull colors also contributes to these emotions. The drawing in the laptop screen particularly highlights how human connection can get lost through a screen.
This poem powerfully demonstrates the challenges of communication in a virtual environment and the detrimental effect it has on patients making them fell that “this isn’t working out”. The contrast between the more detailed complex imagery and emotions used to describe the patient’s experience interspersed with the short, halting stanzas of the doctors mechanical reply emphasises the disconnect between the patient and doctor. This isn’t conveyed specifically through words, just as in a consultation much of communication is non verbal, which reflects how much of those important signs are non existent in virtual consultations. It illustrates the patient’s perspective very well and how they feel even more isolated and alone through the ‘bad connection’ they experience.
This project clearly depicts the struggles of digital care. There are many barriers when it comes to video consultations such as poor connection and poor sound quality, which can easily make a patient become frustrated when they want to tell a GP their problems.
One part of the video I liked was when the patient said: ‘My friends feel so distant. They don’t seem to notice this internal struggle.’ I liked this because it allowed me to understand the relationship that is developed between a patient and a doctor, to the point where a patient can open up about anything, even their ‘internal struggles.’ There are some things a patient is more comfortable saying to a doctor than their own friends because of a good patient-doctor relationship.
One often hears news items and conversations about the impact of COVID-19 on the physical health of those affected. Similarly, the additional strain placed on the NHS by the pandemic is usually not far from front pages. This piece addresses a more subtle, less widely acknowledged impact of the COVID-19 pandemic: loneliness. And it does so powerfully, through poetry. For millions, the world is a lonely place under normal circumstances. In a system in which “self-isolation” and “social distancing” are legally enforced, it might be easier to catch loneliness than to catch COVID; as the author puts it “feeling of isolation are amplified.”
Group 20’s piece highlights the limitations of digital care in helping people who are lonely. The patient, “lonely” and “confused”, pours their heart out to their doctor, but, as the patient so accurately puts it “It’s hard to feel heard When all I see is a screen.” This portrays clearly and poignantly the barriers to care generated by virtual consulting. Within the comment, “all I see is a screen”, there is pain at the loss of the human connection afforded by face-to-face interaction. These barriers to communicating are exacerbated several-fold by the poor internet connection.
The piece conveys clearly the patient’s change from eagerness to seek help to frustration and despair when the consultation begins to go poorly. In one of the moments where the internet connection drops, the doctor interrupts the patient, just as she begins to unpack her wants “I just wish…”. This seems symbolically significant: the poor connection disabling conveyance of the unmet needs of the patient, thereby serving as a barrier to care.
Impressive too is the poignancy of certain lines which at first appear throw-away, but may in fact have some significance to this doctor-patient relationship. For example, in just the second line, “It’s been a while”. At first glance this line does not carry much weight, but upon reflection, it might point to a sense of abandonment in the patient. Or, perhaps it is indicative of the patient taking a long time to decide to seek help, which might stem from denial or fear of stigma. The imagery within “Get rid of this mind pollution” is also of interest: such a quintessentially physical notion as “pollution” being used to paint a picture of mental health problems. Pollution has an association with poison and contamination, which suggests that the “pollution” of her loneliness and other troubles are poisoning her. As such, it feels an even greater shame that the doctor is not able to make much progress with helping the patient in the consultation presented in the poem, so the patient is left ‘polluted’.
I haven’t discussed the images used in the video here, but one could discuss them at length. They serve as a powerful supplement to the poem, colouring in the picture of loneliness and pain drawn by the poem.
Overall, the piece conveys powerfully the isolation experienced by some people during the COVID-19 pandemic and the limitations of digital consultations insofar as enabling doctors to offer support to patients struggling with mental health problems.
This project conveys the idea of disconnection by the buffering of the internet connection, dejected look on the patient’s face and change between coloured with black and white paintings. This represents how the pandemic has affected doctor patient relationships because it is harder to communicate online but also overall indicates how patients feel when communication with their doctor isn’t perfect. The patient says, ‘I hate talking to a machine’. Patients want to be talking to a doctor in person, so they feel like they are being properly heard. Nonverbal communication is important when talking to a patient and this can’t be properly conveyed when talking online.
This project highlights the difficulties doctors and patients faced with regards to online consultations during the pandemic. It was difficult for the patient to convey how she was feeling, partly because she was ‘ashamed’ about her loneliness but also because of connectivity issues, which made communicating how ‘anxious’ she felt even harder. The patient’s frustration with the technology was clearly shown (‘I hate talking to a machine’) which reflects how many patients felt during the pandemic, and her ending the consultation prematurely demonstrates how communicating via a screen can make it harder for the doctor to build a rapport with the patient. I like how the loss of internet connection had a dual meaning – it highlighted not only the technological problems faced during consultations but also the negative impact online consultations had on communication between the doctor and patient due to the lack of non-verbal cues.
Given the recent horrors of the covid pandemic, this piece was unexpectedly hard-hitting and made me reflect on just how isolated people were. It very poignantly highlighted the severe impacts that a loss of connection can have between people. I particularly liked the artwork with the laptop and the story of a patient consultation as I felt that it effectively portrayed the patients internal struggle to seek comfort in the GP’s guidance. The irony here was quite impactful as the piece reflected how despite the rapid development and use of technology to mitigate the impacts of covid, simple issues such as the buffering of the call, could be so demoralising and troubling for patients and society!
https://outofourheads.net/2021/04/01/disconnected-2/#comment-2056
This shows the challenges of isolation and effective communication in digital care, and the increased obstacles in tackling poor mental health with online consultations, where it’s ‘hard to feel heard when all I see is a screen’. It shows the difficulty for both patients and doctors in communication and providing care different to medication. This is reflected by the buffering and colour differences in the video, in which the patient’s array of colours (showing her “mind pollution”) was not mirrored in the doctors perspective of black and white. This represents the lack of mutual understanding between the two and how difficult it is to get past the online barrier. Overall, the video was very impactful in showing how the move to online consultations can disrupt care for those feeling most isolated and alone.
This project effectively shows how difficult it was for everyone during the forced isolations, but especially for those who didn’t like to rely on technology for everything, socialising in particular. The line “my friends feel so distant” hit particularly close to home for me as one of my closest friends lived just down the road from me but even though we we physically very close it was difficult to maintain our close friendship throughout the lockdowns.
The line “I hate talking to a machine” highlights how important even the most subtle of body language can be as whilst she (the patient) is technically talking to another person the response she gets is from a cold and emotionless screen making it hard to feel connected to the person on the other side again reminding me of how difficult it was to maintain close relationships during lockdown.
I was particularly struck by this exchange:
You’re already on medication,
I can increase the dosage,
Is there anything else you want to talk about?
I’m here for you,
You know that.
It made me think abut the pressures GPs are under and the time limitations put on consultations. This is especially difficult when it comes to mental health, where the solution which the patient craves (as in the poem) is unlikely to be found through medication alone. As the doctor says,
” You are already on medication, I can increase the dose” and then he hurriedly moves on….
” Is there anything else you want to talk about? ” Well, probably not…..
“I’m here for you, you know that” . The GP might wish to be but clearly isn’t able to be there for this patient.
As a service user, I think these kind of exchanges are common including in face to face consultations, when GPs are glued to their laptop screens and clocks. While I agree that there are limitations to online consultations and that a poor internet connection can be painfully disruptive, it is not the main issue in this poignant poem and film.
I think that what is being avoided, is the practitioner settling down to listen and really hear the patient’s experience. Doing so might allow this isolated and lonely patient to be seen, heard and thus valued, which might contribute to improving her mental health without increasing her medication. However, this takes the practitioner’s time, which is in short supply these days; a sad and frustrating situation for both parties.