The Butterfly Effect

This installation was presented in October 2016 as part of Nuit Blanche in Winnipeg Manitoba

When I think of communication I usually think of how people share information with each other. Most of the communicating we do with others is pretty easy and is of little consequence. Texting a friend about where we are meeting for supper or arranging an appointment with my car mechanic. But sometimes communication gets more challenging. Why did my friend not return the text message that I sent them? Why did my mechanic not explain to me that they would need to keep my car for a week when I dropped it off? Text messages that go unanswered and learning that I will be without a car for a week is annoying, but rarely do these things have serious consequences. However, especially in healthcare, the consequences of ineffective communication can be far more serious.

Helping patients and their families understand how treatment and illness will affect their lives can be one of the most challenging parts being a healthcare worker. As a researcher who has spent time speaking with patients and their families, I have learnt that patients are often frustrated with not understanding how their diseases will affect their ability to carry out their lives. As a physician, I am always concerned that the information I share is done in a way that it is understood.

Research suggests that there are many variables on both sides of patient-clinician communications that affect the effectiveness of communication. Fear, anxiety, time pressure and lack of information are all variables that have been cited to affect how clinicians and patients communicate with each other. Dr. Feldman- Stewart et al. (Figure 1) suggests that communication in the clinical setting is also affected by the personal goals that both the clinician and the patient brings into the communication.

There is evidence that exists in the medical literature that there is room for improvement in how healthcare workers and patients communicate. As a physician I have had interactions with patients that I am confident went very well, but there are also ones that I wish I could do over. In my research, from speaking to patients about their experiences with doctors, it seems that everyone has had communication experiences that are good as well as some that are bad. What can be done to help clinicians and patients have more good experiences with communication, and less bad ones?

I think one way to evolve how patients and healthcare workers communicate is to bring attention to the challenges of communicating. By transforming an alleyway using light and sound, passersby will have the opportunity to communicate with strangers on the other end of the alley. This installation is designed to be fun, entertaining and a space to get people talking about what affects communication. 
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This installation creates an experience not unlike the communication that occurs between patients and clinicians. First, the environment in which healthcare communication takes place is often unfamiliar to at least one of the parties involved in communication.

Second, we often take for granted that when we are speaking the same language. But in the clinical setting, the language used by doctors is not always the easiest for patients to understand. There may be technical terms or nuances that may be easily misunderstood. In this installation, one of the challenges is to communicate without the tool of spoken language.

Third, external factors can affect communication. Mood, previous experiences, and expectations are  all just a few of the things that can affect clinical interactions. In this installations, microphones are used to manipulate the light and sound being exchange between the individuals communicating.
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Fourth, when both the patient and the physician can communicate effectively, the result can be trans-formative and able to positively influence the life of the patient. In this installation, when two individuals are able to communicate, from opposite sides of the alleyway, the installation transforms (Figure 2). The images seen on the screen fold on their vertical axis, joining at their spine to form an image that may resemble a butterfly, while the sound produced shifts from noise into music.

Figure 1. Schematic of patient-professional communication framework from Feldman-Stewart et al. Psychooncology 2005;14:801-9

Figure 2. Simplified depiction of installation when cameras on each side of the alleyway are occupied.