By Cæcilie S. Laursen
This piece relates to (re)representation of research, storytelling, and reflection on method.
In the spring semester of 2018, I did my Master’s thesis on an object which most people did not know existed. Even now, I am in doubt if the majority of the Danish population knows it exists unless they work at or are patients at a hospital.
In 2016-17 the hospitals in the Capital and Zealand regions implemented a new electronic patient record system called the Health Platform (Sundhedsplatformen in Danish). This you probably know, as it has been highly debated in the media, criticized from various sides, recently by the National Audit Office of Denmark[i]. However, the Health Platform was not my object of study. I was researching the patient portal that came with the new system, which seemingly has slipped under the radar and received none or only little attention by the media. The patient portal is called My Health Platform (Min Sundhedsplatform in Danish) and as the name suggests it allows patients to access their individual patient record. Here patients can see, for instance, upcoming appointments, test results, and their physician’s notes. In addition, they can write to the hospital which they are affiliated with[ii].
In the context of my Master’s thesis, I did fieldwork at one of the Copenhagen based hospitals over the course of six months. I observed as the clinicians began using the patient portal and explore how they could use it in their daily work practices. I also observed patients logging in and using My Health Platform and interviewed them about their experiences.
The visual vignette above aims at communicating what patients see when they access their record and how they respond to what they are seeing. The first image is laid bare allowing you as the viewer to have your own immediate response to the information presented. Perhaps you share the patient’s sentiment or perplexity conveyed in the following image?
The visual vignette communicates only a fraction of what I learned during my research. However, it is a central and important finding, in my opinion. If you did not get the full image (pun intended) from the visual vignette, here comes the wordy explanation.
The images show what patients see when they open a blood test result. They will see their own value and a standard interval[iii]. Perhaps there will be a physician’s note attached to the result. If the patients have given several blood samples over time, they can see a graphical representation of the results. At the top of the page, there is written a disclaimer stating that patients can see results which their physician has not yet had the chance to review or contact them about.
The patients in my study express excitement regarding the access to their health data. They find it interesting that they can see for instance their blood values and they perceive My Health Platform as a portal which provides increased transparency to what the physician sees. However, the patients experience difficulties understanding the data that is available to them. They cannot interpret their blood test results on their own, and the notes in the record are challenging for them to read due to medical-lingo. For this reason, patients engage in, what I call, interpretation work in order to understand the information. They draw on different resources for this work, for instance, Google to translate words, or relatives with a medical background. The patients’ difficulties understanding the information available at My Health Platform can cause a degree of anxiety with some patients, and it can lead them to contact the hospital and seek out an explanation of the data.
Thus, My Health Platform provides patients access to their health data, but the question is how “transparent” the information is for patients when they are not provided with the knowledge or tools to understand the data[iv].
Visual vignette: an alternative way of disseminating research
My visual vignette is a product of the visual vignettes workshop hosted by ETHOS Lab and facilitated by Mascha Gugganig of the Munich Centre for Technology in Society at TU Munich, and Rachel Douglas-Jones, co-head of ETHOS Lab at ITU. In the workshop participants were instructed to shift the ‘division of labour’ between word and image. This challenge the traditional way of communicating fieldwork within anthropology and social sciences, where the text is the primary conveyor and images hold a supporting role. For preparation, participants were encouraged to read an essay in the American Anthropologist which invites scholars to engage with multimodal approaches in their research practices and the dissemination of their research[v]. Visual vignettes can be seen as a response to this invitation.
Participants at the workshop were at very different stages in their research. One was only just commencing her research and preparing for entering her field. Another used the workshop as an opportunity to make sense of her fieldwork, and the vignette functioned as an analytical tool. I was interested in communicating my thesis in an alternate way and wondering if I could use my pictures for that as they were mostly images of screens with words and numbers.
During the workshop I was faced with three frustrations related to leaving the images as the primary conveyer of the research:
- The image material I had did not allow me to communicate the richness of my data. The images depict one story from my research; the story of patients accessing their test results.
- I had to blur a part of the content in the images in order to maintain the anonymity of the patients and also the physicians who have written the notes in the records.
- My images primarily contained text themselves bringing the priority back to the written word.
Given my material, I was contemplating whether this was a beneficial way to disseminate my thesis. Perhaps I needed to have more variating photographs both from patients’ homes and the hospital if this method should make sense. When doing visual vignettes, you are very dependent on the images you have, at least if you commit yourself on using photographs from your fieldwork. With text, you are free to use the words you want to ‘paint’ an image and set the scene. The written text perhaps also provides the writer with more control over how the text can be interpreted, compared to an image. While photographs have been seen as “objective images” which are “untouched by human hands”[vi], photographs are never a neutral media[vii]. I, as the photographer, have carefully selected what to take photos of and in the visual vignette, they are curated in a specific way; content has been deleted and in the second images the photos have been manipulated. Still, despite a particular curation, an image bears a closer resemblance to art than the academic text, and thus, arguably has a higher degree of interpretative flexibility, which in turn limits the control the creator holds over the narrative. This might be both the promise and peril of visual vignettes.
Once I settled on conveying only one story from my research, my initial frustrations with the limited photographic material passed. To make the visual vignette sparked for me a creativity and a play with the aesthetics, which is different from the one of writing. It made me think of my material in a new way and see the richness of the chosen story. I perceive this to be one of the benefits of the method. It can be used during all stages of your research. Visual vignettes can be an alternative way of communicating your findings, but it can also be an analytic tool to aid your analysis or an ordering device for your field material. For future research, however, I plan to be more deliberate in my photography practice in order to get more photos from different settings, since the photos also function as photographic fieldnotes or mnemonic devices[viii].
While I am not planning on leaving behind the academic text any time soon, I see visual vignettes as an interesting way of communicating research, at least as a contribution to the academic text. At the workshop, we also talked about using the visual vignette as a conversation starter during interviews or focus groups, or for communicating your research to people, you have collaborated with during the study. By playing around with more artistic representations and embracing multimodality in science communication, we might also reach a different and broader audience compared to what we usually do and inspire new discussions[ix].
[i] Rigsrevisionen, Beretning om sundhedsplatformen (København: Statsrevisorerne, 2018).
[ii] Region H, ‘Om Sundhedsplatformen’, accessed 19 March 2018, https://www.regionh.dk/sundhedsplatform/om-sundhedsplatformen/Sider/default.aspx.
[iii] Since the writing of this blog post, Sundhedsplatformen and Min Sundhedsplatform has been updated. Min Sundhedsplatform has received a new layout, and now some test results are accompanied with a colour scale where the standard interval is green, and the values above or below this interval are yellow.
[iv] It is a political decision to provide patients with access to their health data, and the decision is supported by the umbrella organisation Danske patienter.
[v] Samuel Gerald Collins, Matthew Durington, and Harjant Gill, ‘Multimodality: An Invitation: Multimodal Anthropologies’, American Anthropologist 119, no. 1 (March 2017): 142–46, https://doi.org/10.1111/aman.12826.
[vi] Lorraine Daston and Peter Galison, ‘Epistemologies of the Eye’, in Objectivity, Paperback ed (New York, NY: Zone Books, 2010).
[vii] Mike Crang and Ian Cook, Doing Ethnographies, Online version (Durham University. United Kingdom: Norwich: Geobooks. Durham Research Online, 1995), http://dro.dur.ac.uk/202/1/202.pd.
[viii] Kim Rasmussen, ‘Sociologens Fotografiske Feltnoter Et Bidrag Til ”Thick Description”?’, SOSIOLOGI I DAG ÅRGANG 37, no. NR. 1 (2007): 13–32.
[ix] See for instance the reflection piece on Culture Night by Sophia Knopf.