1 May 2003

Why we forget what doctors tell us

Patients remember a "strikingly small" amount of the information doctors tell them, claims Dr Roy Kessels in the May Journal of the Royal Society of Medicine, Most patients forget up to 80% of what their medical team has told them as soon as they have left the clinic. Nearly half of the information they do remember, they remember incorrectly. Dr Kessels, from Utrecht University, warns that with the trend towards shorter hospital stays and more outpatient care, it is more important than ever for patients to understand their treatment options. He looks at a range of international evidence to find out why patients forget crucial medical information and suggests ways health professionals can help.

What stops us remembering?
Old age: As we get older, our memory for 'episodic' and unstructured information, such as medical advice and test results, gets worse.

Preconceptions: We are likely to misinterpret or forget information if it does not agree with our personal theories about an illness. Remembering entirely new information is easier than remembering something that challenges existing ideas.

Too much stress: Anxiety leads to 'attentional narrowing', a state where the brain can only focus on the most frightening statements. When a doctor says "you have cancer" we are unlikely to remember anything else. Studies show that if doctors look worried as they give bad news, attentional narrowing gets worse.

Too little stress: We remember facts best when we are in the same emotional state as when we were told them. If you feel anxious as you are given advice in the clinic, you are likely to forget what was said when you are more relaxed at home.

Structure and importance: We are more likely to remember the first statements we are told, and will be able to recall specific information ("take the next two weeks off") better than general information ("you need rest"). Structured, logical information can help the memory as long as the doctor states first what the structure will be.

Spoken words: The more information a doctor presents, the less the patient actually remembers, especially if it is spoken rather than written down. Some hospitals have found that patients who are given pictographs remember 80% of them, while those who were given spoken instructions remembered only 14% correctly.

Practical tips
Dr Kessels suggests some key tips for doctors based on his review of research:

• Use simple, specific instructions, and give the most important facts first.
• Structure information as you give it, and say how it will be structured
• Back up spoken advice with written or visual material.

[ends]

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