Patients’ Memory for Medical Information

Abstract

When important decisions are to be made, the patient must receive detailed information on the illness, treatment options and prognosis. The shortening of hospital stays and the trend towards outpatient care enhance the need of patients and their families for specific information. 1 Practitioners are responding to these demands, yet the amount of information correctly recalled by patients is strikingly small. 2 In this review I examine empirical evidence concerning the obstacles to memory for medical information and offer some suggestions for overcoming them. Clearly, memory for medical information is a prerequisite for good adherence to recommended treatment. Ley's 3 model on effective communication in medical practice (see Figure 1) stresses the importance of memory next to factors such as the understanding of information and satisfaction with the treatment. 40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled; 4 furthermore, almost half of the information that is remembered is incorrect. 5 For the forgetting of information there are three basic types of explanation-first, factors related to the clinician, such as use of difficult medical terminology; second, the mode of information (e.g. spoken versus written); and, third, factors related to the patient, such as low education or specific expectations. 6 Here, I discuss only the second and third, since the communication skills of clinicians have been thoroughly reviewed elsewhere. 7,8 AGE-RELATED MEMORY FUNCTION There is a general assumption that people in later life have poorer information recall than younger persons. However, not all aspects of memory are equally susceptible to age-related impairment and certain forms of memory remain intact over the lifespan. For example, memory for specific events or facts (so-called episodic information, which includes what the doctor tells you) is subject to age-related loss, 9 whereas memory for skills (such as driving a car) or for general semantic information (knowing that Berlin is the capital of Germany) is relatively spared. There is reason to believe that age-related memory impairments arise from defects in encoding and storage rather than retrieval. 10 With respect to medical information, a moderate inverse relation has been reported between age and amount of information recalled correctly. 6 Also, when Morrow et al. 11 investigated the effects of ageing on memory for appointment-related information through an automated telephone messaging system, the older adults answered fewer questions correctly (though there were no differences between young and old with respect to message repetition). Why should older adults recall less medical information than young? Although this can be the consequence of age-related cognitive impairments (e.g. in working memory), another possible explanation is an impaired capacity to deal with unstructured information. That is, older people might have difficulty structuring the information for recollection at a later time. This hypothesis was examined by showing young and old adults videos about osteoarthritis, a condition that can affect both age groups. 4 Two kinds of presentation were tested-either organized (i.e. in a logical order from test results to treatment consequences) or non-organized. Non-organized presentation of medical information is probably more in line with everyday clinical practice, in which the diagnosis and treatment options tend to emerge 219