Co-authored by Emily Asadoorian
We all have some memories that we could never forget. Maybe your favorite one is of the time you went hiking with your best friends last summer. It could even be something you hardly remember, like the toy store you went to one time with your grandma when you were barely three years old. We always seem sure that we remember things exactly as they happened. But how can we be certain we can fully trust our memories? Over the past century, researchers have begun to better understand how memories function and how we remember events. The process tends to be pretty subjective. In providing healthcare, the impact of this issue isn’t only felt by psychiatrists. For all physicians, it’s important to remember that memory can often be faulty by accidental nature. After all, across the medical field, physicians need to ask questions that ask patients to recall events. This can happen to a cardiac surgeon getting familiar with a heart attack that occurred during a gym accident; to a pediatrician who is asking a child about the fever that came alongside a vomiting episode; or to a pain specialist who’s asking how their patient’s first epidural injection went. Unfortunately, the memories that healthcare professionals use to decide their courses of action can be influenced quite easily. Care must be taken to both prevent the implantation of false memories, and to consider evidence that verifies what patients remember.
This is due to how memories may be stored. One popular explanation—the reconstructive memory model—posits that, contrary to what we might think, we don’t store memories in the same way we’d save a video on our computer. Instead, we save two things: the individual events—more akin to photos—and a general outline that connects them into something like those slideshows your camera roll automatically makes for you. Unfortunately, this means that details can get lost. You can recreate a video if you have all the frames and play them back to back; but if you don’t, you’re left with empty spots. So, like with the slideshows, you don’t usually get the full event recorded. In the one made for a Friday night a year ago, you start with the image of you posing with your friends outside a restaurant, and the next one is of you all enjoying desserts. But what was your appetizer? What did the menu design look like? What color were your napkins? Our minds aren’t content with leaving that be. Maybe parts are there, but for those that aren’t, your brain might compensate with details that are recreated or changed. According to CBC News, “Each time we recall a memory, we only remember the last time we recalled that memory. And each time we pull up a memory, we may introduce new details that never occurred in real life.” The overall story may even become changed in the process so that our minds have a cohesive string of events to work with, since certain details may stop working with each other at some point. You may not recognize it consciously, but some level of your mind does, and next time you retell the story about your Friday dinner, you might say you drank some soda with your steak, because you don’t usually go for anything else—but that night you actually drank a mocktail. This comes down to our brains not storing every detail, but hating incompleteness.
So should physicians not even trust their patients? No, not at all. First off, none of this is the patient’s intent. It is our brains that might—and I stress might—deceive us and convince us through positive reinforcement that we are recalling the right info. So when patients present with certain symptoms and describe how they began feeling ill, physicians should use their story as a springboard, and search for other information that can give a more objective picture of everything. This doesn’t have to be anything complicated like necessarily sending them to get scans done for a minor boo-boo. Testing reflexes, feeling lymph nodes, or whatever else the situation and its severity call for may do the job. These are all commonplace things doctors are taught to do, but instead of looking at them as just routine pieces of data, it might be worth seeing them as objective support systems that give a patient’s story and symptoms a more definable structure.
Another reason why keeping the properties of memory in mind is important is that people tend to be susceptible to suggestibility, as we learned with the famous Loftus and Palmer studies on memory. Therein, participants were shown a series of car crashes, and were then asked the same general question: “How fast were the cars going before they crashed?” But “crashed” was either replaced with words with lighter connotations—like “contacted,” “hit,” and “bumped”—or those with harsher connotations—like “collided,” and “smashed.” The more the word choice implied a severe collision, the higher the participants seemed to recall the cars hitting each other quickly, even when they weren’t going too fast in reality. In a subsequent study, Loftus and Palmer asked participants the same question, but only alternated between “smashed” and “hit.” A week later, the participants were surveyed on whether they reported seeing any broken glass. Despite there having been no broken glass anywhere, those in the “smashed” group reported broken glass at a higher rate than those in the “hit” group. What these studies show us is that simple things like phrasing can completely alter how we remember events. When it comes to patients, physicians shouldn’t run the risk of influencing the diagnosis with the way they ask their questions. If they use phrasing that’s too soft, the patient may underplay how they’re feeling. If they use phrasing that’s too strong or suggestive of additional details, then the physician may set themselves up to end up with a harsher diagnosis to give. The use of neutral language and other techniques to decrease suggestion and implications therefore becomes pretty important. There’s a fine balance to strike here, and it involves letting the patient give their version of events while still narrowing down on a diagnosis, all the while without sacrificing an accurate recounting. See how complicated it sounds? That’s why it’s worth considering this early in your medical career so you have time to practice and hone the skill.
Since disease is a subjective process, physicians need to understand how patients are feeling through what they remember. Even though many of us are still years away from ever even being in charge of a medical case, as we go through our training and prepare to give patients the best of our efforts for their health, we should be conscious of these nuances. Building up the habits to counteract the faults in our memory becomes quite important in giving patients the care they deserve. Medicine is a field driven by information that needs to be correct. By using what modern psychology has taught us, physicians can move forward feeling that their choices and recommendations are well founded, and provide the greatest possible benefit to their patients.
References:
- Clear, David B. “Warning: You Can’t Trust Your Memory — Here’s the Science That Proves It.” Medium, 21 November 2019, medium.com/swlh/warning-you-cant-trust-your-memory-here-s-the-science-that-proves-it-91e0601bb2fe.
- Duggan, Graham. “Partial recall: Why we can’t trust our own memories.” CBC News, www.cbc.ca/natureofthings/features/partial-recall-why-we-cant-trust-our-own-memories#:~:text=However%2C%20apart%20from%20the%20central. Accessed 13 March 2024.
- Fanetti, Matthew, et al. “Reconstructive Memory.” Psychology and Learning of Motivation, 1996, https://www.sciencedirect.com/topics/psychology/reconstructive-memory. Accessed 28 March 2024.
- Mcleod, Saul. “Loftus And Palmer (1974): Car Crash Experiment.” SimplyPsychology, 16 June 2023, https://www.simplypsychology.org/loftus-palmer.html.
- “What Is Memory?.” Psychology Today, www.psychologytoday.com/us/basics/memory#:~:text=Memory%20is%20the%20faculty%20by. Accessed 14 March 2024.
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