Information overload during the pre-anesthesia interview

How much can you learn all in one go? Cognitive science has established that on average we can hold only seven or so “chunks” of new information.

In this Sept 2008 study in Anesthesia & Analgesia, patients interviewed in a pre-anesthesia clinic in Boston were heavily overloaded with information by nurses and doctors. Audio recordings showed that nurse practitioners attempted to transmit on average more than 110 pieces of information during the interview. The doctors came in with roughly 50 apiece.

The study also found that neither the doctors nor the nurses used memory aids such as “scripted sequencing” – a fancy term for making the description of the anesthetic into a “story”.

Although these patients weren’t systematically tested, patients contacted within 24 hours of their interview recalled little of what they had been told.

Increased “information giving” by clinicians has traditionally been favorably regarded. But the reason patients like doctors who talk may be that this creates an opportunity to develop rapport, rather than enhancing the transmission and retention of important medical facts or instructions.

When faced with the information overload described in this study (it is unlikely that Bostonian interviewers are more garruluous than those elsewhere in the US or the rest of the industrialised world) patients are unlikely to be able to distinguish important information from that which is less relevant. This makes a mockery of the concept of informed consent.

The authors suggest that reducing information overload and application of memory-enhancing techniques should be joint goals when conducting the preanesthetic consultation. The patient should be informed how the information is organized e.g., “now, I am going to tell you what is wrong with you” or “here is what you must do to help yourself get better.” Communicating in this way gives the patient a mental structure within which to organize new information.

Reinforcement with printed materials or video has been shown to be useful in a number of studies. The authors make no mention of computer-based educational modalities but in my view this medium can be at least as effective as printed materials, perhaps more so because of its interactive nature.

What you – or your doctors – can do

There is little hope that you will be able to recall all of the facts presented to you in a typical preoperative interview. Encourage your doctor or nurse to structure the new information they are about to give you and to repeat or summarise the most important issues at the end of the interview.

Making an audio recording is probably too intrusive for most healthcare providers to handle, in part because of the fear of litigation this may invoke, and although it has been tried in study settings. Taking notes may be more acceptable and you could have a friend or family member come along to help with this.

Finally, make sure you get written instructions, if possible tailored to your condition and the planned procedure, and have a chance to review those instructions with your doctor or nurse at the end of the interview.

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