Behavioural sciences chapters
Memory, thinking and communication
How memory works (sensory, short-term and long-term), why we forget, the types of thinking and common thinking errors, and the communication skills doctors need, from active listening to breaking bad news.
- Memory has three stages: encoding, storage, retrieval; and three stores: sensory (under 1–3 seconds), short-term/working (about 7 ± 2 items, around 20–30 seconds) and long-term (unlimited).
- Thinking uses concepts, reasoning and problem solving; doctors are prone to cognitive biases such as anchoring and premature closure.
- Good communication combines verbal and non-verbal skills: active listening, open then closed questions, empathy, checking understanding; bad news is broken with a structure such as SPIKES.
On this page
Overview
Memory, thinking and communication are central to learning medicine and to every patient encounter. Patients forget much of what doctors tell them; doctors make thinking errors; and poor communication is behind many complaints and mistakes.
Memory
Stages
- Encoding: taking information in and converting it into a form that can be stored.
- Storage: keeping it over time.
- Retrieval: getting it back when needed, by recall (without cues) or recognition (with cues, as in MCQs, which is easier).
Stores (multi-store model)
| Store | Duration | Capacity |
|---|---|---|
| Sensory memory | Under 1 second (visual) to a few seconds (auditory) | Large |
| Short-term (working) memory | About 20–30 seconds without rehearsal | About 7 ± 2 items (Miller) |
| Long-term memory | Minutes to a lifetime | Practically unlimited |
Chunking (grouping items, such as a phone number into blocks) increases what short-term memory holds. Rehearsal and meaning transfer information to long-term memory.
Types of long-term memory
- Declarative (explicit): facts and events that can be consciously stated.
- Episodic: personal events (your first night on call).
- Semantic: general facts and knowledge (the causes of anaemia).
- Non-declarative (implicit):
- Procedural: skills and habits (riding a bicycle, suturing).
- Priming and conditioning.
Procedural memory (skills) is implicit; episodic and semantic memory are declarative.
The hippocampus is essential for forming new declarative memories.
Forgetting
- Decay: memories fade with disuse.
- Interference: old learning disrupts new (proactive) or new learning disrupts old (retroactive).
- Retrieval failure: the memory is stored but cannot be accessed (tip-of-the-tongue).
- Repression (motivated forgetting): painful memories pushed out of awareness.
Ways to improve memory: spaced repetition, meaningful organisation, mnemonics, self-testing, sleep, and reduced stress.
Disorders of memory
- Anterograde amnesia: inability to form new memories after an event.
- Retrograde amnesia: loss of memories from before an event (for example after head injury).
- Korsakoff syndrome (thiamine deficiency, usually alcohol): severe anterograde amnesia with confabulation (filling memory gaps with invented stories, not deliberate lying).
- Dementia: progressive memory loss, recent memory first.
Memory and patients
Patients forget a large share of medical information soon after a consultation. Helps: give the most important information first, keep it simple, repeat, check understanding (teach-back), and give written instructions.
Thinking
Thinking (cognition) is the mental manipulation of information to form concepts, solve problems, reason and make decisions.
- Concepts: mental categories (for example "fever").
- Problem solving: trial and error, algorithms (step-by-step rules that guarantee a solution) and heuristics (mental shortcuts that are quick but can mislead).
- Reasoning:
- Deductive: from general rules to a specific conclusion.
- Inductive: from specific observations to a general rule.
- Creative (divergent) thinking: producing many possible solutions; convergent thinking: finding one correct answer.
Thinking errors (cognitive biases) in medicine
| Bias | Meaning |
|---|---|
| Anchoring | Sticking to the first impression and not adjusting |
| Premature closure | Accepting a diagnosis before it is confirmed |
| Availability | Overrating a diagnosis because a similar case comes easily to mind |
| Confirmation bias | Looking only for evidence that supports your idea |
| Framing effect | Being influenced by how information is presented |
Heuristics make busy practice possible but cause many diagnostic errors. Using checklists and asking "what else could this be?" helps.
Communication
Communication is the exchange of information, feelings and meaning between people.
Verbal and non-verbal
- Verbal: words, language, clarity, avoiding jargon.
- Paraverbal: tone, pace, volume.
- Non-verbal: eye contact, facial expression, posture, gestures, touch, distance, appearance. Non-verbal cues carry much of the emotional message; if words and body language conflict, people believe the body language.
Core skills
- Active listening: full attention, nodding, minimal prompts, not interrupting, reflecting feelings, paraphrasing and summarising.
- Questioning: start with open questions ("Tell me about your pain") to let the patient tell their story; use closed questions ("Is the pain worse on walking?") to clarify details.
- Empathy: naming and acknowledging feelings.
- Clarifying and checking understanding (teach-back).
- Silence: giving the patient time to think and speak.
Begin with open questions; use closed questions to clarify specific details.
Barriers to communication
Language and literacy differences, jargon, noise and lack of privacy, time pressure, hearing or cognitive problems, strong emotions (fear, anger), cultural differences, and the doctor's own attitudes or fatigue.
Breaking bad news: SPIKES
- Setting: private place, sit down, involve family if the patient wishes, avoid interruptions.
- Perception: find out what the patient already knows or suspects.
- Invitation: ask how much the patient wants to know.
- Knowledge: give a warning shot ("I'm afraid I have some difficult news"), then the information in simple words, in small amounts.
- Emotions: respond to emotions with empathy; allow silence.
- Strategy and summary: plan the next steps, check understanding, arrange follow-up.
SPIKES: Setting, Perception, Invitation, Knowledge, Emotions, Strategy and summary.
Expect: the stages and stores of memory and short-term capacity (7 ± 2), declarative vs procedural memory, causes of forgetting, anterograde vs retrograde amnesia and confabulation in Korsakoff syndrome, heuristics and cognitive biases, open vs closed questions, active listening, barriers, and the SPIKES protocol.
Quick revision
- Memory: encoding, storage, retrieval; sensory, short-term (7 ± 2, 20–30 s), long-term.
- Declarative (episodic, semantic) vs procedural (skills).
- Forgetting: decay, interference, retrieval failure, repression.
- Korsakoff: anterograde amnesia + confabulation.
- Biases: anchoring, premature closure, availability, confirmation.
- Open questions first, closed to clarify; active listening.
- SPIKES for breaking bad news.
Written by The House Job from the Handbook of Behavioural Sciences by Mowadat H Rana (named in the UHS PGET syllabus).
FAQ
What is the capacity of short-term memory?
About seven items, plus or minus two.
What type of memory is used for skills such as riding a bicycle?
Procedural (implicit) memory.
What is confabulation?
Filling gaps in memory with invented information that the person believes is true, typical of Korsakoff syndrome.
What does SPIKES stand for?
Setting, Perception, Invitation, Knowledge, Emotions, and Strategy and summary: a structure for breaking bad news.