What is happening to us and to the family in our scenario? Everyone in the room, meaning the physician and the family, is in a thinking, learning state. What is happening in our constant thinking/learning/teaching health care environment?
When we are thinking/learning/teaching, we are using working memory to understand the bits and bytes that we see/hear/say. Take the family: you are giving them a fair amount of information and the information is both complex and freighted with meaning for them. They likely are thinking “Why did this happen?” “What can be done?” “How long do I have?” “How will I explain this to others? Or not?” There are so many simultaneous thoughts and questions; I call this cognitive noise until the thoughts can be teased apart.
Working memory is limited. This family can integrate a limited number of new facts - actually single digit amounts - until they can place that information securely in long-term memory, freeing up more working memory so that they can react, figure out what questions to ask, deal with the embarrassment they may feel by being seen in a vulnerable state, deal with vulnerability while carrying a self-self-expectation of competence. Next post, we will look at the thoughts going through your mind, then begin the framework.