While your patient and her family are gobsmacked, you are constantly assessing whether they seem to understand or not, whether you can add more information, whether they need time, whether it is time to add support or silence, whether they are in a position to make choices. Your thoughts are more deliberate and deliberative than your patient’s and her family’s; you’ve been through this before.
When that new healthcare worker comes through the door, it’s not surprising that some bits and pieces of information the family have heard can be lost or misplaced because of the surprise and the jarring difference in mood, the new demand for attention that the well-intentioned person brought into the room. Their working memory has been overwhelmed; their cognitive load has been exceeded.
Cognitive Load Theory - yes, there’s a lot of research behind this - holds that working memory is limited while long-term memory is practically unlimited. We must work in order to digest information, put it into long-term memory, and free up working memory.
There are three types of load. Any time we encounter new information, there is mental energy we expend in order to process the information and memorize or develop a framework for thinking about it, termed “germane load.” The inherent difficulty of the information is termed “intrinsic load.” Finally, the way in which the information is presented - is it logical or haphazard? Is it in plain language? Is it coming in the midst of jarring interruptions? - is the “extraneous load.” For our patient and her family, the intrinsic load itself may exceed working memory because we may be talking about cell types, medication efficacy, treatment side effects, - things we integrated and developed heuristics for years ago. How can we be alert to whether others’ (or our own) cognitive loads are at capacity? How not to make them overflow and lose valuable content?
Once stored, we, our patients, and others involved in health care have characteristic ways of using information. Now that we have this framework, next session, we will take a bird’s eye view of ways we think about how we use our working or our long-term memory. With this background, in later posts, we will use what we have learned to decide our responses to Wait…What??!! moments.