The Memory Gap in Healthcare

Medical appointments are valuable but rare opportunities for people to ask questions, get answers, and receive expert advice about their health. As such, it’s essential for their quality of care that patients both understand and remember what they learn at each visit.

Good healthcare isn’t just about providing medical advice – it’s about making sure patients can retain and apply it effectively.

Yet, research shows that this is easier said than done. Studies suggest that patients forget or misremember between 40–80% of the information discussed during their medical appointments. This raises an important question: what determines how much a patient remembers? While a doctor’s ability to present information in a clear and actionable way is important, recall also depends on how a patient processes and stores what they learn. The first step in addressing the issue of low patient recall is to understand the factors that shape memory in medical settings.

So, what do we know? Why do some patients struggle to remember what they learn in their appointments, and what factors may be contributing to their forgetting?

Patient Factors

Stress

People tend to visit the doctor when they are already worried about their health, and the information they learn in their appointments (including diagnoses, results, and treatment plans) can be additionally anxiety-inducing. Although this is completely normal, stress can impact how well patients process and remember what they are told.

Research suggests that both high and low levels of anxiety make it harder to remember new information, while a moderate level of anxiety can actually improve memory. It can help to think of anxiety like a volume dial – too low, and you’re not paying attention; too high, and it’s overwhelming. But at a moderate level, you’re focused and engaged, making it easier to take in and remember what you’re hearing.

One way that this can look is called attentional narrowing. When a situation feels very stressful or emotionally intense, our attention naturally focuses on one prominent or “most important” detail. Attentional narrowing helps us cope with the immediate situation, but it reduces our ability to process and retain other important details. For example, when faced with a difficult, unexpected, or even life changing diagnosis, a patient might (understandably) spend part of their appointment simply processing the news. However, this may cause them to miss, overlook, or quickly forget other important details, such as treatment options and follow-up plans.

Health Literacy

It’s very difficult, or even impossible, to remember information that we do not fully understand. In medicine, one’s ability to understand and evaluate medical information, and thus use it to make informed health decisions, is called health literacy – this plays a crucial role in how well patients process and remember what they learn in doctors appointments.

Strong health literacy requires multiple skills, including reading and using health information, communicating one’s needs with healthcare providers, and understanding medical instructions. Strong health literacy has been consistently linked to improved comprehension, recall, and adherence to medical advice, while low health literacy is associated with the opposite. Unfortunately, despite Canada’s ranking as one of the world’s most educated countries, over 60% of Canadian adults lack adequate health literacy.

Problems can also arise when medical information is shared in ways that the average patient might find difficult to understand. For instance, medical information is most often shared with patients at a 10th grade reading level. However, studies demonstrate that most adults read at an 8th grade level, and that 20% of Canadians would benefit from information being shared at closer to a 5th grade level. Complex and jargon-heavy medical information can further add to these issues. This gap can lead to miscommunication, missed follow-ups, and difficulty adhering to treatment. In other words, if a patient doesn’t fully understand what their doctor is explaining, how can they accurately remember it later?

Age

Not all aspects of memory decline with age; some even improve. However, it is well established that as we age, we experience a variety of cognitive changes that can impede our ability to process and remember new information and events.

For instance, our episodic memory – the type of memory responsible for recalling specific events or facts, (including information shared during doctor appointments) naturally declines over time. The same is true of working memory, which allows us to hold information in the short term. As a result, retaining and recalling new information, including medical information, becomes more difficult as we age.

However, age-related memory decline does not exist in isolation. Rather, memory interacts with the other factors mentioned above in order to make retaining medical information more difficult. For instance, a variety of research shows that older adults struggle the most when presented with medical information that is too much, overly complex, or emotionally overwhelming. In addition, compared to younger adults, older adults are less likely to accurately remember medical details that contradict their existing beliefs about their own health.

Clinician Factors

Patient recall isn’t only influenced by how information is received – it also depends on how information is presented. As touched on in the section on Health Literacy, a physician’s ability to communicate complex medical information in a clear, accessible, and actionable way plays a crucial role in how well patients understand and remember what they are told.

So, what other factors may be contributing to patients forgetting?

Amount of Information

In one medical appointment, doctors often cover large amounts of information in short periods of time (including diagnoses, treatment options, follow-up plans, and more). Processing and remembering all this new information can be difficult, especially when combined with the factors mentioned previously.

Generally speaking, the more information a patient is given, the more they will forget. Decades of research on cognitive processing have found that people can only retain around 4 to 7 new pieces of information at a time, and even these are quickly forgotten unless steps are taken to actively commit the information to long term memory.

This principle holds true in medical settings. One 2011 study, for example, found that…

… patients were more likely to forget or misremember details from their appointments when they were presented with more than four four pieces of information.

Mode of Communication

It’s not just the amount of information that affects recall. The way that information is structured and delivered to patients also plays a critical role in how well the information is retained.

There are many different ways for doctors to share information with patients, each with their own advantages and drawbacks.

Verbal

Verbal information sharing is one of the most common methods of doctor-patient communication. Speaking directly to patients is quick, efficient, and encourages questions and further discussion, which can help patient understanding. However, unlike written communication, words spoken out loud are impermanent.

Once the information is spoken, it “disappears”, leaving patients with nothing to refer back to after they leave the appointment, which leads them to remember relatively little of what has been said. This problem only compounds the more information is shared.

Written

On the other hand, when information is shared in written form, patients can refer back to it when needed.

This method of sharing, however, can be limited by the health literacy level of the patient, as well as the language it is delivered i.e. if information in English is delivered to a patient where English is not their native language. Overall, written information can enhance recall, but its effectiveness still depends on how accessibly written the information is.

A variety of research shows that written instructions are easier to remember and led to better treatment adherence, especially when combined with verbal explanations.

Overall, effective memory depends not just on comprehension but also on strategies that support long-term recall, such as clear communication, strategically structured information, and follow-up reminders.