Information Gathering, Recall and Recording

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Unless information is recorded verbatim and in real time (eg on a tape recorder), a record will only be as accurate as the memory of the person making it.  Unfortunately, there is plenty of evidence that our recall of even factual information is unlikely to be completely accurate. 

For instance, a study of 151 patients in a routine rheumatology clinic showed that, overall, only 40% of the information given to them about their condition and treatment was subsequently recalled.  Of this, 48% was misunderstood!  People over 70 recalled less than younger people; interestingly, people who were more anxious recalled more than people who were not.  Patients were selective about what they recalled, being more likely to recall information about treatment than diagnosis.  The more information they were given, the lower the proportion of accurate recall. 1

Another study, of patients at a genetic counselling clinic, also showed that what patients identified as important to remember was not necessarily the same as what the counsellors rated as important.  Although there was an association between the overall number of items that counsellors and patients judged to be important, patients more frequently judged information about family implications to be important than did counsellors. On the other hand, counsellors more frequently judged information about test, diagnosis and prognosis to be important than did patients.2

As can be seen, there are a number of factors influencing the accuracy with which we recall information- these include the importance we assign to the information, the general efficiency of our memory,  the amount of time that has lapsed since we heard the information, and the amount of information given at any one time.  It is estimated that we can only hold 4-5 chunks of information in short-term (or working) memory at any one time. 3  Finally, if we have misunderstood  the information in the first place, we can only at best accurately recall our misunderstanding.

All of these factors point to the importance of recording as quickly as possible, and, even more, of checking out what we have recorded – did we hear it properly? Is our interpretation the same as our informants? Do we understand all the language used?  Are we making assumptions about how the information is to be used, and the significance attached to it by other people?

Our ability to recall information will also be affected by our emotional state.  Although the study quoted above indicates that people who are more anxious recall more information, (perhaps because they are attaching more importance to it, and also because the adrenaline and other stress hormones released by mild levels of anxiety improves memory function 4), very high levels of emotional arousal interfere with our ability to hear, interpret and recall information. – as you will know if you have ever been given bad news.   Not only does activation of extreme fear and anger in the brain “hi-jack” our ability to think straight 5, prolonged exposure to stress damages the hippocampus, where memories are stored 6

This is significant for social workers and other professionals, who will often be working in conditions of chronic stress, and may be also in situations of acute arousal, either because of the nature of a particular case, poor working relationships, or personal issues.  It is also of course highly significant for service users and carers, whose life circumstances and specific situations are almost by definition stressful and emotionally arousing – and who may be further aroused by their need for contact with a social worker or other professionals.  In such circumstances, service users and carers may have difficulty both in conveying information and in understanding and recalling information which has been given them.

Information gathering and recording is thus not a straightforward, unproblematic, activity.  A good social worker will be committed to recording information and actions as quickly, accurately and accessibly as possible.  However, s/he will also be mindful of the many ways in which information may be mistaken, misinterpreted or biased, and will be striving to check out its accuracy.

Despite the importance of records to good social work practice, there is no straightforward prescription for when and how recording should take place.  Relatively little use appears to be made in social work of audio or video taping of discussions and interviews, despite the fact that these can be the most accurate representation of what was actually said.  (There is also a body of research evidence that indicates that giving patients audiotapes of initial consultations improves both recall, and satisfaction 7).   Taking notes during interviews and conversations ( as opposed to after them) reduces problems with recall, and also gives an opportunity to check out accuracy of interpretation.  However, effective communication also depends on noting and interpreting non-verbal behaviours, and on maintaining rapport, and both may be impaired by a focus on note-taking.  Finally, many departmental procedures require the completion of standard, and often long forms.  While these have the merit of consistency and standardisation, and may mesh well with other departmental systems, they may also “shape” the dialogue to meet the department’s agenda, and may miss what is of particular importance to the service user.  None of these approaches to information gathering and recording are problem-free, and all have their advantages.  The social worker’s responsibility is to be aware of the problems, whichever approach so being used, and be looking for ways to mitigate or compensate for them.

 

 

 

1 J. L. ANDERSON, SALLY DODMAN, M. KOPELMAN and A. FLEMING: Patient Information Recall In A Rheumatology Clinic ; Rheumatology Volume 18 no 1, 18-22

2 Allanson A, Bobrow M, French D, Marteau TM., Michie S: Information recall in genetic counselling: a pilot study of its assessment. Psychology and Genetics Research Group, United Medical School of Guy's, London, UK. Patient Education and  Counselling. 1997 Sep-Oct;32(1-2):93-100

3 Cowan , Nelson (2001) The Magical Number 4 In Short-Term Memory: A Reconsideration Of Mental Storage Capacity. http://www.bbsonline.org/documents/a/00/00/04/46/

4 Joseph Ledoux; The Emotional Brain: The Mysterious Underpinnings of Emotional Life   Touchstone 1998 p 206

5 Daniel Goleman; Emotional Intelligence; Why it can Matter more than IQ  
Bloomsbury Publishing 1996 pp 13-26

6 Joseph Ledoux; The Emotional Brain: The Mysterious Underpinnings of Emotional Life   Touchstone 1998 p 240

7 eg de Haes JC, Kuenen BC, Lammes FB, Ong LM, van Der Velden J, Visser MR; Effect of providing cancer patients with the audiotaped initial consultation on satisfaction, recall, and quality of life: a randomized, double-blind study. Department of Medical Psychology, Department of Obstetrics/Gynaecology, Academic Medical Center, Amsterdam, the Netherlands. L.M.L.ONG@MED.UU.NL