Memory, emotion, and compliance

Psychologist, founder of behavioral economics, and Nobel laureate Daniel Kahneman is part of a growing cadre of researchers exploring how human memory works. Although their work spans multiple disciplines, thus far all have concluded that, contrary to the prevailing belief, the human brain does not store memories the same way a digital camera stores pictures of whatever we consider worthy of photographing. But perhaps even more confounding, it appears that our emotions at the time an event ends rather than the event’s content will determine how we will recall it.

Parallel situations to the exchange that Kahneman had with an acquaintance that precipitated his interest in this subject surely will occur to most busy practitioners. In Kahneman’s case, a friend complained that, after enjoying an excellent performance of a favorite symphony, a sour note near the end ruined the entire experience for him. Compare this to Dr. Ohlson who, in response to his wife’s question about his day replies, “It was hell!” based on the fact that he received a phone call from a client shortly before he left the clinic that ended with the client saying something that annoyed the practitioner. In reality, Dr. Ohlson had a very productive and rewarding day up to the point when he received that 5-minute call, 4 minutes and 45 seconds of which consisted of emotionally neutral exchanges. But what the practitioner considered an unwarranted zinger at the end of that conversation so annoyed him, it not only spoiled his memory of the entire call, but also his memory of the whole day.

This example raises three issues specific to quality practice communication. The first involves how Dr. Ohlson’s memory of that last phone call will affect his interactions with that same client when they interact again. If the veterinarian truly believes that the client possesses no redeeming qualities that would make any interaction with that person acceptable, then both would benefit if he terminated their working relationship. In this case, simply and unemotionally acknowledging to the client that they apparently are not on the same wavelength for some reason and suggesting that person seek more compatible help elsewhere will suffice. At best, this may lead to more open communication that reveals the cause of the breakdown in the relationship and its resolution. An intermediate response might involve the client seeking service from another veterinarian within the same practice. Barring that, the veterinarian may suggest that the client establish a working relationship with another practice. Regardless of which path the client chooses, the troublesome situation with its equally troublesome ramifications for the veterinarian is resolved.

What kinds of ramifications? This leads to the second concern related to a negative memory of a client interaction: how it could affect Dr. Ohlson’s ability to communicate in a meaningful manner about all of the events that occurred prior to the upsetting phone call. After his short and not at all sweet summation to his wife, no one in his family feels any inclination to ask him for any details of his day. They reasonably assume it was uniformly bad. Because of this, all family members give the practitioner covert confused looks when they attend a community event that evening and another family approaches and profusely thanks Dr. Ohlson for the extraordinary, what they consider life-saving care he gave their pet that morning. It takes Dr. Ohlson a while before he can recall the event to which they refer. However, fortunately the family is so focused their memory of what to them was the most notable event of the day that they do not notice this.

In this situation, the veterinarian’s failure to recall the client interaction in a comparably positive light does not negatively impact the clinician-client relationship. But suppose he meets another client who refers to some complex husbandry recommendations Dr. Ohlson made during a farm call that same day.

“I gave what you said careful consideration after our talk, Dr. Ohlson, and I think it’s worth the investment,” declares the farmer. “Which of the options we discussed do you think would work best given my situation?”

At this point the veterinarian has two options. One is that he could attempt to summon enough memory of his highly involved discussion with his client to bluff his way through the conversation. However, unlike summoning a vague recollection of a frantic woman rushing into the veterinary hospital with a dog pawing at what turned out to be an easily removed stick wedged in the roof of his mouth, Dr. Ohlson’s interval with the farmer involved analyses of multifaceted herd health and financial data he then incorporated into his recommendations. If his bluff failed, he could lose his client’s respect and the practice even could lose a valued client.

Instead and wisely, Dr. Ohlson chooses his second option.

“I’m glad to hear you’ve decided to make some changes,” he tells his client. “Given all the different factors involved, I want to review my notes rather than trust my memory. I’ll be out your way doing some work tomorrow afternoon. Would it be all right if I stopped by then to discuss this?”

In such a way, Dr. Ohlson gains the time he needs to review his notes and communicates that his client’s request merits his full attention.

The third ramification related to how the human brain creates memories concerns compliance. Just as Dr. Ohlson’s memory of his entire work day became tainted by a brief conversation with a client that ended on a sour note, veterinarians and their staff similarly may taint a client’s memory of a veterinary interaction by unwittingly or deliberately ending it in a similar manner.

For example, Dr. Ohlson’s associate, Dr. Carmody, does an excellent job of outlining a weight-reduction program for Ms. Fletcher’s obese dog, Paddy. In addition to supplying the usual recommendations regarding decreased caloric intake and increased caloric expenditure necessary for weight loss to occur, the veterinarian quizzes Ms. Fletcher about her lifestyle and relationship with the dog. Based on these results, the practitioner offers recommendations most likely to meet human and animal needs.

For example, because the veterinarian realizes how much of a role people-food treats play in the client’s relationship with Paddy, she provides a list of palatable lower-calorie options in that category. Because Ms. Fletcher often must work at home in the evenings, Dr. Carmody provides another list of interactive toys and games that she knows from experience and client reports many dogs will use to amuse themselves. She also gives Ms. Fletcher the names of reliable local dog-walkers who would be willing to give Paddy an hour’s outing when Ms. Fletcher’s schedule precludes her from offering anything beyond outings that allow the dog just long enough to eliminate. The veterinarian even goes so far as to recommend a dog-walking group in the client’s neighborhood where the busy single woman could socialize with others while helping her dog. Given the range, thoroughness, and the client-friendly manner in which all of this information is presented, it is impossible to imagine any client who would not remember the interval as anything but a most positive experience.

But suppose just as Ms. Fletcher, filled with thoughts of all the ways she can help her beloved dog, prepares to leave the examination room, Dr. Carmody says, “Don’t let those excess pounds threaten Paddy’s health and the quality of his life any more than they already have.”

In an instant all memory of the quality information regarding how to resolve her animal’s problem vanishes in Ms. Fletcher’s mind. Instead the thought that the veterinarian believes she was negligent, or that she does not care about Paddy, or that Paddy could die prematurely and it would be her fault fill her mind. Regardless of the exact nature of the negative emotional response veterinarian’s parting comment elicits, it alters the client’s perception of the entire interaction.

Or suppose the client’s interaction with the veterinarian ends on a high note, but when she exits the examination room, she notices how busy the office manager is and decides to put Paddy in the car before paying her bill. However, when she attempts to communicate her intention to the office manager, the office manager snaps at her, “Don’t bother me! Can’t you see I’m busy?”

Here again the negative emotional response triggered by the comment undermines the client’s memory of what up to that point she had considered a fulfilling veterinary experience. Worse, when it later becomes clear to Dr. Carmody that Ms. Fletcher has forgotten much of what they discussed, the practitioner easily but erroneously could attribute this to client disinterest in the animal’s welfare instead of memory sabotage perpetrated by a member of the practitioner’s own staff.

Much has been written about the direct effects of emotion as it enhances or undermines quality communication. The research of Daniel Kehneman and others reminds us that those emotions may affect any memories of that communication too.