Doctor Patient Relations

Why Can’t We Forget Awful Patients? Learn from What You Can’t Forget

By Brian Chou, OD, FAAO

Recently, a colleague and I discussed how we really enjoy seeing our many happy, pleasant patients come back. Yet we also realized and agreed that the patients that we cannot banish from memory–as much as we’d like to–are the minority that are extraordinarily unreasonable, rude and unappreciative. Why is this?

In neuroscience, there is the concept called salience, which describes how a person stands out relative to the background obscurity. Detecting salience is an important step in remembering. It is analogous to how our visual system is tuned to look for change, whether edge detection or movement. In the absence of fresh visual stimulus, things start to fade into background obscurity. Harken back to optometry school, and you’ll remember that this is called “Troxler fading.” The point of this is that the minority of unpleasant patients become salient amid a sea of pleasant and happy patients, making the unpleasant patients regretfully memorable.

Yet this may not be the only explanation why we remember our awful patients. In psychology there is the concept of “flashbulb memory,” in which emotionally arousing events, like September 11th and the Challenger space shuttle explosion, elicit vivid memories about what you were doing when you heard the news. The idea is that emotion can galvanize memory, facilitating learning. Indeed, there are studies that show that epinephrine is associated with memory enhancement in both humans and animals. When the “fight or flight” response is engaged with the consequent release of epinephrine, it appears that the heightened attention facilitates recordation of the surrounding events. We each have patients who push our buttons. After all, we are ultimately human. Perhaps this is also a mechanism by which we cannot forget our awful patients.

The reality is that while these awful patients take up more than their deserved amount of our cognitive space, I take solace in these negative interactions by realizing that without them, there is no appreciation of the happy, pleasant patients. Without experiencing what’s bad, it’s hard to know what is good. Fortunately, I am blessed like many of you with many wonderful, pleasant patients!

How do you use the memories of negative patient interactions to better your performance and that of your staff?

Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.

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