How impressions make lasting memories

Psychological and social factors play a huge role in patient outcomes, one factor we can harness is the Peak End Rule. 

The Peak-End Rule (as described by Daniel Kahneman) that an event is remembered more by what happens at the peak or the end than at any other point in that event. This leads to the formation of biased memories, either positive or negative.

Research on painful medical procedures has shown that people rate a medical procedure as more painful overall if the same stimulus was applied at the end of a procedure rather than at the beginning or the end. Likewise when the most painful experience was during the procedure had a similar impact. 

We rely on this summary we have to remind ourselves later of how an experience was. This impacts our decision of having that experience again. 

So how can we harness this in a consultation? If the peak-end rule can impact a patients memory of a treatment session, an experience that was more unpleasant at the end may be rated as more negative than if that same unpleasant experience was at a different time. This may impact compliance, adherence to exercise plans and trust in what you say. 

So instructing a patient to push into a painful movement, do a test or certain exercise at the end of the session may not be the best idea. Consider attempting harder exercises or rehab which you know may be more painful earlier on in a consultation, likewise for testing, often orthopaedic testing, whist can be important, can often trigger pain. It’s common for people to rest certain movements at the end of the session. 

This heuristic can also be harnessed for positive, knowing what impacts patients memories of a treatment session, ie better experiences towards the end may lead to better compliance and rapport. Giving patients the ok to continue with what they love doing, showing them something they can do now which they couldn’t do before all will have a great impact.  

Simply providing high-quality interactions, great customer service and a really positive environment, you can influence the positive memories in your patients. (However, ideally this is a standard you are doing as a minimum anyway). 

TLDR: End on a high… 

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou