Características de Confesiones Lencería

At any given time, the human senses are being bombarded with multiple sources of information. The human cognitive system uses attentional mechanisms to filter out irrelevant information in favour of processing more important information for the current goal (Styles, 2006). These mechanisms prevent the cognitive system from being overwhelmed by information processing. Attention allows our limited cognitive resources to be allocated to a certain stimuli that the individual wishes to focus on (Styles, 2006). When attention is focused, much of the environment is ignored without conscious awareness (Drew et al., 2013). An example of this can be seen in cases of inattentional blindness (as previously described). Simons and Chabris (2011) demonstrate this effectively through an experiment where participants failed to notice highly salient events when they were concentrating on other things. In their study, participants were instructed to watch a video in which six players, three wearing black shirts and three wearing white were passing two basketballs. Participants were asked to count the number of passes made by the players in the white shirts. During the video, a man dressed in a gorilla costume slowly walked through

77

the players, stopping in the middle to thump his chest before continuing to walk to the other side. Only 50% of the participants reported seeing the gorilla after watching the video. Simons and Chabris (2011) concluded that by focusing attention on counting the passes, important changes within the video were completely ignored (Simons & Chabris, 1999). Inattentional blindness has also been demonstrated in a clinical setting where multiple clinicians including radiologists failed to notice a guidewire that had been left in a patient’s chest (Lum et al., 2005). The guidewire was clearly visible on a chest CT and three x-rays but due to the radiologists’ inattention of the unexpected item it was five days before it was detected and removed. Clearly, this example suggests that medical images used in clinical consultations are susceptible to limitations of attention and could result in both clinicians and patients missing information.

In order to understand how patients may process information shown to them on medical images it is important to understand how people control their attention. Individuals can be easily distracted by new and changing stimuli within the environment and attention can be altered automatically to focus on the novel stimuli (Styles, 2006). From an evolutionary perspective, this is beneficial, as the ability to detect potential dangers through sight, sound or smell is imperative for self-preservation and survival (Styles, 2006). In a clinical context, patients may allocate their attention to the information provided to them during their consultation. However, they may be unable to maintain their attention throughout their entire consultation, particularly if there are interruptions during the conversation. Furthermore, some research has suggested that there is a dual-task deficit of conversing and attention, where the act of conversation impairs attentional processing (Kunar et al., 2008) and vice versa (Becic et al., 2010). This has implications for clinical practice, as it is important to determine whether the act of having patients attend to an image interferes with what they understand from the doctor-patient dialogue.

78

Several theories have been proposed to explain how the active allocation of attention to stimuli occurs. The main argument between the different theories is the time at which the selection of relevant stimuli occurs (Chun & Wolfe, 2001). Early selection theory claims that active selection of relevant stimuli occurs early on in the cognitive system, with the information that is deemed irrelevant and therefore not allocated attention not processed beyond its initial characteristics (Broadbent, 1958). Late selection theory, on the other hand, argues that active selection does not occur until all the information is processed, analysed and categorised and it is only at this point that irrelevant information is discarded (Deutsch & Deutsch, 1963). Attenuation theory appears to offer a compromise of the two positions (Treisman, 1964). Attenuation theory suggests that depending on task demands there is an attenuation of irrelevant information. The information is processed but not to the same extent as the information that is attended to (Chun & Wolfe, 2001). More recent research suggests that attentional processing depends on the perceptual load of a task (Lavie, 1995). If the perceptual load of a task is low (denoting an easy task) then there is more attention available to process other available information. In contrast if the perceptual load of a task is high (denoting a more difficult task) then there is less attention available to process other information. This is an important point to consider when showing medical images to patients alongside a consultation. If showing patients a complex image results in a high perceptual load then they may have fewer cognitive resources left to pay attention to the spoken part of the diagnosis in comparison to a condition when no image was shown.

In contrast, showing participants a medical image may help them attend better to the diagnosis. Attention can be allocated to a variety of tasks, including visual, auditory and tactile tasks. Existing research examining the limitations of human attention has observed that, although it is difficult to attend to two stimuli presented to the same modality, if stimuli are presented in different modalities there should be little attentional impairment (Wickens, 1980). That is, although people will find it difficult to process two simultaneous visual stimuli,

79

they would be able to allocate attention to both a visual task and an auditory task at the same time without difficulty (Styles, 2006). This could be the case within a clinical consultation. Patients can look at visual stimuli, such as an image, while they are participating in a conversation with their clinician without any attentional impairment.