Cognitive Dissonance (courtesy Dr. Andy McLean)
In music, we think of dissonance as a lack of harmony. Likewise, the psychological discomfort someone experiences when holding either contradictory beliefs or acting in ways different from one’s values is called “cognitive dissonance.”
People often deal with this tension by either:
- “Digging in,” i.e., rationalizing thoughts/behaviors or rejecting conflicting information (the quick route of defensive thinking).
- Self-reflecting and potentially revising one’s beliefs and behaviors and understanding that it is sometimes possible to integrate complexity; i.e., both might be true (the longer, mature route).
In healthcare, dissonance is ubiquitous – think of the four elements of medical ethics (autonomy, beneficence, maleficence, and justice) and how each presents with every patient. Clinicians are trained that “the patient comes first,” yet have to deal with the reality of limits in time, insurance coverage, productivity metrics, as well as their own financial incentives. They also are dealing with the cognitive dissonance of patients, which might manifest in treatment non-adherence.
The latter issue is one of the reasons clinicians are taught motivational interviewing skills. To help patients with their ambivalence. Dissonance is not a flaw; it is a signal to the clinician that one’s values, behaviors, or the clinical context might not be in alignment. It is important to be aware of the issue and thoughtfully determine if there is a systems problem, or if one needs to revise one’s beliefs or behavior.
Unfortunately for the clinician, there are times when cognitive dissonance moves through moral distress to moral injury—we saw this occur among many healthcare professionals during the height of COVID-19, where providers knew they were providing substandard care.
Remember: Being able to name the conflict, tolerate the discomfort, review one’s values, decide if a change in behavior/belief is required, and move forward can not only mitigate some of the harm that might occur to oneself or one’s patient, but can improve one’s clinical skill sets.
Reminder, if you would like to share inspirational quotes, stories, or ideas which might be helpful to others, please feel free to email Dr. Melissa Naslund at melissa.naslund@UND.edu.
