In psychology, cognitive dissonance is the mental stress or discomfort experienced by an individual who holds two or more contradictory beliefs at the same time.
Cognitive dissonance theory is founded on the assumption that individuals seek consistency between their expectations and their reality. An individual who experiences inconsistency (dissonance) tends to become psychologically uncomfortable. Since it is impossible for a thinking person to hold two mutually exclusive beliefs simultaneously, anxiety is usually the result.
When the rosy view hits the brick wall
Cognitive dissonance is inevitable in every pharmacist’s life when the establishment’s rosy view of the world collides with that brick wall known as reality. Cognitive dissonance is evident in:
• The contradictions between the chains’ claims that patient safety is their No. 1 priority and the reality that understaffing is a major threat to public safety. When the speed at which pharmacists fill prescriptions is the most pressing consideration, where does patient safety fit in?
• The contradictions between the glowing picture of drugs painted by direct-to-consumer advertising and the reality of a long list of potential side effects gabbled by spokesvoices under the happy music
• The contradiction between the fact that state boards of pharmacy demand patient counseling and the reality that they are too intimidated by the political power arrayed against them even to attempt to require the safe staffing levels that would allow pharmacists time to counsel
• The contradiction between the clinical model promoted by pharmacy schools and the all-too-frequent reality of retail sweatshops
• The contradiction between APhA’s claim that it works hard for pharmacists and the reality that pharmacists’ working conditions and staffing levels do not improve
• The contradiction between the FDA’s seal of approval and the reality that many side effects don’t even appear until after a drug is on the market
• The contradiction between the fact of a healthcare system based on drugs and the reality that prevention is safer and more effective than pills
What I tell myself vs. what I do
Cognitive dissonance often arises when there is conflict between a pharmacist’s positive concept of himself/herself (The drugs that I dispense are safe and effective), and the reality (Some drugs do more harm than good).
How do pharmacists handle this disconnect? Do we react with hostility and denial toward customers who sometimes question the safety of the drugs we dispense? Or do we confront the possibility that there may be some truth in the fears customers express?
The academic viewpoint vs. the line of fire
Another example of cognitive dissonance is illustrated by the difference in perspective between pharmacists in the trenches and academics in their ivory towers.
When practical circumstances prevent pharmacists from doing what we know we have to do, what we should do, and what we want to do, it creates a terrible conflict. This sort of cognitive dissonance hugely compromises anyone who has to endure it.
While the academics are commenting from a philosophical standpoint, the pharmacists in the trenches are getting stomped on all day long, every day. These are two entirely different realities. When the attitudes arising in one reality are used against the truth of the other, it causes a huge conflict among pharmacists.
Behavioral change vs. pharmaceutical intervention
On the one hand, our instincts tell us that human health is primarily the result of basic factors such as good nutrition, healthy lifestyles, maintaining a healthy weight, avoiding a sedentary lifestyle, avoiding the use of tobacco and alcohol, etc.
On the other hand, our healthcare system is based on the manipulation of molecules and cells with powerful synthetic chemicals called pharmaceuticals.
How does one reconcile these opposing views of human health?
Mechanistic vs. holistic
Why does our healthcare system place a mechanistic and reductionistic focus on molecules and cells, rather than a holistic focus on nutrition and lifestyles?
Why is modern medicine fixated on alpha blockers, beta blockers, calcium channel blockers, H2 antagonists, proton pump inhibitors, HMGCoA reductase inhibitors, etc.? Has modern medicine miraculously discovered errors in tens of thousands of years’ worth of human evolution?
Why is modern medicine obsessed with attacking and overwhelming delicate biological processes with synthetic chemicals foreign to human evolution?
Why is our healthcare system fixated on chemistry rather than on nutrition and lifestyles?
Why do pharmacy schools focus so heavily on chemistry, when retail pharmacists have no need for chemistry?
Why are we in the business of pushing pills rather than changing lifestyles, in light of the fact that major dietary and lifestyle changes can, in general, do more to improve the health of our customers?
When worlds collide
The pharmacy establishment (boards of pharmacy, schools of pharmacy, APhA, AACP, Big Pharma, chain drugstores, FDA) promotes one reality. Pharmacists in the trenches experience an entirely different reality.
In order to lessen the inner turmoil caused by the attempt to hold diametrically opposed views simultaneously, pharmacists have to adapt to big contradictions. How do they reconcile the establishment’s rosy view with their daily reality? How do they do it?
Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at [email protected]. His books Chain Drug Stores are Dangerous and Pharmacy Exposed are available at Amazon.com.