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    Pharmacists and cognitive dissonance

    When diametrically opposed views are the framework of daily reality


    Dennis MillerDennis MillerWhat is cognitive dissonance?

    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.

    See also: What kinds of pharmacists get under your skin?


    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

    See also: Is job satisfaction too much to ask?

    Dennis Miller, RPh
    Dennis Miller is a retired chain-store pharmacist living in Delray Beach, Fla. He welcomes feedback at [email protected] His books ...


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    • Anonymous
      You continue to amaze me, Dennis. I can't believe you can read my mind so perfectly! The cognitive dissonance you speak of is as familiar to me as getting out of bed in the morning, and much less palatable. How DO you reconcile what you know to be true with what you must tolerate to survive. For many years, I have felt "two-faced" or phony in my practice of pharmacy. What I really want to do is tell my customers to flush the medication and start taking care of their bodies. What I have to tell them is how the medication will "help" them, and how they should take it faithfully. I've played the part as long as I can - I'm getting out. I can't in good conscience keep shoveling this stuff out. Keep up the good work! Tired Pharmacist.
    • MarkBurger
      Dennis, You're right on the money again! Good job. Another way to ask the question: When did pharmacology and epidemiology trump Physiology and Biochemistry? I saw a cartoon last week: It was of a Scientist looking through a microscope (presumably an immunologist). God, from above, sarcastically said, "What a blunder! I forgot to complete the Immune System! I count on you to address this." We forget, I think, that enzymatic reactions defy the Laws of Thermodynamics and occur in a quantum physics manner. And, finally, there's this from the New England Journal of Medicine :: "Lifestyle intervention reduced incidence of diabetes by 58% and metormin by 31% as compared with placebo; •“The lifestyle intervention was more effective than metformin." ~ REFERENCE Diabetes Prevention Program Research Group, New Engl J Med 2002;346(6): 393-403