This is the Drive Time Debrief, episode 225.
Hey, guys, welcome back to the podcast. I'm Amanda. I'm Laura. And I'm Kendra. And this is the wrap on our incredibly rude and hateful cognitive dissonance series that has offended everyone, especially me. Nope. Little bit me too. Because, yeah, it's so real. This hurts. It hurts bad. But this explains a lot of what we're doing and why we're interfering in our own wellbeing sometimes.
So in episode one, we talked about the cognitive dissonance theory originally put forth by psychologist Leon Festinger. The idea is that humans experience psychological discomfort whenever our beliefs and our behaviors or our identity and our behaviors or our values and our behaviors are in conflict with one another.
Then we went on in episodes two and three and discussed how burnout sometimes becomes identity dissonance, why physicians stay trapped in painful systems, and then last episode we talked about how effort justification, sunk cost fallacy, and martyrdom culture all contribute to our chronic suffering.
So long story short, it's not you, it's that we're human beings and this just is something that we are all prone to. But until you have awareness of it, it's hard to do anything about it. It's just easier to stay stuck. So today we're talking about something more practical, thank goodness, how physicians cope with cognitive dissonance in everyday life because what happens when you get the awareness?
Well, now you're onto yourself and the brain still has the problem of needing relief. So physicians, like all human beings, that's what we don't give ourselves credit for is like, we're human so it's normal that we're gonna act like a human being. We develop strategies that reduce that discomfort. Some of them help long-term.
Others, the ones that tend to be easier for us, relieve the discomfort temporarily but worsen the burnout over time. So today we're gonna discuss the unhealthy ways that most of us reduce dissonance, why emotional suppression and comparison end up being so common in medicine, but then we'll end with healthier ways that physicians can move towards psychological alignment instead of staying in that chronic survival mode.
Okay, so let's start with the unhealthy ways physicians reduce the cognitive dissonance. So once again, reminder, we are all humans, and naturally we want relief from this psychological discomfort. Nobody loves to sit in discomfort for very long. So when physicians especially experience conflict between values and behavior, identity and reality, exhaustion and expectations, personal need versus professional culture, the brain automatically tries to reduce the tension.
And the important thing to understand is many coping strategies are actually not a sign of weakness, they're just ways that we self-protect. It's just our go-to. And the problem is that some strategies reduce discomfort short-term, while actually worsening the suffering long-term.
So rationalization, this is one of the most common dissonance reducers. Like any of these sound familiar? "Oh, this is just medicine. This is what I signed up for. Everyone feels this way. Oh, I'll rest at the end of this month when the partner comes back or when we're not so short," right? "Once staffing improves, things will get better."
Why do we say this every month forever and ever, amen? This was on repeat. Or maybe I'm just being responsible. So some of these statements don't sound bad. They actually contain some truth, but they may also function psychologically to avoid confronting what this really is — this is not a sustainable way of life.
So, for example, the chart-checking physician, a physician that repeatedly checks charts from home, partly because they care, but partly because uncertainty is very uncomfortable. And instead of acknowledging, "Wow, I'm struggling to mentally disengage when I get home or when I leave work," the brain reframes the behavior as, "I'm just being thorough," right?
"I just don't wanna miss anything." Sounds noble, huh? This reduces the discomfort immediately, but it does not address the underlying anxiety or the uncertainty. Or how about this one? The overworker and hyper producer. Many physicians cope with internal discomfort by becoming more productive. Why?
Because productivity temporarily restores identity, something that is very secure when it's wrapped up in being a physician. If a physician may feel, "I'm not enough," achievement temporarily quiets that discomfort. This is why burned-out physicians often pick up more shifts, say yes to a committee, over-commit, or become compulsively productive.
And externally, this doesn't seem bad, may even seem admirable, but internally, it's actually fear-driven. Or how about outside of medicine? Think about someone you know that might be going through a painful divorce and who suddenly throws themselves completely into work. Why? Because work becomes emotionally protective, and busyness means that you're not gonna be still or alone with your thoughts.
And so humans often use productivity to avoid emotional discomfort, and we're especially vulnerable to this because medicine also rewards over-functioning. They prey upon our over-functioning tendencies, actually. Okay, let's talk about emotional numbing and buffering. Some physicians reduce dissonance through a couple bottles of wine, maybe going to the bar after the night shift with the rest of the staff.
Maybe you get home and you just overeat, and what are you gonna grab for? Comfort food. You're just gonna grab whatever's easy and can give you some good serotonin and dopamine. Or maybe you start scrolling on your phone, or maybe you shop compulsively, or maybe you just withdraw altogether, like just totally disconnect from the neck down.
All of these, binge-watching, excessively distracting, this is not that you're weak as a person. It's just the brain naturally seeking relief from this chronic emotional tension. So this is important. Many unhealthy coping mechanisms begin actually as adaptive strategies. Like we said, it's an opportunity to self-protect, and the physician who emotionally shuts down may once have needed that skill to survive either residency, med school, or maybe a hard time growing up in life, or maybe repeated trauma, right, from your family of origin or wherever you came from.
But coping strategies that help short-term can become harmful when they become chronic ways of living.
This, let's never revisit this topic again. This is entirely too painful. We're reading everyone's mail, so welcome to the family. So some other unhealthy ways of coping with this include learning how to override ourselves. So let's talk about emotional suppression and comparison. Emotional suppression, this is when we disconnect from our own emotional signals.
A lot of messages that we absorb include, like, just put your head down, push through, keep functioning, get those five stars, don't fall apart. What about the patients? The patients need you. God, this one is triggering for me at this stage of my life. Mm-hmm. What about them? How about appropriate staffing?
How about making this sustainable? Yeah, anyway the angry part of me is coming out. Or just handle it, right? Temporary compartmentalization can absolutely be useful in emergencies. The problem happens when temporary suppression becomes permanent self-disconnection, and I've been there.
You couldn't tell me what's going on in my body. Suppression is not the same thing as processing because unfortunately, those emotions still exist. They're just pushed way down, and your body is still carrying that stress. Well, why would we do that? Because it does temporarily reduce the dissonance. So imagine a physician who believes, "I'm competent, resilient, I'm capable.
That's my identity." But internally, they're getting the sneaking suspicion that they're feeling overwhelmed or traumatized or emotionally exhausted, anxious even, or numb. This creates a disconnect between, "I should be okay, I'm resilient, I'm tough," and turns out reality suggests I'm not okay.
So actually allowing themselves to feel the distress fully would force a reckoning. It would force confrontation with painful inconsistencies in their life or even their identity. So suppression, you can see how that works for us temporarily, not because the conflict disappears, but because it becomes muted.
It becomes dulled, and then in that way, we can disconnect from our grief, our fear, our vulnerability. Like, God forbid a doctor be vulnerable. It disconnects us from our exhaustion, our resentment, or our sadness, because we should be grateful, right? The volume gets turned down on this disconnect. So a physician example would be the, "Oh, you know, I'm fine."
So a physician experiences repeated trauma, impossible workloads, angry patients, moral injury, chronic uncertainty, which is basically the job description. But instead of acknowledging that distress, they say, "I'm fine. This is normal. Other doctors have it worse," right? Like it's easier to be toxically positive. Meanwhile, the reality is we're emotionally detached at home, we're snapping at family, we cannot relax to save our lives. We are chronically hypervigilant or we start feeling numb. Many of us will start saying later, once we get some perspective, like, "I didn't even realize that I was burned out," because that suppression delays the conscious awareness of it.
It's going on under the surface, but we keep it under the surface. So that's one way we emotionally suppress. But then here's an interesting one. The idea that we use social comparison as a way to relieve the tension. This was another theory developed by Festinger actually, and it's that humans naturally evaluate themselves by using others to either raise our sense of wellbeing or elevate others.
Let me just get into the meat of it because it will make more sense when we start talking about examples. So especially when objective standards are unclear, questions like, am I successful enough? Am I a good enough doctor? Am I coping well enough? Am I handling life correctly? They don't have clear answers, or at least a lot of us aren't able to tap into our own internal North Star, and so then we start looking sideways.
So medicine creates endless opportunities for this. We compare each other's productivity, our views, how we're doing as parents, you know, what school we've got our kid in, how our kids are doing, publications, maybe our emotional resilience. Maybe we compare our own fitness compared to somebody else, or schedules, or charting speed, or career advancements.
There's just endless opportunities if you're not quite sure what you think about yourself. Comparing yourself in any way to something outside of yourself becomes like, okay, well let's just check in. So this might not be readily apparent why this would relieve dissonance, but think about when a physician thinks everyone else seems to be handling this.
This creates a painful tension of why can't I? So that discomfort can drive a physician towards, ah, well, I can fix that. I can overwork. I can become a super perfectionist and make myself exceptionally miserable. We can do more suppression. We could do more self-criticism. And in that way, the dissonance drives more productivity.
And if you are somebody whose identity is related to your productivity, that works for you. But comparison can also reduce dissonance. For example, well, this is just medicine. Everyone I know is miserable. And then in that way, it becomes less personally threatening because it seems universal. So comparison can either amplify dissonance and drive behaviors, or it can normalize it enough to tolerate it.
It all depends on whatever meaning you attach to your comparison. But then this is something interesting to think about as well. We know that sometimes kids will internalize there's something wrong with me because it feels safer than believing your parents or the world are unsafe. But what if some of us are doing this with medicine?
What if some of us are internalizing there's something wrong with me because it feels easier than believing there's something wrong with the system you dedicated your life to? And again, I hate this episode series. Okay, so let's lighten it up. We're bread-pulling you now, people. Yes. Do not get me started.
Luckily this is the last of this series. We will start revisiting some lighter topics hopefully next one. So let's talk about social media, because this is a super easy example of social comparison. So you open up your Instagram and you see another physician who is a famous influencer.
They're working full time, they're incredibly fit, they're publishing, they're raising perfect children, they're meal prepping each week, and somehow they're totally emotionally regulated. And now you're comparison-ing it to your own hot mess that you're existing in. But just know that you're comparing yourself to somebody's carefully curated external presentation. When you do that, your internal thoughts will come up like, "Why can't I handle a life like that?
Everyone else seems more capable. Maybe I'm the problem." And that creates an enormous tension between I should be functioning better. Remember, should is just could with a massive helping of shame or judgment attached to it. So I should be functioning, but the reality is I am overwhelmed. So just know that humans compare their internal struggles to other people's visible highlights.
You never know what's going on inside somebody's head or inside their homes. We rarely see other colleagues crying or lying awake anxious. We rarely see others fighting with their spouses, questioning themselves, or struggling privately. And so many physicians assume everyone else is doing better than I am.
That's not helpful, and it's psychologically exhausting. So not every coping strategy reduces cognitive dissonance in exactly the same way. So we've talked about some. Some strategies like rationalization reduce discomfort by changing the story you're telling about your situation.
Others, like overworking, reduce the discomfort by restoring a temporary sense of competence or control. Like you're taking back the reins because you're overworking and now you're back in control, right? Emotional suppression and comparison work a little differently. Suppression reduces the dissonance by reducing your conscious awareness that there's a problem.
And then comparison helps physicians determine what does this even mean? So it's looking outside of yourself for some sort of explanation. And you might come back with, "I'm failing, so I better double down," or, "I'm failing, but at least the system is still valid. I'm failing, but so is everything else." And so in that way, you might start telling yourself, "This is totally normal.
Everyone else is going through the same thing, so this is fine." Okay. Well, there are some healthy ways that we physicians can resolve our cognitive dissonance. And just remember, paying attention to that feeling of dissonance might be helpful.
Like just noticing the signals. I think I get a kind of sick feeling in my gut is what it is. That's not a problem, that can actually be useful. It's the signal that something feels out of alignment. And a goal might be not perfection, not endless toxic positivity, and not eliminating difficult emotions.
A healthy goal might be just learning to increase the alignment between our values and our behaviors, our emotional reality and our identity. What is it that really matters to me, and am I investing time in that every day? Versus what does not matter to me, how much time am I investing in that? So being truly emotionally honest can be a healthy way for us to learn to navigate these waters of cognitive dissonance.
A healthy response to that feeling of, "Ugh, this just isn't quite right," or, "This is not adding up," or, "This is not what I signed up for," is some honest self-awareness. And we don't ever want to tell you to say, "I shouldn't feel this way." Instead, maybe look at that thought and say, "There's something about this situation that deserves attention."
And what that does is helps us to shift into problem-solving mode, helps us be open to solutions that might not otherwise be available to us if we just tell ourselves we shouldn't feel this way, nose to the grindstone, and just keep working. If we're shaming ourselves for, quote, "feeling ungrateful" or for questioning what we've been through and continue to endure, then we're gonna close ourselves off to solutions.
And some solutions are out there that will work for us, for the patients, and for the system at large. Here's an example. Say there's a doctor who has been trying to look high-functioning but has just been really suffering, and they decide to make some changes, and they start resting intentionally, really reducing unnecessary chart checking if they're a chart checker, or if they're an over-charter, they decide to do some B-minus charts, just testing it out, feeling the discomfort of having one B-minus chart and realizing you didn't die.
Setting some boundaries. "I'm not gonna take work calls at home. I'm not going to respond to text messages about work after 6:00 p.m."
Reconnecting intentionally with their relationships and really learning to pay attention to their emotions and being honest about where those emotions are coming from. This feels uncomfortable at first, and that is actually a sign we're doing it right because we're overcoming some of these neural pathways that have been rutted into our brains and nervous systems for sometimes decades.
And our brains and nervous systems really think they are important to our survival, so they're going to try to throw up red flags when we try to make change. We're not in danger. Healthy behavior is gonna create more dissonance with that old conditioning that we've adapted and adopted and been operating from.
It's like an old operating system. We're just trying to update the operating system. That old identity may still believe that rest is laziness, or that boundaries are selfish, or that good doctors always give more and more and more, no matter what the cost.
And when we start to make change, we can create some evidence that that is not the case. Self-compassion. Many, many, many, many doctors speak to themselves in ways they would never speak to anyone they cared about. They would never speak to a colleague or a patient or a loved one that way. Developing self-compassion is so important to our wellbeing, and it does not mean that we lower our standards or that we have self-pity or that we avoid accountability.
It means that we respond to suffering with humanity instead of contempt, and that includes our own suffering. That includes our own suffering. And here's the reality, our own ability to be compassionate for others is limited when we are not compassionate with ourselves. When we treat ourselves with contempt, we are likely gonna treat other people with contempt.
I personally do not wanna be a person of contempt, so practicing self-compassion is a worthwhile exercise. Research from self-compassion researcher Dr. Kristin Neff shows that self-compassion is associated with resilience, emotional regulation, lower burnout, and healthier motivation. Healthier motivation, like we're doing things because they align with our values, not because we're trying to avoid punishment. One of the healthiest psychological skills we can develop is learning to tolerate conflicting truths.
We were trained up in a system that was very black and white, sick or not sick, bad or good, competent or not competent. And a healthier, more mature way of approaching life is a little more nuanced. The truth is that doctors can love medicine and resent parts of it. We can feel grateful, and we can feel exhausted.
We can care deeply, and we need boundaries. We can be competent and need support. Psychological suffering really increases when people believe they're only allowed to feel one thing, and that is the water we swam in for so long. There is a different way. There is a better way. So here's an example.
If you're only allowed one either/or, then no wonder you're digging in, rather than sitting in complexity. So here's an example. A more integrated or nuanced physician might think, "I care deeply about my patients, and I also need recovery. And going even further, my recovery actually helps me care for my patients more.
I can be committed without abandoning myself. My worth is not dependent on constant productivity." Thinking this way, in this more nuanced, more integrated way, creates so much less internal conflict than this perfectionistic thinking that so many of us came up using and creating a lifestyle and identity around.
So we're gonna talk about a little actionable exercise we can try. This is our alignment inventory. While you're listening here, I want you to think about these topics and rate them. Work, relationships, physical health, emotional wellbeing, integrity, alignment. Ask yourself, where does my current life feel most out of alignment?
I'll do those categories again. Work, relationships, physical health, emotional well-being, or integrity alignment. What discomfort have I been trying to avoid? What coping strategies am I relying on most heavily? Is it overwork? Is it Halloween candy and TV till 4:00 in the morning when you get home from work?
Is it a stop at Taco Bell? All the Real Housewives? Is it a couple bottles of wine? These feel oddly specific, Laura. Okay. Maybe, maybe it's scrolling, maybe it's anger. What is it that I'm doing that is a strategy that helps in the moment but hurts long term?
Again, we invite you to approach this exercise with curiosity instead of judgment. When we judge ourselves, we feel unsafe and we shut down, and we are not open to solutions. There is nothing wrong or bad about what we're doing. We just wanna know, is it getting us where we want to go? Are we on the right boat?
Are we on the right plane? Are we heading to Hawaii or are we heading to North Korea? No judgment about the people on either plane, just where do you want to go? So if this feels like a heavy exercise or you'd like some help walking through it, we love doing this with our clients. We're happy to do it for any physician who wants to meet with us for a free session.
We can definitely help get some clarification around that. That's totally free. There will be a link in the show notes for how to get a physician wellness triage session with one of us so that we can help you get some clarification on these things and make sure that you're on the right mode of transportation, heading in the right direction for where you actually wanna go in this one beautiful, amazing life that you have. Yes.
And remember, cognitive dissonance is not proof you're failing. Don't muster up all that evidence as proof that you're a failure. That's not what this is about. It's just the first sign that part of you recognizes something important that needs attention, and that's information we talk about all the time.
Great, that's data. Now we have information or data, and now we get to choose. And many physicians aren't burned out because we're not resilient. We argue that all the time. Resiliency is not in question here. We have proved ourselves resilient after everything we go through just to get to the spot that you're at.
But we're burned out because we've spent so many years, A, suppressing our emotions, B, comparing ourselves relentlessly, C, overriding our own internal needs because that's the way we were taught, and continuing to try to survive these impossible standards. So often, healing begins the moment we stop automatically defending our lives long enough to honestly examine whether the way we're living is truly sustainable.
And we'll leave you with that. So thanks for joining us today, friends. If you found this conversation helpful, the best way to support us is to subscribe, so click the button now and leave a rating and review because it helps other physicians find this podcast, and it moves us up on the list. And if you do leave a review, take a quick screenshot and email it over to us at [email protected], and we will send you a free e-book on emotional regulation, which happens to be one of our most requested and impactful topics.
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