I recently experienced the phenomenon of cognitive dissonance during a commercial on the evening world news. It was an advertisement promoting a diabetes medicine that showed people with diabetes at a barbecue, cooking and dancing. How different this was from my day in the wound clinic where I saw patient after patient with obesity and diabetes suffering from nonhealing wounds and other complications.
So I tucked this into the back of my mind until another commercial caught my attention. As a litany of awful side effects was delivered by an offscreen announcer, the scene on TV lingered over a young couple enjoying a walk on the beach. The contradictions troubled me, and I started to pay more attention to images conveyed in direct-to-consumer (DTC) pharmaceutical commercials that flood the airways.
Every pharmaceutical commercials has the FDA requirement of revealing side effects, and the list seems to go on forever. This list is delivered by an unseen announcer while scenes of sunsets, parties, and genial family get-togethers are depicted. How does this impact the image of disease in the mind of the public, most of whom are unfamiliar with the true, harsh reality? I believe the juxtaposition results in the unrealistic expectation that modern medicine can transform illness into a pleasant and aesthetically pleasing experience, and perhaps banish it entirely. False expectations indeed – as anyone who works with aging, disease, and end-of-life issues can tell you.
Unrealistic expectations collide with reality when the real world of illness and aging arrives. The images absorbed in front of the television set just don’t jive with what happens in the ICU or rehab unit. When slick images collide with reality, the discomfort of internal contradiction takes over, which sometimes translates into anger and blame – with the healthcare system at fault for not living up to expectations.
Psychologists call this inconsistency between personal expectations and reality “cognitive dissonance.” The anger leads many of these cases to court – in front of juries indoctrinated by the same commercials, which stacks the deck against caregivers.
The advertising industry – not known for its scruples or morality – has flooded us with false images that set the stage for a battleground at the bedside. For geriatricians, dealing with unrealistic expectations is an integral component of many encounters, and translates into hours of discussions with patients and families regarding the realities of aging and death. It can be an exhausting process and an uphill battle, particularly when families return home and turn on their TV sets.
Unfortunately, many caregivers are either untrained or do not have the time to enter into discussions regarding the realities of illness, death, and dying. In bypassing this opportunity, they unwittingly play into false expectations delivered through the airwaves. Geriatricians and palliative care specialists fill in part of the gap, but many opportunities are missed. It’s time for medical schools across the country to recognize the problem and rise to the occasion to train all physicians, regardless of specialty, to educate their patients on realistic expectations of aging, disease, and death.
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