The definition of cognitive dissonance is a feeling of mental discomfort when one holds contradictory beliefs, attitudes, or values. As physicians navigate the complex waters of medical practice, the core philosophy of patient-centered care often clashes with external pressures imposed by a system that prioritizes profitability. This cognitive dissonance is considered a major factor in physician burnout.

While there are systemic factors that need to be addressed to resolve the growing dissonance among clinicians, I think all of us need to develop our own strategies to minimize it.

The basic principle of combating cognitive dissonance is to remember that your foremost allegiance is to the patient before you, but some other actions to consider may be the following:

• Create note templates that tell the truth in terms of what you do most of the time instead of checking off boxes dictated by coders. For example, if you do not routinely examine a part of the body, do not include it in the physical examination. At the same time, ensure that you include everything you actually do, including the extra questions in history, examination findings, and diagnoses not covered in the template.
• Resist the impulse to overstate the time spent to increase the level of billing.
• Familiarize yourself with procedural costs for diagnostic and therapeutic interventions for key insurance carriers and keep the out-of-pocket costs to patients in mind while discussing their treatment plans.
• Periodically examine your motivation behind your actions, especially in terms of ordering tests and prescribing newer, expensive medications.
• Complete tasks delegated to you by the hospital system with respect to documentation, billing, and coding as soon as possible and then forget about them. It is irksome to get notifications from nonmedical staff regarding your work, so it is best to deal with it right away and not think about it further.
• Do not promise what you cannot deliver, even if you want to. For instance, do not give a patient an expectation of receiving a reply to a patient portal message within 24 hours if that is not possible within your practice setting. As a corollary, deliver what you promise, even if it means spending extra time.
• Learn from your colleagues but do not try to copy their practice styles if they do not resonate with you.
• If you have had a stressful day with multiple challenges to your belief system, try journaling or writing about your experience in some form—it can be cathartic and reaffirm your belief in your own values.
• When you agree to take on extra work, really examine your motivation behind it. In productivity-based models, it is easy to accept excessive workload even when you know you are exceeding your capacity.

The last strategy that works for me (but may not be feasible for everyone) is to skip attendance at meetings that focus on discussions of profitability. It helps minimize the dissonance between interpreting medicine as an art and science versus interpreting medicine as a business.

As I wrap up another clinic day, my nurse comes to inform me that one of my patients passed away recently and that his wife called to thank my team for having given him three meaningful years. This expression of gratitude is the best antidote for the cognitive dissonance I have faced throughout the day and will find a place in my journal tonight.

Shuchita Gupta is a cardiologist.