EP438: Recognizing Cognitive Dissonance and Thinking About How to Overcome It When in the Belly of the Beast, With John Lee, MD

Cognitive dissonance — acting in ways that conflict with your own stated beliefs, or holding two contradictory beliefs at once — is harder to sustain the closer you are to patients, which is probably why moral injury and burnout hit bedside clinicians hardest. John Lee, MD, a practicing emergency physician and clinical informaticist who has served as chief medical information officer at multiple organizations, joins Stacey Richter to talk about what to actually do when you're working inside a large healthcare organization — the "belly of the beast" — and recognize dissonance between what the system does and what you believe good care should look like.

WHAT YOU'LL LEARN

✅ Why cognitive dissonance gets easier to sustain the further you are from the exam room, and harder to ignore the closer you get to patients

✅ Why celebrating small wins and acknowledging that you can't fix everything is not a consolation prize, but an actual strategy for surviving inside an imperfect system

✅ Why toxic culture and cognitive dissonance are connected — you can't credibly champion team-based care while tolerating cruelty toward the people on your own team

✅ Why a hierarchical healthcare structure works against the kind of incremental, collaborative improvement that reduces dissonance over time

✅ Why finding like-minded colleagues as a sounding board and support network is Dr. Lee's central piece of advice for anyone trying to do right by patients inside a large, imperfect organization

WHY THIS MATTERS

Almost everyone working in healthcare today is operating somewhere inside a system with real, uncomfortable contradictions between mission and margin — and waiting for a fully rebuilt system before acting on that discomfort isn't a realistic option. The alternative isn't denial or resignation; it's honestly naming the dissonance, focusing on the incremental improvements actually within your control, and building a support network of people who see the same problems you do. For clinicians and leaders alike, that combination is what makes it possible to keep doing meaningful work inside a system that will not be perfect anytime soon.

MENTIONED IN THIS EPISODE

Encore! EP391 with Scott Conard, MD: Apple Podcasts | Spotify | Other Apps

EP421 with Jodilyn Owen: Apple Podcasts | Spotify | Other Apps

EP415 with Rob Andrews: Apple Podcasts | Spotify | Other Apps

Encore! EP326 with Rishi Wadhera, MD, MPP: Apple Podcasts | Spotify | Other Apps

EP430 with Barbara Wachsman: Apple Podcasts | Spotify | Other Apps

EP431 with Kenny Cole, MD: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

07:37 What is cognitive dissonance relative to the healthcare industry?

08:57 What are the systems that start to bear down on individuals within the healthcare system?

10:14 Encore! EP391 with Scott Conard, MD.

10:48 EP421 with Jodilyn Owen.

10:59 EP415 with Rob Andrews.

12:30 Encore! EP326 with Rishi Wadhera, MD, MPP.

13:10 "The system has almost gamed them."

17:49 EP430 with Barbara Wachsman.

19:07 How can alignment still be achieved in the face of cognitive dissonance?

20:34 EP431 with Kenny Cole, MD.

24:06 Why does it take more than one person to solve the dysfunction in the healthcare system?

26:26 What are some little changes that can help change the cognitive dissonance in healthcare?

28:22 Why is a hierarchal healthcare structure not necessarily beneficial?

30:38 The RaDonda Vaught story.

37:58 "Be happy in the small things."