Thread by @Dave_it_up

When the Mind Shuts the Door: How Cognitive Dissonance Keeps Doctors from Seeing Long COVID

In the field of psychology, cognitive dissonance refers to the mental discomfort experienced when someone holds two or more conflicting beliefs, values, or attitudes. In medicine, this phenomenon often arises when new evidence challenges long-standing practices. Instead of adapting, some doctors experience discomfort, leading them to downplay or reject new information to maintain their sense of consistency. As psychologist Leon Festinger, who developed the theory of cognitive dissonance, once said: “A man with a conviction is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources.”

This resistance to change has occurred throughout the history of medicine, from dismissing the importance of handwashing to ignoring the dangers of smoking. Today, we see the same dissonance with Long COVID. Many doctors are reluctant to fully recognize the long-term impacts of COVID-19, despite overwhelming evidence and patient reports. As cognitive dissonance prevents doctors from accepting new realities, millions of patients are left without the care they desperately need.

Historical Resistance in Medicine

One of the earliest examples of cognitive dissonance in the medical community was the resistance to hand hygiene in the mid-nineteenth century. Ignaz Semmelweis, a Hungarian physician, discovered that requiring doctors to wash their hands between patients dramatically reduced infections and deaths in hospitals. Yet, the medical community at large rejected his findings because it implied that doctors were responsible for spreading disease—a concept that clashed with their perception of themselves as healers. It wasn’t until decades later, with the widespread acceptance of germ theory, that handwashing became standard practice in hospitals.

Similarly, when Louis Pasteur and Robert Koch developed germ theory, it met with significant skepticism. At the time, the dominant belief was that diseases were caused by “miasma” or bad air. Doctors resisted abandoning this familiar theory, even as new evidence showed that microorganisms were responsible for illnesses.

In the 1980s, cognitive dissonance surfaced again during the early stages of the HIV/AIDS epidemic. Initially, the medical community viewed the disease as limited to certain marginalized populations, and many were slow to recognize the growing evidence that it was a much broader public health issue. The bias of previous experience and reluctance to confront new evidence delayed effective treatment and public health responses, just as it had in the past.

Modern Examples of Cognitive Dissonance

Even within the past 40 years, cognitive dissonance has continued to shape medical responses. One striking example is the slow acceptance of the bacterial cause of stomach ulcers. For decades, stress and spicy food were blamed for ulcers, even as mounting evidence suggested otherwise. When Australian scientist Barry Marshall demonstrated that Helicobacter pylori bacteria were the real cause, his findings were initially ignored. Marshall even resorted to infecting himself with the bacteria and developing ulcers to prove his point. Still, it took years for the medical community to shift its thinking and change treatment protocols.

The opioid crisis is another clear example. For years, pharmaceutical companies promoted opioids as safe and non-addictive, despite early warning signs of widespread addiction. Cognitive dissonance prevented many doctors from altering their prescribing habits, even as evidence mounted that overprescription was contributing to the crisis. The delay in adapting to new realities contributed to the devastating public health consequences we’re still dealing with today.

A more recent example is the shift in understanding the role of dietary fat and sugar in heart disease. For decades, the medical community emphasized low-fat diets, even as research increasingly showed that refined carbohydrates and sugar were the real culprits. The persistence of the low-fat narrative illustrates how hard it is to shake entrenched ideas, especially when they have shaped public health guidelines for years.

Long COVID: The New Frontier of Cognitive Dissonance

Now, we see cognitive dissonance at work again with Long COVID. Despite increasing evidence that COVID-19 can cause long-term symptoms—ranging from chronic fatigue and brain damage to cardiovascular and neurological issues—many doctors are reluctant to fully acknowledge its existence or scale. This dissonance arises from several factors.

First, doctors are trained to view viral infections as acute illnesses with clear beginnings and endings. The idea that a virus can trigger long-term, debilitating symptoms does not fit this framework, creating discomfort for many clinicians. It’s easier to dismiss or downplay Long COVID than to confront the possibility that SARS-CoV-2 may behave differently than other viruses.

Additionally, cognitive dissonance stems from previous experience with viruses. Many doctors didn’t observe long-term complications from previous viral outbreaks, such as SARS or MERS, leading them to assume that COVID-19 would follow a similar course. This bias towards established beliefs makes it difficult for some to accept the growing evidence that COVID-19 may have lasting effects on a significant number of patients.

There’s also a systemic element. Recognizing the scale of Long COVID would require healthcare systems to make significant changes, from allocating more resources to chronic care to investing in long-term research. Admitting the severity of Long COVID would necessitate a major overhaul of healthcare practices, which many find daunting. Instead of pushing for these changes, many doctors are minimizing the issue to avoid confronting the discomfort that comes with acknowledging such a widespread problem.

Overcoming Cognitive Dissonance in Medicine

Breaking the cycle of cognitive dissonance in the medical community is crucial for progress. Overcoming this resistance requires education, empathy, and systemic reform.

First, doctors must be willing to adapt their understanding as new evidence emerges. Continuing medical education programs should emphasize the importance of flexibility and adaptability in the face of evolving scientific knowledge. Training that teaches clinicians to challenge their own assumptions is key to overcoming cognitive dissonance.

Empathy also plays a critical role. Doctors need to listen to patients’ experiences and recognize that symptoms like those reported by Long COVID sufferers may not fit into traditional diagnostic frameworks. Patient-reported outcomes can offer valuable insights, even if they aren’t fully captured by clinical tests. Listening to patients with an open mind can help bridge the gap between new realities and outdated practices.

Finally, the healthcare system needs to be more agile. We need systems that respond more quickly to emerging evidence, update guidelines in real time, and ensure that resources are available for long-term research. Without these changes, cognitive dissonance will continue to hold back progress, and patients will suffer the consequences.

Cognitive dissonance has long been a barrier to progress in medicine. From rejecting handwashing in the nineteenth century to delaying responses to the opioid crisis in the twenty-first, this resistance to change has caused harm. Today, Long COVID is the latest frontier where cognitive dissonance is holding doctors back. By understanding the roots of this resistance and addressing it head-on through education, empathy, and systemic reform, we can begin to make progress in treating the millions of patients suffering from this complex condition. As we’ve seen throughout history, overcoming cognitive dissonance is the first step toward true medical progress.