Cognitive dissonance is the stress created by experiencing inconsistent or conflicting thoughts, beliefs, or values. The term popped into my head recently at a local meeting of nurse practitioners (NPs). Like many of you, one of the things I have missed due to pandemic restrictions has been the opportunity to network with colleagues. Thus, I quickly accepted an invitation to a relatively small gathering of nurse practitioners that was held courtesy of a pharmaceutical sponsor.

I arrived at our meeting site, an upscale steakhouse, in time to say hello to people I haven't seen in many months. After chatting, we followed the usual procedures for these types of meetings by signing in and stating our preference for red or white wine. We sat down to hear a presentation on a new medication to manage cholesterol, featuring a very personable local speaker.

My inner conflict started almost immediately. The menu included bread for the table, an appetizer, a soup/salad course, a main course with side dishes, and dessert. We're all familiar with these events. Often the main course does not arrive until the speaker has finished. It can be a late evening and there is a lot of food. I used to attend these meetings and become very stressed about the need to avoid overeating. Now I arrive with my carry out bag in hand, because I've learned that if I don't, I'll either waste a lot of food or I'll be there until the take-out boxes arrive at 8:30 or 9:00 p.m., when I'd rather be in my pajamas.

This meal followed the usual format. We were shown a menu and asked to select a soup/salad course and an entree. Everything else was preselected for our group. Upon looking at the menu, I noted that the salad course included options of iceberg wedge with bacon, Caesar salad, or creamy lobster bisque. I could feel the cognitive dissonance setting in. I thought, "What drug are we talking about again?" The soup sounded too heavy and I don't eat bacon bits, so ordered the Caesar salad.

Some time passed and our salad course arrived. As expected, the bisque was in a heavy cream. The Caesar salad I'd ordered hadn't been merely kissed with shaved parmesan, it had a three-ounce block of cheese placed right on top. I reminded myself that parmesan is relatively low in fat compared with other cheeses. Then diners who had ordered the iceberg wedge received their salads. The wedge of lettuce was covered in a thick dressing and had two strips of bacon laid against one side. That's right. Two. Strips. Of. Bacon. On a salad. What drug are we talking about again?

The opposite of dissonance is consonance. I have colleagues who decline all invitations such as the one above due to their concerns about undue influence, or the risk of it, on us as ordering providers. I can understand that. Menu aside, these nurse practitioners are trying to create consonance between their beliefs and their practices. Being thoughtful enough to question standard industry practices and to make a consequential decision about their own behavior is laudable. Although not everyone experiences these events as a direct conflict, it's easy to understand why some do.

Since January 2020, we have all tried to receive and process large amounts of information about a very infectious virus that created a worldwide pandemic. For various reasons, many of us have experienced dissonance about the information received. This includes differences in information conveyed from many different sources as well as the dissonance between this information and what we are seeing and experiencing in practice and in our communities. As clinicians and writers, we must not only make an ongoing attempt to reconcile these disparate realities and to seek consonance, we must also help and assure our patients so that they may do the same.

Cognitive dissonance serves a purpose. It alerts us to something that needs to be reconciled. We can apply it to our science. Is our choice of topic in line with current and emerging information? Are our findings consonant with other research? Are we helping to change practice in a way that is moving us forward to a model of wellness that makes more sense? These questions warrant serious consideration. In other words, they are food for thought.