I first noticed this phenomenon while watching the world news on a weekday after work. It was a commercial for a new diabetes medicine that showed overweight people dancing at a barbecue, cooking and enjoying life. How different this was from my day in the wound clinic, where I saw patient after patient with obesity, diabetes, and nonhealing wounds, as well as other dire medical complications.
So I tucked this image in the back of my mind until another commercial caught my attention. As a litany of side effects was delivered, I heard the words “sudden death” while the TV screen lingered over a young couple enjoying a walk on the beach. The contradiction troubled me, and I started to pay more attention to the images conveyed in the direct-to-consumer (DTC) pharmaceutical commercials that flood the airways.
Every one of these commercials has the FDA requirement of revealing side effects, and the list seems to go on forever. This list is usually delivered by an off-screen voice while visual images 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 unrealistic expectations that modern medicine can transform disease and death into a pleasant and aesthetically pleasing experience, and perhaps banish them entirely. False expectations indeed, as anyone who works with aging, disease, and death can tell you.
These unrealistic expectations collide with reality when people experience the raw truth of illness, aging, and the processes of dying. The result of the collision is battles played out daily across the nation in hospitals, nursing homes, and doctor’s offices. When slick images collide with reality, the discomfort of internal contradiction takes over, which is translated into anger and blame, with the health care system at fault for not living up to expectations. Psychologists call this phenomenon “cognitive dissonance.” Many of these cases end up in court — in front of juries indoctrinated by the same commercials, which stacks the decks 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. Dealing with unrealistic expectations is an integral component of many patient encounters, and translates into hours of discussions with patients and families regarding the realities of aging and death. It’s an exhausting, unending process and an uphill battle, particularly when families return home and turn on their TV sets.
Image credit: Jeffrey Levine