Neurodiversity in medicine

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Autism care professional Aiyana Bailin explains in Scientific American that valuing neurological differences doesn't mean denying the reality of disabilities, "but we also don't assume that neurological and behavioral differences are always problems."

For example, Vassel says, hypersensitivity can make working in a hospital overwhelming, especially for trainees encountering death for the first time. But the same trait helps her connect and build trust with patients quickly.

"What I used to think was weird, I now think of as what makes me different, unique, and in some ways, what I'm good at," Vassel says. She only started feeling comfortable describing herself as neurodivergent a few months ago.

Although the neurodiversity movement has gained mainstream traction and made inroads in medical circles in recent years, medicine has been slow to acknowledge or accommodate neurodivergence within its ranks.

Exact numbers of neurodivergent doctors are unknown and studies on neurodiversity in medicine are mostly small, qualitative, and focused on autism.

Shane Neilson, an assistant clinical professor of family medicine at McMaster University, argues in Canadian Family Physician that neurodivergence may be under-identified in physicians precisely because medicine filters for "high-functioning, intelligent, and conscientious" people whose strengths may mask difficulties.

Meanwhile, Neilson notes, "intense internalized stigma due to professionalism norms discourages anyone from seeking help or accommodation."

According to an editorial in the British Journal of General Practice, many neurodivergent doctors may remain undiagnosed and undercover for fear of workplace discrimination.

However, a growing community of autistic doctors is challenging the notion that neurodivergence is incompatible with a medical career.

Mary Doherty, an Irish consultant anesthetist, discovered she was autistic in her mid-forties. In 2019, she founded Autistic Doctors International, a peer-support and advocacy group, because she was "craving autistic peers in medicine." The group now has nearly 1,000 members, including Canadians like Vassel.

"We all thought we were alone," says Doherty. "Just to be able to come together with a group of people who understand has been phenomenal."

Most of the group members don't fit the category of "doctors in difficulty," though many have experienced challenges at work, usually related to fitting in with colleagues or organizational hierarchy, rather than patient care.

Doherty says it's a "huge loss" for medicine to overlook neurodiversity as an asset to the profession and reject people over things like social awkwardness or lack of eye contact, for example.

"I mean, medicine selects for autistic traits," she says. "Perfectionism, attention to detail, that dogged determination to stick with an idea until it gets resolved, work ethic, loyalty, honesty."

Embracing neurodiversity in medicine could also bring greater understanding and empathy for neurodivergent patients, writes Georgina Taylor in the Australian Journal of General Practice.

Keeping up appearances can be exhausting, says Josée, a forensic pathology resident. Josée says that specializing in pathology, where she can work at her own speed, allowed her to "survive and also thrive."

"I get to be myself when I'm working on my own," she explains. "It allows your brain to think about other things when you don't have to think, "Did I say hi properly to this person this morning? Did I ask enough questions about them?'"

Emerging evidence has linked masking with increased anxiety, depression and suicidal thoughts and behaviors.

According to Shirley Moore and colleagues from the Doctors' Support Network, a U.K. peer-support group, the full toll of masking may only become apparent when a physician reaches a breaking point, "sometimes catastrophically, in the form of a meltdown."

Yet, dropping the mask can be risky, too. "Different learning needs are often overlooked and those who do not fit with society might find themselves undermined or scapegoated," Moore and colleagues write in The Lancet Psychiatry.

As health care faces increasing recruitment and retention difficulties, they note, "employers, managers, and colleagues can no longer afford to overlook the potential of autistic doctors purely because these doctors do not conform to existing systems favoring the neurotypical clinician."

Alex, an anatomical pathology resident who was diagnosed with autism as an adult, says there's often misplaced concern about the ability of neurodivergent doctors to connect and empathize with patients.

On the contrary, Alex has found it easy to relate to patients because "most people have a good grasp of how a doctor should act and there's a very clear script."

"What's very difficult is the interpersonal interactions with the people you work with and figuring out what they expect of you," Alex says. Constant changes in routine and having to renegotiate accommodations repeatedly during training have also been challenging.

Workplaces expect autistic physicians to "spend every second of their day pretending to be as non-autistic as possible," Alex says. "But when you ask for one tiny thing to make things easier for you [such as asking for orientation at a new job or not to be on-call on the first day], people act like it's a really big deal."

Advocacy efforts by Doherty and others in the U.K. have helped to kickstart conversations about neurodiversity internationally, says Elizabeth, a Calgary-based physician who was diagnosed with autism a few years ago. But those conversations are "still very much hidden" in Canada, she says.

"There has to be a recognition that we are here, we've always been here, and we're not going anywhere."