Untapped Potential: Embracing Neurodiversity in Medicine

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Family doctor Jennifer Vassel used to think she was weird. Situations affected him differently than his colleagues. She could remember the exact pages from her 6th grade textbooks. And she’s always been very sensitive to other people’s feelings — “like being a sponge,” says Vassel.

Then she discovered neurodiversity. The term is often used interchangeably with neurodivergence to refer to the idea that there is a wide range of normal variation in the brain and that there is no “right” way to experience and change. interact with the world.

The neurodiversity movement views neurodevelopmental conditions such as autism, ADHD, and dyslexia as differences, not deficits. While these differences can pose a range of challenges to functioning in a largely “neurotypical” society, they are not inherently disabling and can be important strengths.

Autism care professional Aiyana Bailin explains in American scientist that valuing neurological differences does not mean denying the reality of disabilities, “but neither do we assume that neurological and behavioral differences are always problems.”

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

“What I thought was weird, now I think about what makes me different, unique and in some ways what I’m good at,” Vassel said. She only started to feel comfortable describing herself as neurodivergent a few months ago.

Undiagnosed and undercover

Although the neurodiversity movement has gained traction and made inroads in medical circles in recent years, medicine has been slow to recognize or welcome neurodivergence into its ranks.

The exact number of neurodivergent physicians is unknown, and studies of neurodiversity in medicine are mostly small, qualitative, and focused on autism.

Many people may not know they are neurodivergent until adulthood, often when the demands at home or work outweigh their ability to compensate for the differences. Women and high achievers in particular may be overlooked or misdiagnosed if they do not exhibit disruptive behaviors in childhood.

Shane Neilson, Assistant Clinical Professor of Family Medicine at McMaster University, argues in Canadian Family Physician that neurodivergence may be underrecognized among physicians precisely because medicine filters out “high-performing, intelligent and conscientious” people whose strengths can mask difficulties.

Meanwhile, Neilson notes, “intense internalized stigma due to standards of professionalism discourage anyone from seeking help or housing.”

According to an editorial in British Journal of General Medicinemany neurodivergent physicians may remain undiagnosed and undercover for fear of workplace discrimination.

‘We thought we were alone…’

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

Mary Doherty, a consultant anesthetist from Ireland, discovered she had autism in her mid-40s. In 2019, she founded Autistic Doctors International, a peer support and advocacy group, because she “craved autistic peers in medicine.” The group now has nearly 1,000 members, including Canadians like Vassel.

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

Most members of the group do not fit into the category of “doctors in difficulty”, although many have encountered difficulties at work, generally related to integrating with colleagues or organizational hierarchy, rather than patient care. patients.

Doherty says it’s a “huge loss” for medicine to overlook neurodiversity as an asset to the profession and to dismiss people for 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 stubborn determination to stick with an idea until it’s solved, 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 Medicine.

behind the mask

Neurodivergent people often feel pressure to “hide” or compensate for differences in order to succeed in neurotypical contexts. This can include mirroring what others are doing to appear “normal” or suppressing self-soothing behaviors like fidgeting or twisting hair, also known as “stimming.”

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

“I can be myself when I work alone,” she explains. “It lets your brain think about other things when you don’t have to think, ‘Did I say hello to that person this morning? Did I ask enough questions about them? »

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

According to Shirley Moore and her colleagues at Doctors’ Support Network, a UK peer support group, the full toll of masking can only become apparent when a doctor reaches a breaking point, “sometimes catastrophic, in the form of a collapse”.

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

As healthcare faces growing recruitment and retention challenges, they note, “employers, managers, and colleagues can no longer afford to overlook the potential of autistic physicians simply because those physicians are unfamiliar with themselves.” not conform to existing systems favoring the neurotypical clinician”.

Accommodating difference

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

On the contrary, Alex found it easy to relate to patients because “most people have a good understanding of how a doctor should act and there’s a very clear script.”

“What’s really hard is the interpersonal interactions with the people you work with and determining what they want from you,” says Alex. The constant changes in routine and the need to repeatedly renegotiate accommodations during training have also been difficult.

Workplaces expect autistic doctors to “spend every second of their day pretending to be as non-autistic as possible,” says Alex. “But when you ask for a little thing to make your job easier [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.”

A more open discussion about neurodiversity in medicine is needed to facilitate peer and workplace support, according to an article published in BJPsych open. The authors point out that “those who were able to obtain suitable housing, often without realizing why it was needed, flourished”.

Evidence on how to support neurodiverse physicians is limited, and accommodation types will likely vary depending on the individual.

Daniel Robinson, a postdoctoral fellow in psychiatry with ADHD, suggests that learning environments could be improved by increasing the diversity of senior role models, providing timely feedback, and using teaching strategies that make learning processes visible. thinking involved in complex tasks and allow trainees to develop their own thinking.

Medical training should also encourage introspection to help doctors identify if they’re neurodivergent early in their careers, says Andrea, a family physician and preventative medicine specialist who learned she has autism and ADHD. years after his medical studies. “Do thinking exercises early on so people can actually understand that it could be them,” she says.

Advocacy efforts by Doherty and others in the UK have helped start conversations about neurodiversity internationally, says Elizabeth, a Calgary-based doctor who was diagnosed with autism a few years ago. . But those conversations are “still very hidden” in Canada, she says.

“There has to be a recognition that we are here, we have always been here and we are not going anywhere.”

Editor’s Note: Some names have been changed to protect identities.

New study finds autistic and non-autistic people share more in common than previously thought

More information:
Sue McCowan et al, Vive la difference! Celebrating and supporting autistic psychiatrists with international autistic doctors, BJPsych open (2021). DOI: 10.1192/bjo.2021.157

SA Cassidy et al, Is camouflaging of autistic traits associated with suicidal thoughts and behaviors? Expanding the Interpersonal Psychological Theory of Suicide in a Sample of Undergraduate Students, Journal of Autism and Developmental Disabilities (2019). DOI: 10.1007/s10803-019-04323-3

Laura Hull et al, Is social camouflage associated with anxiety and depression in autistic adults?, Molecular autism (2021). DOI: 10.1186/s13229-021-00421-1#Sec2

Shirley Moore et al, Autistic Doctors: Unrecognized Benefits of Medicine, The Lancet Psychiatry (2020). DOI: 10.1016/S2215-0366(20)30087-0

Provided by the Canadian Medical Association Journal

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