What's it like to be a neurodivergent doctor?

I am a Child and Adolescent Psychiatry Registrar.

I am also Jewish and a member of the LGBTI community. Perhaps even more fundamental to my personality and way of thinking is that I am autistic and have attention-deficit/hyperactivity disorder (ADHD).

Many people have asked me why I don’t talk more about being autistic and having ADHD when I have been so open about depression and my treatment as a psychiatrist-in-training (here, here and here).

The answer is simply that these are things that have always been there and are a part of me. So, what is it like to be a neurodivergent doctor?

Although there is minimal formal research in this area, it is widely understood among mental health professionals that many people with ADHD are drawn to high adrenaline careers, and emergency physicians are thought to very frequently have ADHD (here and here).

Autistic doctors often follow their special interests. For me, I had been interested in psychopharmacology since I was an adolescent, and did a PhD in psychology, focusing on health care in my research. When I was in medical school, I developed an interest in reconstructive urology and had a lot of potential to be a great surgeon.

Due to life circumstances, surgical training was not a pathway I could take. I fell back on my background and decided to become a psychiatrist. Much of what I reflect on in this article is related, but not limited, to my experience in psychiatry.

I have spent the past 20 years consciously learning social skills. I have also done a PhD on human communication. This means that I am actively looking for those things that I have in my conscious awareness.

I still miss things that I have never actively learned, very subtle things I am told. This conscious use of communication leads me to use my empathy more obviously than others, and I am indeed regarded as being extremely empathetic.

Having lived experience also imparts a certain connection and empathy that one can never achieve otherwise. Just as those of us who have not experienced psychosis can be as understanding and empathetic as possible with someone who does but cannot truly understand their experience, a neurotypical clinician cannot truly understand a neurodivergent patient’s experience or way of thinking.

This does not limit their ability to work with patients who do not share their experiences, but having a shared experience enhances the exchange.

Autistic superpowers and challenges are not just theoretical to me. I have them both myself. Despite struggling with change, new social situations, and sensory sensitivities, I am extremely organised (by necessity!), plan ahead for multiple possible outcomes, and am very good at assessment and report writing.

I of course did a variety of hospital rotations before becoming a psychiatrist-in-training. I have noticed during this time that pattern recognition is a general strong suit for me. When I was an intern, I had a patient with what had been regarded a mystery disease — hepatitis, headaches, and respiratory symptoms and had had what people thought was every test under the sun.

It just looked like Q fever to me. In true House fashion, I asked them if they had any animals on their property. Lo and behold, they were a sheep farmer and subsequently tested positive for Q fever and recovered well with treatment. To me, this example reflects the power of autistic pattern recognition. If someone can use this skill while being open to being wrong, they can be an incredible diagnostician.

My discussions with patients who may be newly diagnosed or struggling with their neurodivergent challenges about development, maturation, and achieving in life are not based on statistics. They are based on interactions with neurodivergent people from a variety of backgrounds and professions as well as my own experiences.

I generally make an instant connection with other autistic people. People used to ask me about rapport and conclude that the patient could not possibly be autistic. This is incorrect for two reasons: i) autistic people can have very highly developed learned social skills, and ii) because we are both autistic, we do not rely on the same cues as neurotypical people to achieve rapport. I carry a bit of pride in my accuracy. Given that this has been an almost automatic perception, it has in the past been somewhat difficult to articulate the reasons. This is something I have been honing with support from my supervisors.

So, this is what it is like to be this neurodivergent doctor. This is my story, and others may have very different experiences, challenges and superpowers. Whatever your interests and abilities, there is a place for every doctor in the wide world of medicine.

Dr Israel Berger is a Child and Adolescent Psychiatry Advanced Trainee at Goulburn Valley Health and is involved in medical and public health education at the University of Sydney and Monash University.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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Resources:

https://www.autismspectrum.org.au

https://aspergersvic.org.au

https://www.amaze.org.au

Books:

Unmasking autism: the power of embracing neurodiversity by Dr Devon Price

NeuroTribes: the legacy of autism and the future of neurodiversity by Steve Silberman

The power of neurodiversity by Thomas Armstrong

Being twice exceptional by Melanie Hayes