A young autistic surgeon makes several social faux pas, leading to clashing with his boss repeatedly. This eventually leads to the young autist being transferred to pathology against his will. Unable to cope with the change, he stands up to his boss to seek reinstatement as a surgeon, and he is consequently fired for disrespecting authority by standing his ground.
Sound familiar? That’s because it’s one arc of ABC’s The Good Doctor and shows several features that are common among autists: differences in social communication, difficulty with change, passionate special interests, and displaying a strong sense of justice without deference to the authority of the antagonist. It’s also a common reality for many autistic doctors. While the autistic surgeon in question has a happy ending (Dr. Shaun Murphy gets his job back, Dr. Jackson Han is fired for discriminating against an autistic physician, and Dr. Shaun Murphy eventually finishes residency and becomes an attending surgeon), that is not necessarily the case for real-world autistic physicians.
Real-life success stories do exist — for autistic pathologists. What about the real Dr. Shaun Murphys of the world? The autists who very much want to be included in social spheres, not relegated to the less social specialties due to misconceptions that autists are better off as pathologists than as surgeons, psychiatrists, or general practitioners.
One study found that autistic medical trainees struggle with bullying, isolation, anxiety, and feeling victimized by the medical training system, with a tendency to struggle with peers more than patients. Many autistic doctors are great with patients but struggle with the broken medical system and the bureaucracy of medical culture, with rigid hierarchies and complex social dynamics. When autistic medical students express their difficulties in training, the system can fail to accommodate appropriately, with comments like, “But you’re going to be a doctor one day, so you need to get used to it.” But that toxic culture of medicine leads to dire outcomes. Another study found that 77 percent of autistic doctors consider suicide, and 1 in 4 autistic doctors have attempted suicide.
Many medical professionals have not kept up to date with advances in autism research. Stereotypes and misconceptions are abundant, leading to significant human rights abuses and harms of autistic trainees. One example is the message that an autistic trainee in primary care received from their training program:
The panel regrets to learn of your recent diagnosis of ASD [autism spectrum disorder], but since this is a life-long developmental syndrome which causes permanent impairment of many of the competences required for independent practise as a GP, the panel cannot see how any workplace adaptations could now be put in place to successfully alter your outcome.
This decision was ultimately overturned, and the trainee was reinstated with an apology. One wonders, though, how many unhappy endings are hidden in secret shame, how many autists have lost their careers and their lives because of blatant discrimination?
The exclusion of autistic doctors happens despite the fact that people with ASD are capable of overcoming autism-related deficits. Research shows that those on the spectrum are capable of great empathy even if they have unconventional ways of demonstrating empathy, and autists can learn to develop and enhance their communication skills to the required standard.
The problem appears to be simple: lack of awareness and acceptance. Many training programs or workplaces do not know they have an autistic physician, and may wrongly interpret that their trainee or employee is incompetent or otherwise too flawed to work in medicine. In order to comply with the Human Rights Act, we all have a duty to familiarize ourselves with the signs of autism, so as not to fail in a duty to inquire if a struggling physician needs accommodations to excel. If we do know a physician is autistic, we ought not perpetuate myths and stereotypes in order to avoid underestimating the capabilities of autists who are different, not less. We must educate ourselves on the strengths of autism that make physicians on the spectrum an asset to medicine, and support people with ASD in overcoming their weaknesses and developing their skills, to polish the diamond in the rough.
Advocacy efforts are mounting as doctors with ASD speak out against stigma, and there is now open discussion of autistic doctors as assets to their fields — even highly communication-based fields like psychiatry. We can recognize that autistic doctors have untapped potential that needs to be championed.
And yet, a friend of mine in a psychiatry residency program was told that autistic people cannot be psychiatrists, even though that is unequivocally incorrect and discriminatory. Even though she was diagnosed in medical school in a different city and had no problem completing her MD, her psychiatry program required her to have another assessment done and to have her undiagnosed as autistic. This is not an isolated case, as several medical training programs are guilty of holding anti-autism discriminatory attitudes. She has to closet who she is in order to survive in this field, and she is not alone; 72 percent of medical students do not disclose, 29 percent of autistic physicians do not disclose, and there is an association between non-disclosure and no self-harm or suicidal ideation. In other words, coming out as autistic risks not only significant career damage but also correlates with a desire to die.
Are we really willing to turn away bright minds from medicine because we choose to discriminate based on stereotypes rather than open our minds?
Are we really willing to accept that autism is a closeted condition for many physicians, where disclosure is correlated with suicidal ideation?
Are we really willing to accept that 77 percent of autistic doctors consider suicide and 24 percent attempt to end their lives?
The medical field can, and must, do better before it’s too late and an autistic doctor dies in a preventable story about the tragedy of lost potential.
Patricia Celan is a psychiatry resident.
