Life as a doctor with Asperger's syndrome
British Medical Journal, 2004
Frustrated with an inflexible, serious, and eccentric colleague? He or she may have Asperger's syndrome, or at least a few of its traits. So try to be compassionate and understanding, says this doctor with the full blown syndrome.
According to my profession and the International Classification of Disease (ICD-10) I am a doctor with a recurrent depressive disorder. This is an unhelpful diagnosis, and what has helped me get on with my life is recognising that I also sit at the high functioning end of the autistic spectrum. I owe far more to the consultant psychiatrist who suspected that I had Asperger's syndrome (and paved the way for a diagnostic assessment at a tertiary centre) than I do to all the other psychiatrists who suggested clever drugs to manage my depression.
What is it?
Asperger's syndrome is a form of autism, and most patients have very high IQs. Of course, a high IQ can make it easier to get into medical school, and other characteristics of the syndrome are compatible with being a very good doctor. Long term memory is often excellent, and a highly developed ability to interrogate is very useful for good history taking. Perfectionism is ideal in the world of medicine, and a very high level of respect for oneself (and for humanity) often translates into a very strong and overwhelming passion for patients' care. Maybe these characteristics describe you too (see box)?
I now know that the clues to this diagnosis were always there, even though it was not recognised until I was in my early 30s. I had never really heard of Asperger's syndrome until I received my diagnosis. Important clues that led to my diagnosis included difficulties working with other people within teams. A solitary childhood was pivotal too, as is a reasonably isolated adult life. An interesting speech abnormality failure which I have always had is referring to oneself consistently as "one" or "we," and never the more usual "I" or "me." I also have other subtle abnormalities of speech and writing. In addition, I am frequently baffled by how people "tick" as I perceive the world around me in a very "black or white" sort of way.
Although my management still includes antidepressants there is so much else that can be done for those of us on the autistic spectrum. As I am a psychologically minded doctor, it gives me great pleasure to realise that my own best care lies in my colleagues allied to medicine, rather than in medicine itself. Life is going well at the moment, and I am free of depression (and completing a course of antidepressants).
Stigma and disclosure
The key to living with this diagnosis (and it cannot be "cured") is recognising it and framing my work and home environments around the constraints posed by the condition.
I owe a lot to my trust's consultant in occupational medicine, who oversees my care, even though it was exceptionally difficult for us both before my illness had been diagnosed and serious difficulties have occurred over time, such as disclosure.
I realise than I am me, and changing "me" is difficult, or even impossible, due to the condition's characteristic rigidity
As I don't like sharing personal information (exceptional regard for privacy is another characteristic of the syndrome), I have always insisted on confidentiality, which means that my diagnosis is shared only with occupational health. I believe that a strong stigma is associated with Asperger's syndrome, even though it is a psychological development disorder and not a psychiatric condition. The reality is that in medicine most of us stigmatise both psychology and psychiatry alike.
Poor understanding of the syndrome worries me as does the fact that it is often not being viewed as a valid "entity," although it is in ICD-10. Perhaps what worries me most is the culture in medicine that the job "must be done" so those who "cannot stand the heat should get out of the kitchen."
My work environment is the result of discussions between occupational health, myself, and my consultant.
How many characteristics of Asperger's syndrome do you have?
Although few of us have the full blown syndrome, the diagnosis requires a range of features and evidence of disruption to day to day life caused by the following traits.
- Being a loner ill suited to team work
- Seriousness with an unusual sense of humour
- Having little or no common sense and lacking "street credibility"
- Generating novel and unusual "off track" solutions to problems
- A pedantic inflexibility making it difficult to handle all the changes that come with working in the NHS
- An inability to multiskill, so that working in acute specialties is disastrous
- Subtle speech difficulties, making communication with colleagues and patients problematic
- Eccentricities—"the mad professor"—making it hard to fit into conformist medicine
My characteristic eccentricities are largely accepted, especially recognising and understanding that six monthly rotations are not for me. My work is paced and structured with clear beginnings and ends.
However, I don't yet have a mentor at work who is able to give me advice both on a proactive and on a reactive basis (something that is recognised as being particularly useful for managing this syndrome).
I have not disclosed my diagnosis to anyone at work, except few select colleagues. Interestingly, one seems not to accept it, and there certainly have been (and always will be) occasional conflicts with that colleague. But I realise than I am me, and changing "me" is difficult, or even impossible, due to the condition's characteristic rigidity. Other colleagues recognise my important contribution to patients' care but also the areas that I find more difficult (mainly communication and team working).
A final thought
Asperger's syndrome polarises strengths and weaknesses in a way well beyond the "norm," but everyone has strengths and weaknesses. Please try to be compassionate and understanding, but, most importantly, start to look at yourself and others around you: a few of your colleagues may have Asperger's syndrome, but many more may have the odd trait. Perhaps even you?