Aged 62, GP Dr Linda Mayer was suddenly able to make more sense of her life after she was diagnosed with autism, ADHD and an inability to identify and describe emotions, known as alexithymia.
She says the diagnoses both explained some challenges in her professional life and why she excelled in other areas, not just her work as a GP with NSW’s Justice Health, but as a showjumping horse rider and motorbike racer.
Having joined advocacy group Autistic Doctors International, she realised many other doctors had similar experiences.
She spoke with AusDoc.
AusDoc: What led to your diagnosis?
Dr Linda Mayer: I was attempting to help a friend whose daughter was being assessed for autism.
He suddenly stopped me as I was talking and said, ‘I think you are on the spectrum, Linda.’
I disagreed, but after a bit of reading and some online tests checked by my doctor-daughter, it became obvious.
It was because of my daughter that I sought formal diagnosis. I needed to validate her life with me.
Past events made more sense to me. My own daughter suddenly made more sense to me.
She grew up ‘social translating’ for me and I often used to smugly tell her how in error she was.
That eats at me still.
AD: Was it difficult to get that formal diagnosis?
Dr Mayer: Yes, after many months I was able to get a consult with Diverse Minds in Sydney.
The diagnosis was made over four testing sessions with my daughter and a friend interviewed as well.
I scored 178 (the cut off for autism is 66 with most people with autism scoring between 120-130) and equally as high with ADHD.
AD: What struggles had you faced and how did the diagnosis help?
Dr Mayer: Throughout my life I never understood why most routine events turn into epics for me.
I was thrown out of school assemblies and asked to leave the lecture theatres in medicine a few times. I must have been fidgeting or talking.
Now I know why my student friends could have a social life while I had to learn all my medicine at home after hours — I simply did not take anything in due to the sensory overload of crowded lecture theatres.
I went to many ophthalmologists for painful eyes. I had no idea it was a sensory issue, as was noise.
I would often be so exhausted that I thought I would die — I now know it was autistic burnout.
I know so many of my neurodiverse (ND) friends have wonderful insight into themselves, but I had none.
I literally live in my own world, walking to the beat of my own drum.
Thankfully this saved me from noticing much of the nastiness.
Through research and reading, I now have an excellent library of data to understand neurotypical (NT) behaviours as well as a massive library of facts about neurodiversity to ‘info dump’, which is often used as a form of affection by ND people towards those they like and each other.
AD: How did your colleagues react?
Dr Mayer: Many of my ED nurse friends and some colleagues said: ‘We knew you were autistic Linda, but we didn’t want to hurt you.’
This taught me that most people think an ND diagnosis is a bad thing.
Some others, including psychiatrists and paediatricians, told me: ‘You’re not autistic because you have empathy or because you can do this or do that,’ effectively negating my experience and professional diagnosis.
AD: Which elements of neurodiversity are beneficial as a doctor?
Dr Mayer: There’s pattern recognition, attention to detail, honesty, a heightened sense for fairness and justice, unambiguous communication style, ability to hyperfocus and become very good at tasks or areas of special interest.
ND doctors will also frequently default to logical analysis in a crisis despite many experiencing hyper-empathy.
AD: For your work specifically, what are the benefits and challenges?
Dr Mayer: This question I love because I really feel I am useful in my job.
Up to 50% of people who are incarcerated are ND, mostly ADHD and/or FASD and some autistic, many with complex PTSD.
I speak their language.
And due to my own background, growing up in disadvantage, I think I can understand and know some of their challenges.
At nearly every consult day I will get a comment similar to ‘you’ve listened’ or ‘you get me, miss’ when really, I have just validated their distress and often their lives without them having to tell me much.
The personal challenges are mostly sensory.
There is a lot of noise and I like to work with the lights out.
I am fortunate that I work mostly alone, autonomously with good clinical back up by phone if required.
I am institutionalised, in that I have not worked in private practice.
But institutions have rules and I am good at following rules if they make sense and are fair and just.
AD: What issues do ND doctors typically face?
Dr Mayer: I belong to Autistic Doctors International and my experience is similar to many of my autistic colleagues.
We’re often great doctors, can be successful supervisors, teachers and examiners, and excel in our areas of intense interest.
But we have had to make huge extra effort to navigate the workplace not set up for us, which can burn us out.
It is almost impossible to climb the career ladder, no matter how good one is, in the same time frame as an NT person, if at all.
Most of us have had mutual misunderstandings with many of our colleagues; however we do get on with our patients.
It has also been shown that autistic people are usually not affected by the bystander effect.
While that’s very good for an organisation wanting to be alerted to problems, it is rarely conducive to belonging and being liked by colleagues and can lead to being an accidental whistleblower.
I experienced this when working in aviation medicine.
I called out problematic people and it led to an inspector general inquiry.
Unaware of my neurodivergence at the time, I was confused, naïve and vulnerable.
Though I was previously one of the most respected at the base, I was overwhelmed with the backlash and the closing of ranks.
I was eventually asked to return and did so for a short time, more for my own closure.
AD: What do we know about mental health among ND doctors? Do they struggle to find appropriate healthcare?
Dr Mayer: This is the most important question and why I have come out with my diagnosis and why I wish to amplify the existence of ND practitioners in Australia.
I could write pages on this topic.
The mental health impact of neurodiversity is nothing short of appalling, but it is not inevitable.
Urgent improvements are needed regarding recognition, accommodations and equitable access to all healthcare services.
Management of co-occurring mental health conditions that are adapted for autism/neurodiversity are needed, as well as recognition and management of the high rates of co-occurring physical health issues.
Autistic Doctors International membership has been a massive career support for not only myself but also so many others.
I encourage everyone to access their site and read the many articles pertaining to autistic medical practitioners.
A recent paper, published in Frontiers in Psychiatry, was damning.
Based on a survey of 225 doctors, 64% with a formal diagnosis of autism, it revealed 24% had attempted suicide and three-quarters had contemplated it.
Nearly one-third of the doctors worked in general practice.
AD: What is the estimated proportion of ND doctors in Australia?
Dr Mayer: I am unsure.
My opinion is that there would be more in any intellectual profession than in the general population and perhaps more females than males — females mask it more.
I also think there would be an older cohort of doctors that gained entry with grades only, as it would be difficult to pass the interview and undergraduate medical admission tests for many with autism and possible undiagnosed ADHD.
AD: Would you encourage any neurodivergent prospective medical student (or specialist trainee) to tell medical schools/colleges about their diagnosis?
Dr Mayer: I think we are many years away before disclosing becomes safe for any prospective student or junior doctor/trainee.
We must first positively discriminate and place ND doctors into positions that implement change to make it safe for younger ND doctors.
AD: What are the main points of ignorance within the medical profession about neurodiversity?
Dr Mayer: Where do I start?
The inability of many colleagues to see the limitations of their knowledge with respect to ND differences is a problem that needs education to change.
At present, it is primarily the ND doctor’s responsibility to learn NT language — there are lots of books for us to learn how to mask to fit in to this world — and this leads to burnout and mental health decline.
Doctors of all levels of seniority regularly have diagnoses dismissed by colleagues if they disclose.
Even minimal, reasonable accommodations are often still denied.
On a positive side?
My experience speaking and attending the conference of the Australasian Society for Developmental Paediatrics was mind-blowing to me in that they were made up of inclusive, warm professionals that did not display the same ego protective behaviours that I have experienced in other specialties.
I am guessing because they work with ND patients and their often ND families.
Additionally, the society has established a neurodiversity special interest group.
I believe every specialty should incorporate an ND special interest group to create positive change.
AD: What’s your advice on the best ways to support an ND colleague?
Dr Mayer: Understand that we experience the world differently.
Be clear and specific with language. While this sounds easy, an autistic person’s understanding of specific is often far more precise than an NT’s understanding.
While we may not be able to chit chat — it can be almost physically painful — please include us at the decision-making table.
Give us time to process information as more often than not we can come up with great ideas and innovative clinical management approaches.
Understand that sensory overload is real and exhausting.
And, as an exercise, imagine you were born into an alien world of overwhelming sights and noises and grew up constantly interpreting a foreign language while being told that you were known and understood because they had a relative of your type or read a book.
In other words, do not patronise us.
All ND people are different just as all NT people are different.
- Epigenetics as an explanation for autism and the ‘extreme male brain’ – the implications could be immense
- Patients with autism avoiding GPs because of discomfort in waiting room
- GPs need better training to deal with ’emerging ADHD crisis’
More information: Front Psychiatry 2023; 18 Jul.