By Dr. Joy Eberhardt De Master, WCI Columnist
What if we got it all wrong? No, I'm not talking about race with that headline. I’m talking about you making more money, and I'm talking about how we all see the world. I know how to help you partner with efficient, reliable people to support your business ventures.
Imagine that sound you hate. Hear it. Sit with it. Close your eyes and let it in. OK, stop. Now breathe—in and out. Feel your body and let it relax.
In the Spanish language, we say, as we refer to colors, white and black instead of black and white. It’s the same thing. Or is it? How we talk about the world affects how we think about the world and, subsequently, how we see it, feel it, and hear it. It bestows respect, power, and money. Or it can rob those keys to life.
What if you knew a loyal, intelligent, creative employee/colleague who heard that horrific sound while at work that prevented them from doing their best? What if you had the power to stop the sound, but you didn’t? Not because you didn’t care but because you didn’t hear the sound yourself. To you, the sound simply didn’t exist.
The reality is you know someone who hears this unbearable sound. That person is autistic. (And don’t go now or you’ll miss the good part.) Here’s what you should know if you have autistic people in your life.
First, you need to know autistic is a way of being. It is not a disease or illness. It’s like saying someone has brown hair. It’s OK to have brown hair. Many people have brown hair. And some don’t. Some people are autistic, and others are not.
Another term is neuroAtypical vs. neuroTypical. (NeuroTypical people are those people who fit the mold of the world without masking, aka they don’t hear that annoying noise nor do they have to pretend they don’t hear it.)
Now erase your idea of what you think it means to be autistic. Instead, imagine a beautiful female-identifying physician loved by patients for their empathy and knowledge. Autism does not mean a certain look. It does not mean a certain gender. It does not mean a certain profession. I am that physician. (No, I’m not being egotistical. I’m being honest.) I live in the world of sensory overload (where I can't escape that sound), and it’s one of the reasons I quit my employed job as a pediatrician. It’s one of the reasons I make less money.
More information here:
The Challenges of Being an Autistic Physician
I am autistic. Or at least I think so. My father was diagnosed a decade ago, and my kiddo was diagnosed in 2021. I am a lot like my kid, and that has made me stop to wonder if I’m autistic. I’ll know in January 2023 when I have a formal assessment.
Sadly, autistic individuals are disproportionally unemployed or underemployed. But they are also intelligent, capable, and loyal. The work mold doesn’t fit. They can not aguantar (endure) the noise.
Before you think this is a “pity party,” know it’s not. It’s a reality statement and, even more so, a wakeup call to you, the neuroTypical. If you know this sound (or, more aptly put, “varied sensory profile”) exists, you can make more money. And you can stop being afraid of the autistic difference. My chief of pediatrics told me in 2021 how she had to “deal with a patient with autism” and “you know how it is with people with autism.” Do I? My family is neuroAtypical.
For those who are neuroTypical, you need to change your expectations. If you can do this, you will find people to partner with and support your business ventures. How, you wonder? I thought you’d never ask.
More information here:
Privilege, Power, and Kindness
How We Can Work Together
Look at how you move in the world and interact with others. Don’t make assumptions about how people want to communicate or what they need. Ask them what they need. Be clear in the asking and be kind. (I don’t recommend talking in terms of “those people with autism,” as my chief of pediatrics did.) Use first-person language with any self-identifying factors. It's an autistic person, not a person with autism.
What to change:
- Reduce sensory input. Yes, that may mean working from home. It also means changing the work environment, such as the pace of work; the frequency of interruptions; and yes, the sounds.
- Reframe your idea of communication. Some autistic people are non-speaking which is different than non-verbal, and they can also be highly intelligent. Some autistic people prefer non-speaking forms of communication, such as writing, but can also move fluidly into speaking forms of communication.
- Reconsider your hiring process. I still remember the residency interviews where I thrived and also the ones where I failed. The difference was the process and if I could make myself “fit the mold.” I remember the interview where we all sat in a noisy room at round tables talking; I couldn’t hear myself think.
Most importantly, remember autistic people are humans. They are loving, and they can take other people’s perspectives.
It might look different than you expect. But there are people to partner with—to hire and to work alongside—and to make money with. You just have to unplug your ears and listen.
We know you visit The White Coat Investor to learn about investment strategies and planning, and we’ve always strived to teach financial literacy to physicians, high earners, and anybody else who finds their way here. But the COVID pandemic has also shined a light on physician burnout and its dangers. That’s why we feel compelled to run articles and columns like the one you just read—to make sure white coat investors stay mentally healthy. We know mental wellness is what leads to a long, fruitful financial life, and we’ll continue to run pieces like this because combatting burnout has become such an important part of everybody’s financial journey.
What specialties are compatible with prospective doctors who have autism?
I would assume that any surgical field would be off the list due to the inherent chaos and unpredictable nature of the operating room.
If chaos is bad, the ED isn’t going to work either.
Pathology and diagnostic radiology seem like good candidates.
Hm, what speciality. It depends the autistic person just like it would for a neuroTypical person. Varied sensory input needs are just that – varied. I wouldn’t rule out OR or ER. The overlap between autism and ADHD is well known. Sensory input can be sensory seeking as well as sensory avoiding. We have to keep an open mind and simply look at the sensory needs of our patients as well as our own.
Thank you for this post. I’m the father of an autistic son, who is a delightful little 4 year-old boy and a beacon in my life.
There are challenges, of course, and everything that might be an easy accomplishment for a NeuroTypical takes time with us.
However, there are certain things that he does, that completely astound me, such as his amazing sense of direction and his incredible memory.
Every autistic person is different, and there’s no clear prescription for what works for one versus the other. While there are many sounds that my son hates, he loves the sounds of airplane noise and is happiest at a local community airport, watching planes takeoff and land. He knows every instrument in the airplane cockpit better than most student pilots.
There are devices out there to suppress sound, and reduce sensory overload, which are commercially available, for those who may need it.
It is not an easy road, but then again what really is?
Cobra – You are right! It’s not simply sensory avoiding. I put the “reduce sensory input” in my column as in medicine we are not good at realizing this. And yes, we need to look at what sensory input to promote.
The adage goes that if you have met an autistic person you have met only one autistic person. You can’t generalize for the whole population. I highly recommend the website neuroclastic.com to learn more.
Also this link talks about the importance of environments we create for children. https://www.psychologytoday.com/us/blog/everyday-neurodiversity/202108/are-we-giving-autistic-children-ptsd-school
Sounds like you are present and response to your kiddo. As a pediatrician, I love this sheet for all kids. https://drdansiegel.com/wp-content/uploads/2020/10/POSU-Refrigerator-Sheet.pdf
Thanks for having the courage to share your perspective.
I used to have brown hair.
Check on this link to learn more about “brown hair.” https://www.facebook.com/NeuroClastic/videos/411922610071040
This seems backwards, is it? “Use first-person language with any self-identifying factors. It’s an autistic person, not a person with autism.”
Good question! Check out this link: https://neuroclastic.com/person-with-autism-or-autistic-person/
As another physician who is on the spectrum and has ADD and mildly dyslexic with trouble both reading/writing, I can attest to the difficulties of those who are neuro-atypical. I have had a varied career and suffered as many with neurodiversity have with “imposter” syndrome and anxiety/depression, etc. I have learnt a few tips over the years from so many struggles.
1) Live in the moment
2) Being open with my diagnosis to my colleagues, staff, and at times my patients (after working for some time). This can sometimes backfire, but can be helpful. For example, usually my brain goes from point A to Z without being able to explain the steps to colleagues/patients/etc. I often tell them they need to stop me as ADHD (unmedicated) makes me zoom through things.
3) Be compassionate with patients/staff/oneself, it can be helpful for others when overlooking your differences
4) Don’t take criticism too harshly, others will not understand your struggles
5) Be open to modifying one’s career/practice location/etc. to draw on my particular strengths (I was an interventional cardiologist, but let cath work go when anxiety became overwhelming).
6) Use prayer/meditation/yoga/journaling as stress relievers
7) Ask for accommodations (once you’ve been working for a while). I asked for a scribe as I have issues writing (dictating is better)
8) Work for a large organization (there are checks and balances and laws that protect you). Don’t work in solo/small practices or as an independent contractor (this one is from experience); you are not protected.
9) Serve the underserved. I worked 2 years at a free hospital for the poor in the third world and helped create a program at this hospital where we close congenital heart defects that is one of the largest in the world. I learnt early on that I can really shine in these unique roles which very few are interested in and it can boost one’s self worth.
10) Read and use the “Mood Log” in the “Feeling Good Handbook” by David Burns, MD; it’s transformative
11) Try to develop “Flow,” a management concept where your expected works is not too difficult or too easy and where work become “natural.” This is very important for those with ADHD who have “hyperfocus,” and who have difficulties in mundane tasks/organization and also suffer from anxiety. An important part of this is letting go of those things that give you anxiety (for me taking interventional call/cath lab work). As a side note, when working at a free hospital and was in my “flow,” I could cath adults/kids with complex congenital defects/do all sorts of procedures, without problems. I realized that in competitive environments I just couldn’t work in high stress environments and perform well, and so I let go (with great difficulty and a lot of inner reflection) when I move back to the States.
12) Share your journey with others (I do with my fellows and residents); it is therapeutic
These are tidbits from my own journey
Thank you. I will apply what I learn. I can identity with number 11. Something about high competitive environments is stifling to me too. I wonder if the competition is its own “stimuli.”
I thought you’d like this share. https://psycnet.apa.org/fulltext/2019-75285-001.pdf
Man Joy, you sure don’t write like somebody who I would think lies on the spectrum! excellent article and point well taken. I will have to reassess how I view what it means for a person to autistic and sensitive to how they sense the world.
btw my wife has been binge watching both “Atypical” and “The Good Doctor” on Netflix. Seems these shows show how high functioning people on the spectrum can integrate with society, and kind of goes away from the classic Rain Man movie that I grew up with which formed the basis of my stereotypical depiction of somebody with autism. Not sure if you approve of Rain Man causing a sterotypical depiction of an autistic person, but it did put awareness of autism front and center and boosted research for ASD for years to come.
Thanks for the compliment about my writing! 😉 Feel free to reach out to me if you have more questions. Best on your journey.
Check out this link to learn more. https://neuroclastic.com/talent-isnt-enough-ableism-gifted-autistics/
It’s one of many.