Hey neurokin, Aussie queer AuDHDer here, in recovery from my medical career (I walked away because I couldn’t practice in line with my values).
It’s really interesting to hear this discussion. The dynamics you’re describing exist here too, but maybe not at level 10,000 like in the episode. My colleagues would roll their eyes at patients who came in with information, dismissing it as “Dr Google.” Even before I knew I was Autistic, I said I enjoyed working with patients who I’d describe (and defend) as engaged in their own healthcare. Even when our perspectives diverged, they were usually open to more information, including on how to assess its strength. I didn’t need to agree with their conclusions to pursue their line of investigation—if it was subjectively meaningful to them, then it was clinically relevant. For me that was the real application of patient-centred care, a phrase that was constantly thrown around as a buzzword but wasn’t visible in systems or practice.
Often with patients I could pursue dual pathways (their way and my way) because I treated their material as worth engaging with, and they usually did the same for me. It also let me be honest: I could say, I totally believe you and think you’re right, but if I do this other thing I’ll be in a professionally vulnerable position and open myself up to discipline. Can we do both? We shouldn’t have to, it’s not evidence-based, I’m sorry to ask.
The converse situation that made me roll my eyes were when patients performed appeals to sympathy. Over time I began to realise they did that because they had to with my other clinicians. I tried to make it clear they didn’t need to do that with me. I work from need and capacity, not deserving. I told them explicitly I would believe them and take them at face value unless there were loud red flags for deception, but I wasn’t looking for it. My job was to help, not to police or gatekeep. At the end of the day, it was more important to me that they got the care they needed than to be right, and although I aimed to be fair and responsible with resources so the system was sustainable, it didn’t come out of my pocket nor was my job to reduce costs, there are teams and teams of people to do that.
The appeals to ego were irritating and confusing for me. I worried it was something about me specifically that elicited that behaviour. Hearing in this episode that people do that because most doctors (ie. the role) needed it, is reassuring—it wasn’t about my fragility (well, not about the size of my degrees anyway, I’m sure I’ve got fragility to unpack elsewhere haha). Thank you for making those dynamics explicit and helping me contextualise my experiences.
I got feedback that I was well liked by patients and “gentle” in my interactions, but I also knew I worked differently to the rest of my multidisciplinary team. It was difficult to reconcile being called gentle with obvious experiences of friction where I was painted as too much, unreasonable or disruptive. I worked in a multidisciplinary team, and they had a lot of resistance to my personalisation (and what I thought were improvements) of my working systems and style—though in hindsight, I was just accommodating my Au needs without realising that’s what I was doing.
An example: the health service recorded appointments in a billing system that wasn’t accessible off-site. As part of my role, I was required to be on the after-hours, on-call, and night rosters, so I needed to manage fatigue by altering my start times. Sometimes they’d cancel early patient appointments, then nothing booked until after lunch. I’d come in mid-morning to minimise disruption to the team, not knowing their wasn’t anything booked. Obviously this was pointless—I should have extended my rest which was rare and precious. And those patients should have been offered later appointments instead of just being cancelled. So I asked for off-site calendar access.
The resistance was extreme. At first, reception started making dual appointments in Outlook and the billing system. But when they did rescheduling, only Outlook was kept up to date. Eventually they realised they could just enter appointments into the billing system when patients arrived in realtime. That change saved them time, compared to the old complex process of deleting, rescheduling, and correcting no-shows. They ended up being happier and changed the process for all the doctors.
There is an opposite show, called High Potential, to the one mentioned with the autistic investigator politely feeding breadcrumbs to the official detective. (Sorry, don’t know that one, but Psych would probably be a kindred spirit to it — highly observant person pretends to be a psychic while helping the police.)
High Potential kicks off with a neurodivergent-coded cleaner noticing a key error on a police murderboard and adding a note/correction. The police are pissed but follow up on both how the note got there and its contents. Amusing bad relations between the cleaner and the assigned detective ensue, as they have complementary strengths which also cause arguments. The cleaner is not willing to take a backseat…except when she has just screwed up and the detective gets through to her about *why* that screwup creates a real problem for solving and prosecuting the case. Procedure just for procedure’s sake doesn’t make sense to her.
Side note: One topic I am interested in hopefully finding more perspectives on is PDA. Specifically adult children of PDA parents and how various parent/child dynamics have managed.
I'm a psych nurse, in a clinic. I really don't like my current job for a lot reasons discussed above. One small victory I get to accomplish regularly though is "chart corrections." A whole lot less patients with flagged charts. Are they aggressive, really, nope not anymore. I've worked in a State Hospital, I know what an aggressive person looks like. Also... magically, eye contact disappeared from the chart template when I started working here.... strange....
So here's an absolutely disgusting but surprisingly useful phrase to use at the doctor... "oh yeah, my husband/brother/father/random human with a penis was actually wondering if it might be (insert condition i have extensively researched here), and I promised I'd ask what you thought."
Because sometimes the doc will listen to the (possibly imaginary) dude in your life more than than they'll listen to you. But if that's what you gotta navigate to get care, well, this works really well.
Hey neurokin, Aussie queer AuDHDer here, in recovery from my medical career (I walked away because I couldn’t practice in line with my values).
It’s really interesting to hear this discussion. The dynamics you’re describing exist here too, but maybe not at level 10,000 like in the episode. My colleagues would roll their eyes at patients who came in with information, dismissing it as “Dr Google.” Even before I knew I was Autistic, I said I enjoyed working with patients who I’d describe (and defend) as engaged in their own healthcare. Even when our perspectives diverged, they were usually open to more information, including on how to assess its strength. I didn’t need to agree with their conclusions to pursue their line of investigation—if it was subjectively meaningful to them, then it was clinically relevant. For me that was the real application of patient-centred care, a phrase that was constantly thrown around as a buzzword but wasn’t visible in systems or practice.
Often with patients I could pursue dual pathways (their way and my way) because I treated their material as worth engaging with, and they usually did the same for me. It also let me be honest: I could say, I totally believe you and think you’re right, but if I do this other thing I’ll be in a professionally vulnerable position and open myself up to discipline. Can we do both? We shouldn’t have to, it’s not evidence-based, I’m sorry to ask.
The converse situation that made me roll my eyes were when patients performed appeals to sympathy. Over time I began to realise they did that because they had to with my other clinicians. I tried to make it clear they didn’t need to do that with me. I work from need and capacity, not deserving. I told them explicitly I would believe them and take them at face value unless there were loud red flags for deception, but I wasn’t looking for it. My job was to help, not to police or gatekeep. At the end of the day, it was more important to me that they got the care they needed than to be right, and although I aimed to be fair and responsible with resources so the system was sustainable, it didn’t come out of my pocket nor was my job to reduce costs, there are teams and teams of people to do that.
The appeals to ego were irritating and confusing for me. I worried it was something about me specifically that elicited that behaviour. Hearing in this episode that people do that because most doctors (ie. the role) needed it, is reassuring—it wasn’t about my fragility (well, not about the size of my degrees anyway, I’m sure I’ve got fragility to unpack elsewhere haha). Thank you for making those dynamics explicit and helping me contextualise my experiences.
I got feedback that I was well liked by patients and “gentle” in my interactions, but I also knew I worked differently to the rest of my multidisciplinary team. It was difficult to reconcile being called gentle with obvious experiences of friction where I was painted as too much, unreasonable or disruptive. I worked in a multidisciplinary team, and they had a lot of resistance to my personalisation (and what I thought were improvements) of my working systems and style—though in hindsight, I was just accommodating my Au needs without realising that’s what I was doing.
An example: the health service recorded appointments in a billing system that wasn’t accessible off-site. As part of my role, I was required to be on the after-hours, on-call, and night rosters, so I needed to manage fatigue by altering my start times. Sometimes they’d cancel early patient appointments, then nothing booked until after lunch. I’d come in mid-morning to minimise disruption to the team, not knowing their wasn’t anything booked. Obviously this was pointless—I should have extended my rest which was rare and precious. And those patients should have been offered later appointments instead of just being cancelled. So I asked for off-site calendar access.
The resistance was extreme. At first, reception started making dual appointments in Outlook and the billing system. But when they did rescheduling, only Outlook was kept up to date. Eventually they realised they could just enter appointments into the billing system when patients arrived in realtime. That change saved them time, compared to the old complex process of deleting, rescheduling, and correcting no-shows. They ended up being happier and changed the process for all the doctors.
There is an opposite show, called High Potential, to the one mentioned with the autistic investigator politely feeding breadcrumbs to the official detective. (Sorry, don’t know that one, but Psych would probably be a kindred spirit to it — highly observant person pretends to be a psychic while helping the police.)
High Potential kicks off with a neurodivergent-coded cleaner noticing a key error on a police murderboard and adding a note/correction. The police are pissed but follow up on both how the note got there and its contents. Amusing bad relations between the cleaner and the assigned detective ensue, as they have complementary strengths which also cause arguments. The cleaner is not willing to take a backseat…except when she has just screwed up and the detective gets through to her about *why* that screwup creates a real problem for solving and prosecuting the case. Procedure just for procedure’s sake doesn’t make sense to her.
Side note: One topic I am interested in hopefully finding more perspectives on is PDA. Specifically adult children of PDA parents and how various parent/child dynamics have managed.
I'm a psych nurse, in a clinic. I really don't like my current job for a lot reasons discussed above. One small victory I get to accomplish regularly though is "chart corrections." A whole lot less patients with flagged charts. Are they aggressive, really, nope not anymore. I've worked in a State Hospital, I know what an aggressive person looks like. Also... magically, eye contact disappeared from the chart template when I started working here.... strange....
So here's an absolutely disgusting but surprisingly useful phrase to use at the doctor... "oh yeah, my husband/brother/father/random human with a penis was actually wondering if it might be (insert condition i have extensively researched here), and I promised I'd ask what you thought."
Because sometimes the doc will listen to the (possibly imaginary) dude in your life more than than they'll listen to you. But if that's what you gotta navigate to get care, well, this works really well.