Embracing neurodiversity in medicine: Insights from an autistic medical student

Two decades ago, I was diagnosed with moderate autism spectrum disorder. My physicians at the time questioned whether I would be able to live independently. I did not speak until I was 4, went to four elementary schools and two middle schools because my autism made it challenging to find adequate support, and received a decade of therapy.

Today, I am a first-year osteopathic medical student at Philadelphia College of Osteopathic Medicine (PCOM) and am defying expectations and preconceived notions surrounding my diagnosis.

As an autistic medical student, I bring unique perspectives and experiences to the table, which strengthens the medical community’s collective understanding of the world around us. This will ultimately make me a better doctor.

Like many with autism, I struggled as a child to take in verbal and nonverbal cues and gestures to communicate both smoothly and effectively.

I took social dynamic classes, learning how to initiate conversation, respond to others, read facial expressions, understand social cues, and so much more. In a typical conversation, I often have to intentionally think about those lessons, and systematically apply them to every aspect of my interactions with others. Am I maintaining eye contact? Am I matching their body language? Am I sharing the appropriate amount of information?

The best analogy I’ve come across to describe this process is when someone is speaking a language that is not their native language. They will usually have to consciously refer back to their first language, which can be exhausting and mentally draining.

When I am actively listening, I also have to engage in a technique referred to as masking. Masking is when an autistic person suppresses their autistic traits (stimming, oversharing, hyperfocusing, etc.) in order to conform to socially compatible mannerisms. When a person is very good at masking, you’ll often not even realize they’re doing it.

Having developed these skills over the years, I feel confident in my ability to communicate with my medical school peers, but can sometimes miss nuances or come off as awkward. Autistic people tend to think very literally, so recognizing idioms, sarcasm, and passive-aggressiveness can be a struggle. This might make us appear to be instigative, when in fact we might have completely misunderstood someone’s point. Although many of us struggle with outwardly expressing feelings, I am empathetic and compassionate, like almost every autistic person that I know.

According to the CDC, 1% of the world population is autistic, and autism is just one disorder under the neurodivergent umbrella. Statistically, that suggests other autistic medical students are also attending PCOM, with their own perspectives to share.

Whether autistic, allistic, neurodivergent, or neurotypical, we all possess unique traits. Our neurodiversity is not a hindrance, but strengthens our ability to become good doctors. My therapy has allowed me to excel in helping people in a moment of crisis without using drug treatments. I worked as an emergency room technician prior to coming to PCOM, and my life experiences made me a valuable contributor whenever an autistic patient came to the emergency room.

The Tenets of Osteopathic Medicine, which all osteopathic student doctors agree to uphold, affirms that physician understanding of patients is paramount to providing effective treatment and compassionate care. Our differences can also provide perspective in fostering the holistic approach to patient care for which PCOM is known.

I manage the challenges of autism on a day-to-day basis. This is also true for other students who are neurodivergent and those who identify with the many diverse groups that make up the PCOM community. Those challenges – and all of our differences – form the basis of our experience and are what make us unique. They are worth celebrating and will make us better doctors, and ensure our patients are seen and heard.

Fox Ryker is a first-year PCOM medical student from Coatesville and contributed this article in recognition of World Autism Month and Celebrate Diversity Month, each recognized every April to encourage inclusivity, celebrate differences, and honor the diversity of the world around us.