Is there much neuro-diversity amongst doctors and surgeons?
In recent years, awareness of the existence and features of neuro-divergent conditions has increased significantly. It is to be welcomed that both children and adults have better access to well-informed diagnosis and assistance than ever before, with fewer people left to struggle under incorrect or even pejorative labels.
Some studies studies indicate a rapid rise in the diagnosis rates of neuro-divergent conditions. However, there remains a considerable number of undiagnosed individuals in the UK population. For instance, a study published in August 2021 in The Journal of Child Psychology and Psychiatry titled "Time trends in autism diagnosis over 20 years: a UK population-based cohort study" reported an exponential increase in recorded autism diagnoses. It concluded that the surge was primarily due to heightened diagnosis among adults, females, and individuals with higher functioning. Similarly, in June 2023, The Lancet published "Autism in England: assessing underdiagnosis in a population-based cohort study of prospectively collected primary care data", projecting exploratively that up to approximately 1.2 million people in England may be autistic and undiagnosed. [please insert link to https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13505]
As far as we are aware, there haven't been any reliable studies aimed at determining the number of neuro-divergent doctors and surgeons practicing in the UK. However, it's reasonable to assume that there are likely many, both diagnosed and undiagnosed. Encouragingly, some neuro-divergent doctors are openly sharing their experiences, underscoring the numerous strengths they bring to their clinical practice. Examples include Dr Lucy Clement who shared her experiences of qualifying as a GP in 2013 and then being diagnosed with ADHD in 2019, in The Times (ADHD and women: the hidden epidemic [insert link to https://www.thetimes.co.uk/article/adhd-and-women-the-hidden-epidemic-90h8vftxx], and Catriona McVey, whose essay “Neurodiversity in doctors and its impact on their profession” is published on the website of the Royal College of Psychiatrists [insert link to 'Neurodiversity in doctors and its impact on their profession' (rcpsych.ac.uk)]. Organisations such as Autistic Doctors International (https://autisticdoctorsinternational.com/) seek to (among other things) provide a peer support network for doctors who might otherwise feel somewhat isolated by their condition(s).
What does the GMC say about neuro-diversity in doctors?
The GMC provides a guide titled “Welcomed and valued: Supporting disabled learners in medical education and training.” This guide explicitly acknowledges that autism and ADHD are covered under the definition of "disability" according to The Equality Act 2010 and the Disability Discrimination Act 1995. It offers advice to assist organizations in considering the best approaches to support medical students and doctors in training. Regarding "Interaction with colleagues and patients," the guide prompts organizations to contemplate, "What reasonable adjustments have been made for the doctor? For example, a doctor with autism spectrum disorder could receive training to support them with their communication skills…" However, this GMC guide does not address the support for doctors or surgeons who are already qualified and established in their careers, and who may have recently received or are seeking a diagnosis. Additionally, the guide does not explicitly recognize that many neuro-divergent doctors and surgeons consider it inappropriate and harmful to use the impairment-based word "disability" to describe their condition, and prefer to identify as neuro-divergent rather than disabled.
What about Good Medical Practice 2024?
The GMC has introduced updates to its code of conduct document, Good Medical Practice (“GMP”), effective from 30 January 2024.
Notable revisions in GMP 2024 include a clear mandate for doctors and surgeons to treat both patients and colleagues with “kindness, courtesy, and respect.” GMP 2024 underscores, in paragraphs 23a, the importance of “communicating sensitively and considerately, particularly when sharing potentially distressing issues about the patient’s prognosis and care.”
Concerning colleagues, GMP 2024, as outlined in paragraph 49, emphasizes the necessity to: a) listen to colleagues, b) communicate clearly, politely, and considerately, c) acknowledge and respect colleagues’ skills and contributions, and d) engage collaboratively with colleagues, being ready to lead or follow as circumstances dictate.
While these objectives are commendable, there is a concern that neuro-divergent doctors and surgeons (whether diagnosed or not) may face challenges in demonstrating compliance, compared to their neuro-typical peers. For instance, individuals with ASD may struggle with eye contact, which could be misconstrued as inattentiveness. Similarly, those with ADHD might find it challenging to communicate clearly under pressure or make tangential comments, while others may have difficulty interpreting social cues, inadvertently appearing rude or inappropriate.
Consequently, neuro-divergent doctors and surgeons might be disproportionately affected by hospital and/or GMC investigations, based on alleged breaches of the new “kindness” requirements.
On a positive note, GMP 2024, in paragraph 56, unequivocally states that GMC-regulated individuals must refrain from abusing, discriminating against, bullying, or harassing anyone based on their personal characteristics, including disability. Given that many neuro-divergent conditions fall within the definition of “disability,” there should be enhanced protection for neuro-divergent doctors and surgeons facing prejudice or discrimination. Any GMC-regulated individual found to discriminate against a neuro-divergent colleague would be violating GMC 2024 and could be subject to a hospital or GMC investigation.
What about employment law?
Regrettably, neuro-divergent doctors may encounter challenges stemming from their conditions, particularly in communication, which can lead to disputes with their employers, including NHS Trusts.
For instance, in July 2023, an Employment Tribunal (in Mr A Macleod v Royal Berkshire NHS Foundation Trust, Case Number 3332631/20148) ruled that an autistic NHS doctor had experienced direct disability discrimination from a neuro-typical colleague. The colleague made insensitive remarks about the doctor's condition during a meeting, ironically convened to address concerns about the doctor's communication style. In a remedies hearing in November 2023, the autistic doctor received compensation. Representing himself in the Employment Tribunal proceedings, the doctor highlighted the challenges faced while working with predominantly neuro-typical colleagues. The Judge accepted that he had been “…in a position of considerable distress for a number of years…” prior to the meeting at which the discriminatory comment had been made.
How can neuro-divergent doctors and surgeons protect themselves?
The question of how neuro-divergent doctors and surgeons can protect themselves is extremely complex. Most neuro-divergent conditions are spectrum conditions, so there will be a wide variation in what aspects of a clinical job the person will find more difficult, and the severity of the difficulties. Also, there are a huge variety of clinical roles, and difficulties can change over time as a person becomes more senior and is expected to take on new responsibilities. Therefore, the question of how any individual doctor or surgeon can best protect themselves and their career has to be considered on a case-by-case basis.
It is essential that neuro-divergent doctors and surgeons are supported (and, where necessary, represented) by compassionate specialists who are also literate in neuro-diversity issues. If a dispute is or could be referred to the GMC, then the professional regulatory issues require very careful balancing to achieve the best outcome. The same fact can be exculpatory in one respect, but harmful in another. For example, if a doctor’s explanation for alleged rudeness is their ASD, it helps that there was no intention to offend. But if the doctor’s ASD is so severe that they cannot communicate ‘kindly’ even with adjustments and support, then the GMC will have to consider whether the ASD is a health issue that affects the doctor’s fitness to practise. Advice on remediation will be needed, which must be holistic to take into account both the regulatory issues and clinical factors about the doctor’s condition. Matters can be further complicated where there is an employment dispute going on between the doctor and their employer, or a dispute between the doctor and a private hospital over their practising privileges.
How can Incision help?
Incision Members have cover for the cost of specialist legal advice in GMC investigations. Incision works with exceptional lawyers who have the knowledge and experience to get the best available outcome for its Members, including those who are neuro-divergent or suspect they may be.
Just as importantly, Incision provides a 24/7 medico-legal helpline, so that Members have access to a sympathetic and knowledgeable medico-legal team to provide additional support when issues do arise.
If an Incision Member is facing difficulties in their professional life that may be related to a neuro-divergent condition, they should call the Incision helpline to discuss as soon as possible. Try not to wait until the issue has escalated to a formal employment dispute or GMC referral, because most difficulties can be addressed more effectively at an earlier stage.
Part 2: Recording for Entertainment Purposes
As clinical consultations witness a growing trend of patient-initiated recordings, whether via video services or mobile devices, the landscape presents new challenges for surgeons and doctors. More professionals may encounter requests for consultations to be recorded, and sometimes discover post-consultation recordings without prior consent.
Understanding the Intentions
Part 1 delved into recordings for a patient's personal use, aiding their comprehension of advice. However, some of our members have had patients who want to make the recording for entertainment purposes only. Examples have included patients who are lifestyle vloggers who want to share the footage with their followers. There have also been patients appearing on reality TV, so the footage would be broadcast or streamed. The phenomenon is particularly relevant to cosmetic or aesthetic medicine, but such requests have been known even for routine orthopaedic surgery.
Balancing Professional Conduct
Consultations should involve a full and frank discussion. There is a risk that the patient will omit important medical information, or their real reasons for wanting the procedure, if they are being filmed. That would make it much harder for you to give the right clinical advice, and to get their informed consent. The purpose of these recordings doesn't align with aiding patient understanding; instead, they serve as entertainment for third parties or for the patient's professional/publicity motives. Politely refusing such requests is often appropriate, safeguarding both patient and practitioner interests.
Considerations for Filmed Consultations
Doctors and surgeons filmed for entertainment should be vigilant about data rights and professional reputation. Uncontrolled usage of footage could compromise your reputation. Deepfake technology poses further risks, potentially distorting the reality of the footage, impacting your credibility. Sadly, there have also been incidents where a patient has taken a covert recording and shared it online or on social media without consent, often accompanied by disparaging comments. If you become aware of any such incident, you need to seek medico-legal advice immediately. It is vital not to comment online about any aspect of the incident without medico-legal advice, because of professional conduct considerations such as patient confidentiality and acting with integrity. You may need formal legal advice about what remedies are available to get the footage taken down and to protect your reputation.
Managing Complicated Scenarios
Perhaps the most difficult situations will arise where the patient does have a genuine medical need to make the recording to being to revisit and understand your advice properly, but also wishes to publish the footage for entertainment, professional or publicity purposes. The difficulty is that you may not be able to prevent the creation of the recording itself, but ideally you would still want to prevent it being broadcast or shared afterwards.
In this scenario, if at all possible you should pause or postpone the consultation until you can get medico-legal guidance on how to manage the various issues properly in the specific circumstances.
Support from Incision
Our members have the benefit of medical indemnity insurance to protect them in the event of a claim, including those where the evidence includes consultation recordings. Just as importantly, they have the benefit of cover for the cost of legal advice and representation if these issues result in a referral to the GMC.
Members also have the benefit of 24/7 medico-legal advice provided by dual-qualified doctors and lawyers. This means that as developing trends and evolving technologies raise new ethical questions and new liability risks for doctors, surgeons and clinics, there will always be specialists on hand to provide expert yet sensitive guidance to Incision members.
Extending far beyond our comprehensive coverage, Incision provides all members with a wealth of risk management material, educational resources and 24/7 in-house medico-legal support.
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