A Note to My Younger Self

I was thrilled to get the chance to write this blog for the Association for the Study of Medical Education (ASME), who are leaders in teaching and professional development for medical educators in the UK. Teaching doctors, and the doctors of the future, is an incredibly important responsibility. What I love about ASME is their organisational approach to diversity, inclusion and equity. I learned a lot from their recent Black History Month feature.

My blog is featured in a booklet titled "ASME Celebrates People With Disabilities". You can find more excellent resources about disability in medicine on the ASME page here: https://www.asme.org.uk/about-us/diversity/disability-awareness-2022.html

Here is my piece:

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A note to my younger self....

There you are Sarah, running late to your 8am university lecture. Again. Rehearsing excuses like frantic prayers. Cursing yourself.

Why can’t you just be at the right place, and on time like everyone else?

It’s not like you have a good reason to be late. There’s no crisis. You’re not unwell.

Sliding into the lecture hall through the back entrance (you know all the back entrances by now!). A classmate notices your arrival with amusement. Sarah-always- late! Someone has collected a handout for you.

They think it doesn’t bother you. After all, you always look calm and unemotional (you later learn muted facial expressions are part of your autistic motor apraxia). In second year, medical school you already have a reputation for:

• Early morning no-shows (task initiation difficulty).

• Sloppy handwriting (motor apraxia plus joint hypermobility).

• Scraping through assessments, last minute cramming for exams (planning and organization difficulty).

• Being friendly, honest and very shy (difficulty processing verbal conversation, dislike and avoidance of social politics).

Others see it as a lack of passion for high achievement. Which is: Not. True.

Being accurate, excellent, reliable and delivering on commitments runs deep in your personal integrity. These frequent slip-ups are like burn marks on your soul! It was a shock to discover university is not comfortably routine like school. The energy you spend just to be on time, know when assignments are due, how to study, and how to make friends...

It feels like running up the down escalator.

You wear the mask of scattered-but-friendly. People find it likeable. But you are struggling to find a solid group of friends at university. In high school, you had a small group you really connected with (spoiler: they were probably neurodivergent too). But friends like that take time to find, and right now you feel uprooted and overwhelmed!

You guess maybe you’re not smart after all. Everyone must have been wrong about you. In high school, you sailed through the academics with a quick grasp of concepts, and intense but last-minute study. That doesn’t seem to work in medical school due to the sheer volume of units and demands. Maybe you haven’t got what it takes to be a good medical student.

What if you haven’t got what it takes to be a doctor?

Oh university Sarah.

That hidden struggle.

I would like to tell you: you are doing the best that you can.

It’s not that you aren’t trying hard enough. It’s because you’re autistic and an ADHDer. “Basic organisation” is as inaccessible to you as stairs to a wheelchair user.

Sarah. To level the playing field, you would need to exert the same executive function, communication and social effort as your classmates. That would be possible if you were given:

• A study plan, broken down into manageable steps

• Communication that suited your needs: text based and visual, NOT verbal

• Supportive social community: connecting with others based on shared interests NOT gossip and group politics

• Help for executive function: manage your finances, prep your meals, clean your house, do your paperwork.

• Time and encouragement to sensory-regulate...

THEN you would be a high achiever.

That’s the support you have now in your future.

Now that you’ve identified your neurodivergence and learned to stand up for what you need to thrive.

It took having 2 beautiful autistic ADHDer kids and standing up for them, to find this out about yourself.

Your time will come. You will be a specialist geriatrician and an neurodivergent disabled advocate. The future is busy and golden.

I love you so much.

Be you later,

Old Sarah.

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Recommended Resources:

My blog about disclosing my neurodivergence at work https://neurodivergentdr.wixsite.com/website/post/getting-my-neurodivergent-on-at-work

My podcast interview for Neurodivergent Woman Podcast about disabled identity, and being a disabled doctor https://omny.fm/shows/the-neurodivergent- woman/disability-with-dr-sarah-bernard

Emma Sharma “Neurodivergent Emabler” an autistic ADHD inclusion advocate has created this wonderful guide to executive function reasonable adjustments in the workplace. This is suitable for employees with executive function, and managers/employers: https://www.neurodivergentemabler.com/files/Workplace%20Adjustments%20for%20Executive%20Dysfunction.pdf?fbclid=IwAR1SUhiMp9AkjOhCUTE_LQ9CrS7Ssh9XSXr57hJHA_XKNQLpiTJwA2-2OAY

Reframing Autism is a fantastic website full of neurodiversity affirming autism resources, suitable for autistic people and allies: https://reframingautism.org.au/

Neuroclastic is a neurodiversity affirming autistic advocacy organisation based in the United States, with a wealth of resources and infographics. This site is suitable for autistic people and allies. The intersections of oppression between autism, race and nonspeaking status are a strong focus in their resources and advocacy https://neuroclastic.com/