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Dr. Shaun Murphy (played by Freddie Highmore) is a young surgeon with autism spectrum disorder (ASD) in "The Good Doctor," now in its seventh and final season on ABC. Especially early on, the character's job at the hospital was frequently threatened and would have been lost were it not for the practical and emotional support from the hospital president.
I don't know how many "Dr. Murphys" practice medicine in real life -- ASD prevails in about 1-2% of the general population -- but I do know that ASD is a complex neurodevelopmental disorder characterized by two main types of symptoms:
1. Social communication and interaction challenges: People with ASD often have difficulty with social aspects of communication and interaction. These can include:
- Difficulty with social-emotional reciprocity, such as initiating or responding to social interactions
- Challenges in nonverbal communicative behaviors used for social interaction, like eye contact, body language, or understanding and using gestures
- Difficulty in developing and maintaining relationships appropriate to the developmental level
2. Restricted, repetitive patterns of behavior, interests, or activities: People with ASD may display behaviors, interests, or activities that are restricted and repetitive. These can include:
- Stereotyped or repetitive motor movements, use of objects, or speech
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior
- Highly restricted, fixated interests that are abnormal in intensity or focus
- Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment
The severity and combination of symptoms can vary widely among individuals with ASD -- hence the word "spectrum" was added to the diagnosis of autism in 2013. Symptoms of ASD are typically recognized in the early developmental period, but may not fully manifest until social demands exceed the individual's capacities. Symptoms can also be masked by learned strategies in later life, but individuals may suffer from the stress and effort of maintaining a socially acceptable facade.
This last point, that symptoms may be masked in adulthood, weighs heavily, because I can see myself as an outlier on the autistic spectrum. Not too long ago, a colleague who knows me well suggested half-kidding that I may have had autism as a child.
"No way," I said.
"Think about it," she replied. "You don't socialize much, you have rituals (two showers a day), you're rigid and set in your ways, and you're fixated on your hobbies. I bet if we gave you the ADOS-2 [Autism Diagnostic Observation Schedule, Second Edition], you'd come out on the spectrum."
I was speechless. I revisited the DSM criteria for ASD and researched some of the characteristics that may potentially correlate with or predispose someone to a career in medicine. Here is what I found:
Attention to detail: Many individuals with ASD have an exceptional ability to focus and pay attention to detail. This can be particularly useful in medicine, where precision and meticulousness are crucial.
Strong memory skills: Some people with ASD have excellent memory skills, particularly for factual information or processes. This could be beneficial in a medical profession where remembering large amounts of information is required.
Systemizing tendency: People with ASD often have a strong interest in systems. This can translate into an interest in the human body's systems and a passion for understanding how they work, which is a fundamental aspect of medicine.
Perseverance: Many people with ASD can be exceptionally determined and persistent, especially when they are passionate about a particular subject. This trait can be very advantageous in the demanding field of medicine.
Honesty and directness: Individuals with ASD often have a straightforward and honest communication style. While they may need to develop soft skills for patient interactions, their honesty can be an asset in a profession where transparency and integrity are valued.
Special interests: People with ASD often have intense special interests. If their interest lies in the field of medicine, they could excel in this field due to their ability to focus intensely on their area of interest and specialization.
Until recently, there has been little research into the experiences of doctors with autism. However, a 2023 of 225 physician members of the U.K.-based support group , representing about 45% of its membership, shed light on challenges faced by neurodivergent doctors in their profession. The findings are shocking:
- 24% have attempted suicide
- 77% have contemplated suicide
- 49% engaged in self-harm
The average age at a formal diagnosis of autism for doctors was 36 years old, confirming that high intellect and specific aptitudes – in this instance, aptitudes viewed as medical "assets" -- may explain why signs can go undetected for years and mask the diagnosis in adults.
There have always been autistic doctors, but this survey revealed that the field of medicine is extremely challenging for the neurodivergent clinician to navigate. The survey also highlighted the need for greater support and understanding of autistic doctors -- and autism in general -- within the medical community.
Indeed, a 2019 demonstrated that medical students report low knowledge of ASD, and more than 90% of students cite inadequate preparation for caring for individuals with autism. Medical students also reported a greater need for increased education and training in ASD care.
Although a diagnosis of autism can have unfavorable consequences if individuals are met with denial or discrimination from employers, the condition is not a reason for organizations to impede the successful practice and career progression of doctors with ASD. Like the good Dr. Murphy, a successful career in medicine is possible for doctors on the autistic spectrum if the condition is recognized and supported sooner and appropriate accommodations are made.
I don't doubt I share some of the disorder's features with individuals who fall on the autistic spectrum. Considering that ASD is a spectrum disorder, meaning characteristics can vary greatly from person to person, not all individuals with ASD will have these traits, and having these traits does not necessarily mean an individual with ASD will want to or be able to become a doctor.
To be clear, I was never diagnosed with an ASD. But for anyone, receiving the correct diagnosis -- in the field of psychiatry, especially -- can be a moment of sudden enlightenment and perhaps explain a lifetime of difficulties.
, is a former , a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of and .
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