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I'll finish up my fellowship this summer and it will have been a solid 10 years from when I started medical school. The vast majority of people have no idea what goes into medical training (even my own parents remain confused) - and that's okay, there's no need for everyone to know these ins-and-outs, but when we're passing judgment on the medical curriculum and adding additional things, it does become important.

You can talk about adding a class in medical school addressing neurodivergence and disability, but how do you really address that spectrum of diversity in a single class? And what aspects do you really retain a decade out when patients with neurodivergence can be relatively rare (depending on your specialty)?

In the end, I think the best learning comes from seeing patients (especially, again, as the spectrum of what these patients experience is so diverse and individual). I am always grateful to patients who provide guidance along with parents or caregivers and nurses who had often cared for that patient before for their advice on how to approach a specific patient, along with individual behavior plans if in place.

Not to diminish the difficulty of the existing curriculum, but it doesn't seem fair or sustainable to ask for patients to train and guide each physician they see in how to work with neurodivergent individuals. I'm sure there is much from formal education that new physicians don't retain, but that doesn't mean it is not worth teaching.

I see neurodivergent individuals (or at least, significantly neurodivergent that a more individualized approach is needed) relatively rarely in my field of work (adult oncology, where the average patient is much older and has often had significant exposure to the healthcare system). Every patient I've seen has been very different in terms of needs and their prior experiences and so I have difficulty imagining a "standardized" curriculum for these patients that is specific enough to add value but broad enough to apply to every medical student, but I'm happy to be corrected on this.

And, I mean, if we're talking about neurodivergence more broadly and including people who generally "pass" as neurotypical, then that's a huge chunk of the population. Really, any time you talk to a patient, you should be assessing where they're at, in terms of general understanding and preferences, and should always tailor your approach to an individual.

Seems like the most obvious solution would be to have some sort of case manager/continuum of care type support for these types of individuals. I’m pretty sure this already exists for geriatric patients but maybe not widespread enough?

There’s too many particularities that can come up with individuals that are “non standard” for whatever reason. Any new physician for a particular patient could easily get up to speed on those particularities at the time it’s needed and not have to fumble through the friction it presents AND they don’t need any extra training to do so (probably?).

As an autistic person, it unfortunately does not work like that. Every single neurodiverse person has their own unique needs. There is no one size fits all technique, not even close. The best you can do is teach some general strategies and an awareness of the fact that these people have unique needs. And generally we do teach these things.

It unfortunately is up to the individual to work with their practitioner to come up with an individualized plan of care. It really can't be any other way. Any attempt you make to come up with a universal standard of care for neurodiverse patients will necessarily exclude and likely harm people on other parts of the spectrum.

Over-generalizing these things sounds like a good idea up front, but it ends up causing more harm overall. We get stuck with narrow and rigid standards of care that just don't work for more than a small subset of people. This has been a real problem with autism in particular: until very recently the diagnosis and treatments were only concerned with young white boys. There's a very serious problem with women, adults, and all other groups being drastically under-diagnosed and left untreated. More generally, there are very few resources for autistic adults because of this. It's very slowly changing though

> For anyone who wants to complain about what doctors should or should not learn during medical school: first go learn what the curriculum does teach, then ask yourself if you're even mildly qualified to make those judgements based on your understanding of healthcare, and then maybe you could comment on what would have to be left out of education to accommodate for X, because the curriculum is already super bloated and a firehose of information.

I think this knee jerk reaction is unwarranted. The writer is a doctor herself, so she's well-versed with the breadth and depth of medical school curriculum, and everything that comes after that.

But I don't agree that your breakdown about medical school curriculum is accurate or correct, definitely not across different schools. For example, the Harvard Medical School curriculum offers classes for Sports or Rural medicine practice (subjects for highly specialized medical focus), so I don't understand why something for autistic or disabled patient care cannot be included in either those subjects, or separately. My guess is that it probably is to some degree, but not to the degree that this article writer would prefer. Source: http://tinyurl.com/mr8ncn2p

All specialized fields have "firehoses of information", and dismissing an opinion about improving the quality of care for patients who have different needs as "adding too much" is just lazy.

I’ve always wondered if a lot of the dismissive culture is an institutionalized mechanism to help people cope with the fact that some of what they learn and do is either very suboptimal or harmful. The history of medicine is long. You can see some big differences if you work on stuff that touches different countries.

That's a complete dodge, and exhibits exactly the kind of arrogance people complain about when physicians ignore what patients have to say. People have valid opinions and expectations of their own healthcare or that of loved ones, no matter whether they can design or refine a medical school curriculum or not. It's silly to suggest that nothing they have to say is valid if they can't. People know when they or their family are receiving good care, and when they are not. To reject their experiences is, again, arrogance.

No its not. Random people have no fucking clue what they're talking about, HN is a perfect example. As it turns out, looking at WebMD for 15 minutes is actually not a comprehensive medical education.

Both parents are doctors. They complain all the time how they get patients who have no idea what they are talking about come and assume they know better than them. Patients lie ALL THE TIME for no reason at all. Patients also expect long periods of 1:1 time with Doctors about dumb BS a Resident could handle by tossing handfuls of Motrin at the patients general direction and counting how many pills fall into their mouths.

I personally saw one patient scream many slurs at a Doctor for being bad at medicine after the doctor asked what drugs they may have taken (a innocuous question), and ripped out their IV and ran away.

This is the shit that Doctors/Nurses/Medical staff deal with. Hospitals are not a place to go to be pampered.

The 1949 Nobel Prize in Physiology or Medicine suggests the medical field can probably do a better job at building trust with the public. It’s a two-way street after all.

I know when my restaurant food tastes good and when it doesn't. But if I've never cooked the dish before, I don't know the first thing about how exactly to improve it.

Someone can know that their loved one was given substandard care, yet not know enough to know how to improve the system such that the care would have been better. Case in point: the family of the patient who died in the linked article, seem to think the systemic improvement that is needed is neurodivergence training. When in actuality, it was a failure to take into account the medical history of the patient which led to the malpractice that caused his death. It wasn't that the doctors didn't know what autism was or something.

Actually, most patients have no clue when they are receiving good care or not. For example, studies have shown that patient satisfaction after an office visit is highly correlated with whether they received a prescription. A lot of patients feel like they got their money's worth if the doctor hands them a script, regardless of whether they needed it.

I had to deal with pediatricians and Neurologists for last couple of years. My general experience is that their training is severely deficient in the empathy. I don't think it should be hard to accommodate it in their training plan.

I can say that doctors in Ireland aren’t categorically worse than doctors in the US so maybe we should start training doctors alright after HS instead of requiring a 4 year degree