Introduction
My relationship with medicine has often been viewed, both by myself and others, through the lens of mental illness and burnout. Looking back with the benefit of an autism diagnosis, I see a different story. The recurring problem was never medicine itself. The problem was the cumulative sensory, social and cognitive load of trying to function in environments that demanded far more from me than anyone realised, including myself.
Education
I studied postgraduate medicine at Warwick University. I loved the academic side of the degree and progressed through the examinations with relatively little difficulty. The clinical side was very different. Patient contact was extremely challenging from the outset. During placements I was almost always paired with a clinical partner and I would often let them take the histories because I genuinely did not know how to approach patients or what questions to ask. I was frightened of getting it wrong and lacked the intuitive social framework that seemed to come naturally to everyone else.
I reached final year still struggling with this. By that stage I hated the degree and wanted to quit. However, I was determined to finish. My grandparents were incredibly proud of me and I was also conscious that I had previously left my first degree after one term. Completing medicine became something I felt I had to do.
Graduation
Shortly before finals I was told that I would fail if I did not learn how to take a history properly. It was at that point that I realised I genuinely did not know how to ask questions. Throughout life I had largely relied on people volunteering information rather than actively seeking it. A friend effectively taught me how to take a history from first principles. She explained the thought process, the structure and the purpose behind the questions.
Once the framework became explicit, everything changed. I became good at history taking. However, I still struggled whenever a patient gave an unexpected answer or presented with something that did not fit a diagnosis I had already considered. My mind would freeze and go blank. Again, my friend taught me strategies. She explained that I could ask broader, open questions to generate new information or simply tell the patient that I needed a moment to process what they had said. Once I understood these rules, clinical work became much more manageable.
Misconception
Looking back, this pattern occurred repeatedly throughout my life. I was not unable to do things; I was unable to do them intuitively. Once somebody made the hidden rules explicit, I could often perform very well.
I passed finals without difficulty and started Foundation Year 1 in 2010. During the second half of the year I began to struggle significantly. I had no social network, spent most of my time either working or travelling to see my husband, and hated the job. At the time I assumed everyone found Foundation Year 1 difficult and that I simply needed to persevere.
Gradually my sleep deteriorated. I lost my appetite. I became increasingly distressed and could not talk about work without crying. I progressed into Foundation Year 2 and started a GP placement. This was probably the worst possible environment for me. Every consultation involved uncertainty, rapid decision-making, emotional interactions and constant switching between different problems. Patients would come into the room distressed and I would think to myself that I was coping far worse than they were.
Admission
After a short period I saw my GP and was signed off work because I was barely sleeping and could no longer think clearly. At the time I had not appreciated how impaired I had become. My identity was so tied to working that I could not imagine surviving without the structure it provided.
Initially, the time off made little difference. Then, after several weeks, my brain seemed to stop fighting and I crashed completely. I lost a large amount of weight, slept only a few hours each night and no longer wanted to be alive. During a meeting with my supervisor he immediately recognised how unwell I was and arranged admission to a psychiatric unit.
I remember little about that admission. What I do remember is struggling enormously with the noise and sensory environment. In hindsight, the sensory difficulties were becoming increasingly prominent. Following discharge, I slowly improved. I became pregnant in 2012 and a change in medication led to another significant deterioration. During pregnancy I was admitted to a mother and baby unit. I experienced severe distress and intrusive thoughts and eventually underwent multiple courses of ECT both before and after my son’s birth.
Medication
Although depression was undoubtedly present, what stands out to me now are the symptoms that were never fully explained by depression alone. Throughout this period I experienced what I called “brain burn” – an overwhelming burning/prickling sensation in my frontal lobe that indicated my brain was being overloaded. Light, sound and touch became almost unbearable. Small amounts of sensory input could trigger intense worsening of symptoms. Walking down a corridor felt like trying to force my body through thick treacle. There was a constant sensation of downward pressure inside my head, as though my brain was being crushed under a weight.
Eventually the right combination of medication brought some improvement. During this time clinicians suggested that I might be autistic, particularly given my sensory difficulties and family history, but I was considered too unwell for formal assessment.
After a total admission of approximately one year I was discharged. For a prolonged period my parents and my husband’s parents shared much of the care of our son because I was unable to do so myself.
Diagnosis
Several years later, once I was sufficiently well, I underwent a formal autism assessment and received a diagnosis of autism with marked sensory involvement.
The impact of the diagnosis was profound. My recovery accelerated afterwards. For the first time I understood why I had struggled with things that appeared effortless for other people. I stopped comparing myself to people whose brains worked differently from mine. Difficulties that I had previously interpreted as personal failings suddenly made sense.
I decided that I owed it to myself to try medicine again. I had invested so much effort into becoming a doctor that I felt I needed to determine whether medicine itself was truly the problem. My plan was simple: if I still hated it, I would leave.
Instead, I discovered that I loved it.
Employment
I returned to work in 2018 and remained in a small hospital for five years. The environment was relatively manageable. There were quieter areas, opportunities to step away when needed and a level of predictability that suited me. I enjoyed my work and remained committed to medicine.
This period is important because it demonstrated something I had never previously appreciated. The issue had never been clinical responsibility. It had never been a lack of ability. Given the right environment, I could practise medicine successfully and happily.
In 2023 I entered specialty training. Even the interview process highlighted some of my differences. When asked why I wanted to do the specialty, the only answer I could generate was “because I want to do it.” My husband largely helped construct interview responses that translated my motivations into language that interviewers expected to hear. Looking back, this was probably influenced by alexithymia. Once I had learned the framework, I performed very well at interview.
Regression
The problems began again after moving to a new trust. I started in intensive care. The environment was completely different. There were unfamiliar systems, difficult workplace relationships, constant noise, sensory overload, night shifts and frequent context switching. Some interactions with colleagues left me feeling belittled and scrutinised. I disliked the IT systems and struggled increasingly to switch back to a normal sleep pattern after nights.
At the same time, I was preparing for PACES. The examination itself was not simply a test of medical knowledge. It required prolonged social performance, rapid adaptation and sustained processing under pressure. By the time I sat PACES in February 2024, my cognitive resources were exhausted. I could no longer think clearly and I failed the exam.
I was subsequently absent with burnout for six months, followed by a prolonged phased return.
Reflection
What strikes me most when looking at the entire timeline is that the major deterioration was rarely triggered by clinical complexity itself. Instead, it consistently followed periods of excessive cumulative load: noise, constant social interaction, uncertainty, unfamiliar systems, lack of recovery time, sleep disruption and sustained sensory exposure.
The common factor was not medicine.
The common factor was an autistic nervous system being pushed beyond its capacity for too long.
Conclusion
For many years I interpreted my experiences as evidence that I was struggling to be a doctor. The evidence now suggests something different. Throughout my career I repeatedly succeeded once expectations and frameworks were made explicit. I passed medical school, completed foundation training, returned to work after severe illness, practised successfully for years and entered specialty training.
The challenge was never whether I could do medicine.
The challenge was determining the conditions under which medicine was sustainable.
Understanding that distinction has changed the way I view my entire career.
