Dr A will see you now
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7526.1211-a (Published 17 November 2005) Cite this as: BMJ 2005;331:1211
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As the mother of an adolescent with an Asperger Syndrome diagnosis,
and friend to many on the autistic spectrum, I was gratified to read Colin
Douglas' apology for his shockingly offensive attempt at humor, "Dr. A
Will See You Now." To err is human; to publicly acknowledge error, humane.
However, no matter how sincere the remorse of its author, this collective
character assassination was not simply the work of a "lone gunman." What
could Dr. Godlee, Dr. Smith and their colleagues have been thinking when
they approved this piece for publication? Will they have the decency and
humility to apologize, too?
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor
Colin Douglas is to be congratulated on his gracious apology.
As far as I know, I am not an ‘Aspie’ but I recognise some of their
qualities in myself; a preference for routine, a dislike of interruption,
a liking for structure.
The most contentious, and wounding, claim about people with
Asperger’s is that they lack empathy. A claim more precisely formulated by
those who say they ‘lack interpersonal skills’.
This canard is commonly used by those who wish to condemn the medical
profession, indeed a popular patient satisfaction survey styles itself as
testing doctor’s interpersonal skills rather than their consultation
skills.
In more tolerant times, quiet people were simply described as shy, or
reserved. However, since the end of the Cold War, barely contained
emotional incontinence seems to have become the standard against which
behaviour is judged.
Many people now act in public as they would in private.
Newsreaders seem unable to pass on the most trivial items of information
without waving their arms and grimacing at the camera as though the Last
Trumpet were echoing through the studio.
Their editors are constantly alert for the latest opportunity to
proclaim a period of national mourning, with the now statutory two minute
silences being televised almost weekly.
In the words of Theodore Dalrymple: “ No grace, no reticence, no
measure, no dignity, no secrecy, no depth, no limitation of desire is
accepted “
Those of us who watch these developments with bewilderment are
inclined to wonder precisely who it is that needs support groups.
John Hopkins
Competing interests:
None declared
Competing interests: No competing interests
To quote a fellow Soundings columnist from a few years back, ‘I’m in
trouble this week, and deservedly so’. In a recent column (BMJ 2005;
331:121) I tackled a sensitive issue in an insensitive way: writing – on
the basis of a range of observations over the years, but no very deep
scholarship – about issues that may arise for and around people in
medicine with Asperger’s syndrome.
A series of rapid responses have made clear a number of things: that
quite a few people – with and without Asperger’s, within and beyond
medicine – were seriously offended; that the tone of the piece – at once
flippant and somewhat glacial – was a major source of the offence caused;
and that any less than appropriately professional and compassionate
reference to any disability is unacceptable, in Soundings columns as
elsewhere. On reflection, therefore, there are no excuses: this was a
column to apologise for, and I am more than happy to apologise for it.
I learned other things too: that the sensitivities around any form of
autism are such that all comment must – quite reasonably – be carefully
and sensitively phrased; that there are people with Asperger’s in medicine
who are doing very nicely, and I am pleased to have heard from them; and
that some people with Asperger’s call themselves Aspies (whereas non-
autistic folk are labelled, for better or worse, neurotypicals).
I find myself now not only apologetic, but interested, more
sympathetic than I was, and wanting also to know more about the topic I
addressed. Are there studies, and if so what do they tell us? Is career
guidance available, and is it useful? And is there a support group, and
if not why not? But it would have been far better to have got there
without causing offence; and, for any offence I have caused along the way,
once more may I say frankly that I am sorry.
Competing interests:
None declared
Competing interests: No competing interests
The editors may now rest assured that with continued publication of
materials like these in what was once a serious and worthy journal, the
feared (which does not seem a terrific motivator to me) tabloid future for
BMJ is not a prediction, but a prophecy. Yet another low point for the BMJ
- what else is in store?
Dr. Reay, I agree with your sentiments. But I wouldn't be surprised
if the BMJ were soon to publish an openly homophobic or racist article.
After all, it once published a letter linking homosexuality and
paedophilia; recently a political opinion on why a Tory leader should not
be elected.
Nervous laughter? Shameful might be a better substitution.
The publication policy for 'Rapid Responses' reads that "gratuitously rude" responses will not be published. Yet the BMJ seems comfortable with not just rude, but bigoted and offensive personal opinions. That's hypocrisy.
Competing interests:
None declared
Competing interests: No competing interests
Dear Editor
I read with disbelief the soundings column written by Colin Douglas, ref.
as above. Whilst I appreciate that this may be his personal view only, to
suggest that doctors who are poor communicators all suffer with Asperger's
syndrome is unsupported by any evidence. Yet this was the least offensive
part of this column, which implied that people with this diagnosis are not
'normal people' and should be discriminated against in application for
medical school places. He celebrates the likely decline in predominantly
male Asperger sufferers in the medical profession as something 'a
blessing' to be celebrated with the corresponding rise in female doctors.
Not in my name, please.
Each paragraph has something critical to say about those colleagues he
finds poor communicators, and therefore feels confident in defining as
having Asperger's syndrome.
Asperger's syndrome is a disability which sufferers struggle to overcome.
The diagnosis is based on clear DSM criteria and cannot be made accurately
by labelling those colleagues the author finds difficult to get on with.
It is unlikely that such an article would have passed editorial review had
it suggested that the paraplegic, or deaf or blind doctor should be
taunted in this fashion and discriminated against purely on the basis of
their disability label. It is worrying that the author may even have sat
on Advisory Appointments Committees or medical school interview panels
with such prejudiced and unsubstantiated views.
Mental health disorders are genuine disabilities, yet this article shows
that this is still not well recognised even by our own profession.
Finally, I would much prefer to be treated by a doctor with an 'appetite
for detail' with poor eye contact than one with the cheerful yet warped
charm of Shipman.
Your sincerely
Helen Fidler BSc MD FRCP
Consultant Gastroenterologist
University Hospital Lewisham,
Lewisham High St,
London
SE13 6LH
Competing interests:
None declared
Competing interests: No competing interests
This piece just goes to show that insensitivity can creep into our
lives in many forms. It was socially very difficult and excluding, for
example, to become a parent of an autistic child. I am sure neither we, or
almost anyone we knew, coped with it at all well.
I have often thought it could be socially very problematic to write
fiction, manipulating experience for artistic or financial ends. How do
you feel about the people whose lives become your material (even in a
removed way)? How do they feel about you?
I wonder how many doctors feel really good at breaking bad news. I
also wonder whether the problem of Asperger syndrome is not lack of fellow
feeling, but rather an inability to pick up on certain codes.
Competing interests:
Autistic son
Competing interests: No competing interests
I was almost not going to respond, dumbfounded by Colin Douglas'
piece, but then I came across a poster of the "see me" campaign at
Edinburgh University today. Although this campaign is about mental health
and autism is not a mental illness, I was struck with how well the slogan
fits:
"see me, I am person, not a label"
It is absolutely unnecessary to label a person or group by their
medical condition (if Asperger's is a "medical condition" at all) to
describe the fact that some doctors (male AND female according to my
experience, btw) lack interpersonal skills. This is certainly a fact,
however this is nothing that could be amended by identifying "Asperger's"
in male doctors as the cause and stigmatising anyone who has been
diagnosed with Asperger's to this extreme.
When my best friend's son was recently diagnosed, she was glad that
she might understand and help him more appropriately. I am sure she would
be rather upset if she knew that there are people who think that her son
per default/label will have "little or no value for, or even awareness of,
the feelings of others", that he'd be "odd, insensitive" and be "stuck in
the middle order". It is opinions and opinion pieces like these that make
the lives of the "labeled" persons more difficult.
So, see the person, not the label.
Catherina Becker
Competing interests:
None declared
Competing interests: No competing interests
A doctor with particular attention to detail and encyclopedic
knowledge of his specialty is what EVERY patient needs. Bedside manner
may count for something , but in the final analysis, it's a doctor's drive
to practice successfully and with excruciating perfection that saves the
patient's life.
Competing interests:
None declared
Competing interests: No competing interests
I could easily accept the premise of this article and state that I
have a GP like that, however that would miss the point. I am the one with
Asperger's syndrome not he.
The author of this article is clearly more in tune with the urban
legends of autism than the reality, for I am sure no one would describe me
as uncaring, having spent half a life time caring for a disabled mother
whilst still finding time to be an advocate and volunteer for other
disabled people.
Indeed the author fails to see that what passes for empathy is often
nothing more than a social construction that hides the thin veneer of self
interest for many neurotypicals (non autistic folk. The word has been
unknown in the English language for centuries, the population having got
by without invoking its usage until the recent popularity of Sociology.(an
infection that I too have succumbed)
I would rather see a doctor who is competent to practice medicine, who
can distinguish fact from fiction and accuratly diagnose a complaint, than
someone who passes the time in idle chatter,
remembers nothing and misses the whole point of the consultation.
Competing interests:
None declared
Competing interests: No competing interests
Autism Awareness Training
One of my medical colleagues made me aware of the outrage that had
been provoked by Dr Douglas's original article followed by his subsequent
apology and request for education. I do not wish to add to the debate but
feel that our service could participate in the rehabilitation of his moral
and intellectual reputation through the offer of a place on the Autism
Awareness training that we run at the Glasgow Autism Resource Centre.
The Glasgow ARC is a joint venture between the Greater Glasgow NHS
Board, Glasgow City Council and Voluntary agencies (National Autistic
Society, Scottish Society for Autism, Strathclye Autistic Society). The
Centre was established with funding from the Scottish Executive and has a
remit to develop services for adults with Autism Spectrum Disorders
including Asperger's Syndrome. We provide diagnosis and support to
clients and their families or carers and will train anyone interested in
increasing their awareness of autism for free.
We look forward to adding Dr Douglas to the list of over 1500 people
we have trained in the past year who have included clients, parents,
teachers, police officers, social workers, psychologists, junior doctors
and consultant psychiatrists. Our courses are run all day on a Wednesday
and are usually oversubscribed. However, we will make a special
concession and keep a place for Dr Douglas.
All he needs do is give us a call (0141 201 6247),clear a day in his
diary and bring a packed lunch. We will ensure that for the price of his
train fare from Edinburgh he has a stimulating educational experience that
brings him up to date with autism.
Competing interests:
None declared
Competing interests: No competing interests