17 March 2025
In this RCEM Blog, Paul Robinson, post CCT clinician and Co-Lead for Neurodiversity on the College Equity Committee, shares his personal journey with ADHD for Neurodiversity Celebration Week.
Here is a recent story to start us off. I recently commuted to London from the midlands to attend my two-day ATLS instructor course. During the first ten minutes of the introductory lecture I was conscious of the following background noise in my head:
The song ‘Family Madrigal’ from ‘Encanto’ that is on my daughter’s bath time playlist. The scene in ‘Return of the Jedi’ where Luke pushes a stick in the Rancor monster’s jaws. What to say about my evening plan to my wife and her mother in law and why I left undiscarded empty bottles on the drainer, they have a purpose, don’t throw away my things. The inappropriate jokes the course director said the first time I did ATLS in 2013. The excellent salt and pepper beard on the candidate from Glasgow. Wondering if I know the other candidate in his group, where do I recognise her face from. Catastrophising about the course and also my exam result. The college of radiology is on the shady side of the square, hilarious.
And more.
The strange difference between this now, and, say five years ago, is that I have a diagnosis, some insight, and I’m medicated. I can see what is happening, and I understand now.
My journey into medicine was unconventional, starting medical school at 29. My prior as far back as the start of primary school described someone smart with clear inattentive traits. However, I did well enough to succeed and meet expectations, and never badly enough to raise major concerns. I swore from a very early age. Impulsivity leapt out from the depths of my stomach. An adult neurodivergent diagnosis is partly a curse, as it forces you to look at your entire past life through the lens of new understanding. What you find there is abundant grief, and shame. Shame for your behaviours, your lapses. Mine was grief for how many times I was gutted, destroyed by dysphoria at criticism and rejection, at how many times ADHD burnout obliterated me. “Cannot focus” and “Must try harder” in everything. And yet I made it to medical school with a masters degree under my belt. What was wrong?
I was misdiagnosed at 24 with a depressive illness, although I don’t blame the kind and brave GP who saw me. Medicating helped in the short term, sometimes, although the emotional numbing of twenty years of SSRIs is another different problem. Internally however I always knew. I knew, profoundly, that me interface with the world was not typical – and that is the core of neurodivergence. My feedback as a doctor was of a high standard and I’d (perhaps tellingly) found ED as a career irresistible.
But there were problems. Persisting agony and burnout, compounded by rejection-sensitive dysphoria. Extreme justice sensitivity creating conflict where iniquity was present. Friction with faculties. At my best, patients and juniors extolled my virtues. At my worst I was described as a “difficult doctor”.
I am telling you all this so very candidly because it matters. Neurodiverse individuals are three times as likely to divorce. Five times as likely to meet the legal system. Their peak earning potential is capped at £30k less than the neurotypical equivalent. Over a third of practitioner health program referrals relate to ADHD, and we are barely scratching the surface of recognition, diagnosis and need. We are, categorically, NOT “all a bit neurodiverse aren’t we”, as the aphorism goes. ADHD and its untreated consequences had been rampant in my life, with enormous misery and pain. It matters, because the prevalence of neurodiversity amongst Emergency Medicine clinicians is, at a rough guess, tenfold that of the background population.
That’s a lot of misery that your friends and colleagues endure.
Having approached a specialist psychiatrist, and then a psychologist in 2023 I was told what a part of me knew all along. The psychiatrist, particularly, said “You have ADHD. On every criteria. Adult and childhood. What speciality do you work in again..?”
My diagnosis gave me a tiny handhold to look at my life and career differently. The right medication immediately made a vast difference. I continued to progress and eventually got my CCT, but more pertinently I could begin to start processing over forty years of that grief, and shame, and who I was.
More introspective than ever, it turns out.
If you are reading this and wondering what the point is (not a typical blog post) then here it is: if you have a colleague with struggles on any level, consider undiagnosed neurodiversity. Practise radical acceptance for this array of conditions. Push for your hospital to recognise and support. Do everything you can to make your acceptance and reasonable adjustments work from the ground up, every day. You will have less friction, less sickness absence, less burnout, less shame.
And a happier, more attention-replete ED.”
RCEM – Share Your Story: At RCEM, we believe that sharing our experiences can foster inclusivity, understanding, and equality within the Emergency Medicine (EM) community. We invite you to contribute video or written insights for medical awareness and diversity days throughout the year, selected by our EDI team and NHS Employers.
