I seem to have found my practice niche. It was not my intention to care for so many families affected by autism, ADHD, and other developmental issues, but it seems that I attract these diagnoses.
I think part of the attraction has to do with how we run our practice. If you arere interested in working with this population, here are my thoughts on creating an autism-friendly practice.
Consider your space. Look at your waiting room when it’s empty. Consider whether there is a way to create a quieter pace in your waiting room. Can you add partial walls or rearrange the chairs so that there is a section with less visual stimulus? And then, take another look when it’s totally full of waiting patients. What does it sound like? Can you hold a conversation at a reasonable volume with a full waiting room? Or, does a crowd in that room require you to shout over the noise? Are your staff able to communicate with patients at the registration desk at a reasonable volume and maintain privacy? Are they able to hear your most soft-spoken patients? If the volume is a problem, consider modifications like acoustic panels to dampen the sound. This will make it easier to communicate while also preventing sensory overload in your sensitive patients.
Analyze your workflow. How many transitions do your patients make from the time they checked in until the time they leave the office? How many different rooms must they pass through? Transitions are difficult for some autistic people. Work processes that allow patients to remain in one room while the staff comes to them are generally easier on the patient.
Build stress-reducing techniques into your practice. White noise machines and lighting with adjustable intensity can help make patients more comfortable. Training in stress reduction techniques around painful procedures, like immunizations, can make those procedures go much more smoothly. Consider whether it’s worthwhile to have items available to reduce stress like topical anesthetic, fidget toys and other distractions, background music, etc.
Educate your staff. Most people have never knowingly worked with an autistic patient. Even if they have, many have misconceptions about the way that autistic people interact with the world and the way that they process things like noise and pain. Local advocacy groups may be able to help staff understand ways to help autistic patients cope better with the stress of medical visits.
Adjust your expectations and thicken your skin. We all know that people who are stressed or in pain don’t always communicate effectively. This is much more evident in some autistic people. Train your staff to identify the difference between tone of voice and the message being communicated. Above all, it is your job to remain professional, compassionate, and understanding even in the face of an apparently rude patient. In the case of an autistic person, the perceived rudeness is often unintended. The loud voice or abrupt tone may be more indicative of their neurodivergence than of their underlying emotions.
So many of the problems that autistic people face in the world of medicine have to do with misconceptions around these subtle social factors, and this can lead to misunderstandings and mistreatment by medical staff. While no one should be verbally or physically abused at their workplace, it is important that medical personnel learn to interpret words without taking subtleties like tone, eye contact, and voice volume personally.
Ask before touching. For some autistic people, physical touch his painful. Do not touch a patient until you explain what you are about to do. (This should be your practice with all patients, IMHO.) If they tell you it hurts, either stop what you’re doing and adjust your technique or explain why the pain is necessary (as it is with some orthopedic injuries.) Autistic patients are capable of understanding the maneuvers that you need to perform in order to do your job, but taking the extra step of explaining before making physical contact will make things much easier on both of you.
And ask how to help. If a patient appears to be struggling, ask how you can help. Ask a panicking or upset patient how you can help them cope. Do NOT instruct them to “calm down.” Never, in the history of calming down, has anyone ever calmed down after being told to calm down! Train staff on real de-escalation techniques and use them when they think they’re appropriate.
Ask for feedback. Reach out to your autistic patients and asked them what they think you could do better. In the end, these patients are the experts in what they need to survive and thrive in the medical environment. If we intend to serve these patients, we need to consider them when planning our practices. In the end, all of our patients will benefit.
Check out part 2 for more advice.