Why have I been so unpopular in my clinical classes and how can I fix that? (I'm autistic)

[adrenocorticotropicana]

I'm not going to lie -- until years after I graduated from undergrad in 2013, I resented premeds (I didn't tell this to their face) and I never really got well with them because in my mind, I was always going to be a researcher, crystallize proteins and work in a lab and all that good stuff. I was naturally inquisitive and I always tried to understand an underlying idea or concept or connect ideas together especially if the lecturer mentioned something that made it seem they might be related where I thought they hadn't been before. (I think the latter is especially my worst trait.)

I started getting hospitalized in my last year of school and after school because I had PTSD (interacting with undiagnosed autism) that was misdiagnosed as schizoaffective disorder and this only started getting rectified in 2015. (I'm not going to blame the medical system because I kind of tried to delete all my childhood trauma at the age of ten and I kind of believed I was fine for a long time.) Now that I've received appropriate treatment and I'm a lot better, I also have a chip on my shoulder about "changing the system!!11!" from being hospitalized so frequently and that's 50% of my reason for attempting to enter psychiatry. I really try to hide this from my peers in class, because it's not an agenda that seems really popular or a popular motivation for being a premed, but it comes out in unexpected ways.

This spring, my phlebotomy class was mostly comprised of nursing assistant students from poor neighborhoods. However, the instructor kept talking about medical and physiological concepts (e.g. small needle gauge will cause hemolysis and distortion of blood results) that intersecting with both direct experience and material that I tutored frequently (well obviously, small needle gauge at high pressure would dramatically increase the Reynolds number of the blood flow, which increases turbulence and therefore explains increased observed hemolysis). To me, if I connect material to previous concepts that I have come across, the material is "solidified" or cross-linked. However, I became very unpopular among my classmates which is a huge problem when you need to find partners to help you practice venipuncture. The instructor explicitly asked me not to bring up ideas which were outside of scope of the class.

However, even this summer, when I have been taking an EMT-B class comprised of very rich and privileged first and second year premeds from very wealthy neighborhoods (I did not expect this), this hasn't reversed. A lot of the material reminds me of my own experiences (I have had to be intubated while awake, I've had to drink 4 gallons of PEG solution for a lithium overdose, I've been hit by a car and sent to trauma ER, I've been transported unresponsive to the ER a lot) and when classmates were blaming a 15-year-old mom who got pregnant at age 12 (the instructor was recalling a call he went out on), I reminded them that 75% of all teenage pregnancies involve a father older than the age of 18 (essentially, child sexual abuse) and the classroom became uncomfortably silent.

Classmates freely socialize with each other but not me, which is an issue because I am trying to practice for the practical exam that is coming up in a few weeks. I try my best to shut my mouth and not talk, but it's really hard to keep my mouth shut at times because it's very uncomfortable when parts of the material directly relate to something you did, happened to you, that you have strong memories of, even if only conceptual (maybe this is the autistic part).

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[Catalystik]

Why have I been so unpopular in my clinical classes and how can I fix that? (I'm autistic)
I'm not going to lie -- until years after I graduated from undergrad in 2013, I resented premeds (I didn't tell this to their face) and I never really got well with them because in my mind, I was always going to be a researcher, crystallize proteins and work in a lab and all that good stuff. I was naturally inquisitive and I always tried to understand an underlying idea or concept or connect ideas together especially if the lecturer mentioned something that made it seem they might be related where I thought they hadn't been before. (I think the latter is especially my worst trait.)

I started getting hospitalized in my last year of school and after school because I had PTSD (interacting with undiagnosed autism) that was misdiagnosed as schizoaffective disorder and this only started getting rectified in 2015. (I'm not going to blame the medical system because I kind of tried to delete all my childhood trauma at the age of ten and I kind of believed I was fine for a long time.) Now that I've received appropriate treatment and I'm a lot better, I also have a chip on my shoulder about "changing the system!!11!" from being hospitalized so frequently and that's 50% of my reason for attempting to enter psychiatry. I really try to hide this from my peers in class, because it's not an agenda that seems really popular or a popular motivation for being a premed, but it comes out in unexpected ways.

This spring, my phlebotomy class was mostly comprised of nursing assistant students from poor neighborhoods. However, the instructor kept talking about medical and physiological concepts (e.g. small needle gauge will cause hemolysis and distortion of blood results) that intersecting with both direct experience and material that I tutored frequently (well obviously, small needle gauge at high pressure would dramatically increase the Reynolds number of the blood flow, which increases turbulence and therefore explains increased observed hemolysis). To me, if I connect material to previous concepts that I have come across, the material is "solidified" or cross-linked. However, I became very unpopular among my classmates which is a huge problem when you need to find partners to help you practice venipuncture. The instructor explicitly asked me not to bring up ideas which were outside of scope of the class.

However, even this summer, when I have been taking an EMT-B class comprised of very rich and privileged first and second year premeds from very wealthy neighborhoods (I did not expect this), this hasn't reversed. A lot of the material reminds me of my own experiences (I have had to be intubated while awake, I've had to drink 4 gallons of PEG solution for a lithium overdose, I've been hit by a car and sent to trauma ER, I've been transported unresponsive to the ER a lot) and when classmates were blaming a 15-year-old mom who got pregnant at age 12 (the instructor was recalling a call he went out on), I reminded them that 75% of all teenage pregnancies involve a father older than the age of 18 (essentially, child sexual abuse) and the classroom became uncomfortably silent.

Classmates freely socialize with each other but not me, which is an issue because I am trying to practice for the practical exam that is coming up in a few weeks. I try my best to shut my mouth and not talk, but it's really hard to keep my mouth shut at times because it's very uncomfortable when parts of the material directly relate to something you did, happened to you, that you have strong memories of, even if only conceptual (maybe this is the autistic part).

Have you discussed your concern with your psychiatrist? SDN is not for medical advice and isn't the best place to request social coaching.

 

[adrenocorticotropicana]

I really wanted peer advice, and I talk about this every so often. I'm about to go to my appointment in five hours lol.

 

[ChymeofPassion]

From what I've read, you're very inquisitive and you love to learn. While the first case of contributing knowledge to the class may annoy the instructor and students because it can come off as being a "know-it-all", setting privileged kids (and this is coming from a privileged kid) straight by educating them on something like teenage pregnancy is important to do, and I feel that I would have been ashamed of myself and perhaps grateful that you educated me; however, for the less mature of my generation, they might feel like you were attacking their intelligence. Perhaps bite the bullet for now, and save your contributions for the teacher after class; I'm sure they would appreciate it. Your future patients will for sure appreciate it when you can empathize with them.

 

[OneTwoThreeFour]

I'm not going to lie -- until years after I graduated from undergrad in 2013, I resented premeds (I didn't tell this to their face) and I never really got well with them because in my mind, I was always going to be a researcher, crystallize proteins and work in a lab and all that good stuff. I was naturally inquisitive and I always tried to understand an underlying idea or concept or connect ideas together especially if the lecturer mentioned something that made it seem they might be related where I thought they hadn't been before. (I think the latter is especially my worst trait.)

I started getting hospitalized in my last year of school and after school because I had PTSD (interacting with undiagnosed autism) that was misdiagnosed as schizoaffective disorder and this only started getting rectified in 2015. (I'm not going to blame the medical system because I kind of tried to delete all my childhood trauma at the age of ten and I kind of believed I was fine for a long time.) Now that I've received appropriate treatment and I'm a lot better, I also have a chip on my shoulder about "changing the system!!11!" from being hospitalized so frequently and that's 50% of my reason for attempting to enter psychiatry. I really try to hide this from my peers in class, because it's not an agenda that seems really popular or a popular motivation for being a premed, but it comes out in unexpected ways.

This spring, my phlebotomy class was mostly comprised of nursing assistant students from poor neighborhoods. However, the instructor kept talking about medical and physiological concepts (e.g. small needle gauge will cause hemolysis and distortion of blood results) that intersecting with both direct experience and material that I tutored frequently (well obviously, small needle gauge at high pressure would dramatically increase the Reynolds number of the blood flow, which increases turbulence and therefore explains increased observed hemolysis). To me, if I connect material to previous concepts that I have come across, the material is "solidified" or cross-linked. However, I became very unpopular among my classmates which is a huge problem when you need to find partners to help you practice venipuncture. The instructor explicitly asked me not to bring up ideas which were outside of scope of the class.

However, even this summer, when I have been taking an EMT-B class comprised of very rich and privileged first and second year premeds from very wealthy neighborhoods (I did not expect this), this hasn't reversed. A lot of the material reminds me of my own experiences (I have had to be intubated while awake, I've had to drink 4 gallons of PEG solution for a lithium overdose, I've been hit by a car and sent to trauma ER, I've been transported unresponsive to the ER a lot) and when classmates were blaming a 15-year-old mom who got pregnant at age 12 (the instructor was recalling a call he went out on), I reminded them that 75% of all teenage pregnancies involve a father older than the age of 18 (essentially, child sexual abuse) and the classroom became uncomfortably silent.

Classmates freely socialize with each other but not me, which is an issue because I am trying to practice for the practical exam that is coming up in a few weeks. I try my best to shut my mouth and not talk, but it's really hard to keep my mouth shut at times because it's very uncomfortable when parts of the material directly relate to something you did, happened to you, that you have strong memories of, even if only conceptual (maybe this is the autistic part).

I'm not in any position to give you specific advice so I'll try to mostly ask questions here.
My experience with people with autism has been their difficulty in recognizing how they come off to others or are not good at reading the signals of others. For example, when you were in the phlebotomy class mentioning the Reynolds number-do you think anyone else in the class had actually heard of the Reynolds number before? While it may have helped you understand the concept, might it have been a waste of everyone else's time?I think it is a positive step that you recognize there is a disconnect between you and your classmates but if you look at the language you're using it is almost always adversarial: you are always in the right- inquisitive, challenging the system, making astute connections- and you imagine that you're unpopular because of it. Imagine instead that every time you're in your EMT class someone mentions how the material connects to astrology. Or if there was a parent in your group, every time a pediatric point was mentioned they related it to their child. Would that make you annoyed? Would you want to have anything to do with them?

You mention an interest in psychiatry-next time you're at an appointment, try to make a mental note of how much your doctor speaks compared to how much you speak. I'd bet the number is pretty close to 90% you-10% them. Now imagine you're the 10%, and rather than connecting the material directly to "something you did, happened to you, that you have strong memories of" you're instead asking questions, paying attention to what they aren't saying, or how they're saying it, or what their body language is. I'd actually argue that connecting the material (your patient) to yourself is almost exactly what you're not supposed to do.

For good or for bad, you can't go through medicine as an island without connecting with your peers-med school is hard, residency is hard. You need to depend on others and they need to depend on you. You need to make good small talk to get good evaluations. You need to play nice with your consultants or your local PCPs if you want referrals of your own.
I hope you don't read any of this as me thinking you can't do it or that you haven't already been incredibly resilient to get as far as you've gotten. But it seems like there is still some work to be done!

 

[AttemptingScholar]

Everyone learns different ways, and what works for you (crosslinking) doesn't necessarily work for everyone. By sharing this, you are taking up class time for their education for something that is mostly for your benefit, almost showing off. For example, if someone learns best by drawing pictures and graphs, imagine if they continuously tried to draw for you, when you haven't asked! You might appreciate the fact they want to share with you, but it would get annoying and wasteful fast.

And I get wanting to share your experience, but that wouldn't help me? You having a personal experience of intubation helps you learn about intubation, you telling me about it annoys me and takes up times I could have been studying intubation, because just telling me doesn't give me that personal experience.

Consider how the other students interact with each other. How much of the time are they talking about relevant work and how much time are they spending on more enjoyable topics? For how long does each person speak? Remember, conversations should be equal among participants. It shouldn't be someone lecturing to others, and than a new person lectures. The flow of the conversation is important. Don't talk about past topic or something tangentially related. Ask questions, focus on the other person, rather than what you want to talk about. Sometimes, you will have entire conversations where you don't add anything, and that's okay! That fits with the point and goals of social conversations, to be not stressful and to keep the flow.

You got this, but yeah, learn to separate class topics and conversational topics, and don't take up other people's class time with your stories.

 

[adrenocorticotropicana]

I actively try as much as possible not to talk about myself or my interests. My problem right now is dealing with the compulsion, or the discomfort, of not being able to talk about a vivid image in my head that's literally trying to burst out of me, and sitting with it, without having to like, run out of the room, I guess.

Saying it out loud like ... gets it out of my head. Maybe I should just ask the class if I can say random things to out loud to myself so I can memorize stuff and ask them to ignore me if my hands aren't raised.

Something I didn't get before is how most people want to separate work / class from everyday life. I have strongly personal motivations for taking clinical coursework, so that probably explains why I didn't see the boundary before.

 

[DrElliotReid]

Have you discussed your concern with your psychiatrist? SDN is not for medical advice and isn't the best place to request social coaching.

I agree and disagree with this. Of course, speaking to a professional who knows you better is preferred but I think there is something valuable to be gained from anonymous peer advice as strangers can be more objective. However, OP, this also needs to be taken with a grain of salt because we can only advise based off of what you tell us and might not get the whole story. We cannot observe your interactions and give you feedback on that. Might I suggest, if you're looking for peer advice, asking a close friend (or a couple of them) you feel has good social skills and seeing if they can provide you with some honest feedback as well?

On a side note, when I was in residency we had an attending who was 100% on the spectrum (via observation/interactions...we have obviously never asked him or had him confirm this), and although he was socially awkward and everyone knew who he was, he was also a highly respected gentleman and probably one of the smartest people I know. After we spent more time with him, we got used to his quirks and he actually became quite endearing for many of us residents.

 

[adrenocorticotropicana]

Thanks! My close friends aren't premeds, though some work in harm reduction (syringe exchange) and drug policy reform. Also 1/3 of my close friends are also autistic. I had a close working relationship with my last psychiatrist, but he graduated from residency in June. I am going for a second appointment with his successor (another resident) in a few hours and he seems really cool.

I'm really bad at knowing how others perceive me. I don't think I am as unpopular in this class as I was in the last class. Maybe I just don't connect well because I am in the 90th percentile of the class by age (I'm 28). There's only two people in the class older than me (they are both working mothers, aged 35 and 40).

 

[AttemptingScholar]

Saying it out loud like ... gets it out of my head. Maybe I should just ask the class if I can say random things to out loud to myself so I can memorize stuff and ask them to ignore me if my hands aren't raised.

Please don't. Unless you can mumble it so people next to you can't really hear it? But think of it this way, I concentration best with music. Imagine if I were sitting next to you singing Broadway--even if I told you to ignore it, it would be pretty distracting. We don't talk about it, but everyone in class is making sacrifices to ensure a smooth learning environment for the larger class. For me, it's sometimes sitting in places where I can't see with my eyesight, saving my questions for after class even if I can't understand the lecture until I have them answered, and not singing! It's a social norm associated with classes.

You sound like a great guy who is trying really hard, and I totally respect that. Keep practicing, because I firmly believe social skills can be improved upon. Good luck!

 

[Goro]

Thanks! My close friends aren't premeds, though some work in harm reduction (syringe exchange) and drug policy reform. Also 1/3 of my close friends are also autistic. I had a close working relationship with my last psychiatrist, but he graduated from residency in June. I am going for a second appointment with his successor (another resident) in a few hours and he seems really cool.

I'm really bad at knowing how others perceive me. I don't think I am as unpopular in this class as I was in the last class. Maybe I just don't connect well because I am in the 90th percentile of the class by age (I'm 28). There's only two people in the class older than me (they are both working mothers, aged 35 and 40).

I'm not going to lie -- until years after I graduated from undergrad in 2013, I resented premeds (I didn't tell this to their face) and I never really got well with them because in my mind, I was always going to be a researcher, crystallize proteins and work in a lab and all that good stuff. I was naturally inquisitive and I always tried to understand an underlying idea or concept or connect ideas together especially if the lecturer mentioned something that made it seem they might be related where I thought they hadn't been before. (I think the latter is especially my worst trait.)

I started getting hospitalized in my last year of school and after school because I had PTSD (interacting with undiagnosed autism) that was misdiagnosed as schizoaffective disorder and this only started getting rectified in 2015. (I'm not going to blame the medical system because I kind of tried to delete all my childhood trauma at the age of ten and I kind of believed I was fine for a long time.) Now that I've received appropriate treatment and I'm a lot better, I also have a chip on my shoulder about "changing the system!!11!" from being hospitalized so frequently and that's 50% of my reason for attempting to enter psychiatry. I really try to hide this from my peers in class, because it's not an agenda that seems really popular or a popular motivation for being a premed, but it comes out in unexpected ways.

This spring, my phlebotomy class was mostly comprised of nursing assistant students from poor neighborhoods. However, the instructor kept talking about medical and physiological concepts (e.g. small needle gauge will cause hemolysis and distortion of blood results) that intersecting with both direct experience and material that I tutored frequently (well obviously, small needle gauge at high pressure would dramatically increase the Reynolds number of the blood flow, which increases turbulence and therefore explains increased observed hemolysis). To me, if I connect material to previous concepts that I have come across, the material is "solidified" or cross-linked. However, I became very unpopular among my classmates which is a huge problem when you need to find partners to help you practice venipuncture. The instructor explicitly asked me not to bring up ideas which were outside of scope of the class.

However, even this summer, when I have been taking an EMT-B class comprised of very rich and privileged first and second year premeds from very wealthy neighborhoods (I did not expect this), this hasn't reversed. A lot of the material reminds me of my own experiences (I have had to be intubated while awake, I've had to drink 4 gallons of PEG solution for a lithium overdose, I've been hit by a car and sent to trauma ER, I've been transported unresponsive to the ER a lot) and when classmates were blaming a 15-year-old mom who got pregnant at age 12 (the instructor was recalling a call he went out on), I reminded them that 75% of all teenage pregnancies involve a father older than the age of 18 (essentially, child sexual abuse) and the classroom became uncomfortably silent.

Classmates freely socialize with each other but not me, which is an issue because I am trying to practice for the practical exam that is coming up in a few weeks. I try my best to shut my mouth and not talk, but it's really hard to keep my mouth shut at times because it's very uncomfortable when parts of the material directly relate to something you did, happened to you, that you have strong memories of, even if only conceptual (maybe this is the autistic part).

Get thee to a therapist, stat.
Also suggest taking acting, public speaking or debate classes.

 

[adrenocorticotropicana]

Please don't. Unless you can mumble it so people next to you can't really hear it? But think of it this way, I concentration best with music. Imagine if I were sitting next to you singing Broadway--even if I told you to ignore it, it would be pretty distracting. We don't talk about it, but everyone in class is making sacrifices to ensure a smooth learning environment for the larger class. For me, it's sometimes sitting in places where I can't see with my eyesight, saving my questions for after class even if I can't understand the lecture until I have them answered, and not singing! It's a social norm associated with classes.

You sound like a great guy who is trying really hard, and I totally respect that. Keep practicing, because I firmly believe social skills can be improved upon. Good luck!

Probably not relevant but I wasn't sure if I stated this somewhere above because I'm like a CSA survivor with an ACE score of 6, but I'm a woman, which is probably why I went undiagnosed for so long (today's appointment actually concerns a neuropsych referral for formal testing XD). The only reason why I probably didn't get impregnated by my own father at a young age is because for various intersex reasons that are probably TMI, I am infertile. Just wanted to state this because not everyone who's autistic and unlikeable is male.

 

[adrenocorticotropicana]

Get thee to a therapist, stat.
Also suggest taking acting, public speaking or debate classes.

It's called stimming -- autistic people do this -- and I was on my parliamentary debate team in undergrad, scored 2nd place in the state of Maine for junior varsity Lincoln-Douglas debate (high school achievements are irrelevant but I'd also like to say I can be pretty eloquent sometimes when my left ventrolateral PFC isn't being emergency-vetoed by my right amygdala) and yes I already do EMDR and DBT... and also I did not come here for clinical recommendations even though this is yes, a student doctor forum. XD

 

[DrElliotReid]

Probably not relevant but I wasn't sure if I stated this somewhere above because I'm like a CSA survivor with an ACE score of 6, but I'm a woman, which is probably why I went undiagnosed for so long (today's appointment actually concerns a neuropsych referral for formal testing XD). The only reason why I probably didn't get impregnated by my own father at a young age is because for various intersex reasons that are probably TMI, I am infertile. Just wanted to state this because not everyone who's autistic and unlikeable is male.

This is an example of saying too much to get your point across and making situations awkward and uncomfortable for others. Not as bad since this is the internet and not a face-to-face interaction, but if it was...oh boy. I get that your brain seems to work best by providing information to support your answers, but for example, all you had to say was "Actually I'm a woman, but thanks!".

 

[adrenocorticotropicana]

I also don't meet many premed students with adverse childhood experience (ACE) scores >= 4 and had experience with the child protective services and the foster care system, and I kind of feel sad and isolated about it since this is my primary motivation for trying to enter medicine -- so I was trying to kill two birds with one stone.

The median ACE score of my closest friends is like 5 or 6 but in my clinical classes it's like 1.

 

[ProspectivePostPreDent]

I also like connecting concepts. Why not write them and build mind maps? Much quieter and also can be highly gratifying.

 

[gyngyn]

Closing. We wish you well, OP.