Dyslexia in medicine

Abstract

On a recent ENT placement, I was taking a
history from a patient on the ward during
which the patient asked me If I would be able
to explain their diagnosis further to them.
During the morning ward round, they had
been given a brief explanation of their
condition by a member of the surgical team
and given a patient information leaflet about
their condition.
The patient confided in me that although
they don’t have problems with their vision,
they have never felt comfortable reading as
they feel the words can move around the
page. They went on to mention how they are
very embarrassed about struggling to read
and feel modern life is very difficult when
you can’t read. The patient reported about
how narrowed their life opportunities were
by this. They will only ever eat from one
takeaway and order the same meal each time
because they don’t know what the other
words say. Although this is on the extreme
end of the spectrum, this patient is clearly a
member of the 10% of the population who
have dyslexia.(1)
Dyslexia is a learning difficulty which is
typically characterised by difficulties
reading, writing, and spelling, despite
affected individuals having normal levels of
intelligence.(2) In normal physiology the
reading pathway includes Broca’s area, the
inferior parietotemporal lobe (including
Wernicke’s area), the anterior, middle lobe
and the left occipitotemporal sulcus. These
four areas are vital for phonological
processing and have been shown on
functional MRI scanning to be far less
activated in people with dyslexia.
This is compensated for by a greater use of
the alternative anterior systems. These
anterior systems can enable accurate
reading but are unable to support fluent or
rapid reading to the same extent as is seen in
the more established reading pathway. (3)
People with dyslexia experience significantly
reduced reading and writing speeds,
experience problems with reading and
problems with phonation. In addition to
these more classical symptoms these people
also experience problems with working
memory impairments (4) and auditory
temporal processing. (5)
Dyslexia is also strongly linked to low self
esteem which is likely to be caused by
individuals at a young age having difficulties
both inside and outside of school. (3)
As dyslexia is typically diagnosed by an
educational psychologist it is not commonly
considered to be within the remit of
medicine. However, it is important to be
aware of the struggles which it may cause
patients. A quick screening question which
can also cover patients who don’t have their
reading glasses could be ‘If I were to give you
a patient information leaflet would you have
any difficulty reading it’. Doctors and Medical students are constantly
being asked to consider more and more
issues which may seem to run adjacent to
the practicing of medicine. This is
undoubtedly a challenge but patients with a
better understanding of their own
conditions, internal locus of control and
better relationships with their clinicians
have better outcomes. (6)
As 10% of our future patients are likely to
have dyslexia it might be worth having a
think about thinking of some ways in which
we can ensure such patients are as engaged
and integrated into their own care as we
would want any of our other patients to be.
My experience
Having dyslexia is often thought of by many
as being both a gift and a curse. Dyslexia
provides a lot of advantages in terms of
lateral thinking, imagination and problem
solving. The disadvantages are evident:
challenges with reading speed—both aloud
and silently—writing difficulties, and
impaired short-term memory.
The only problem is that in third level
education its more likely that the downsides
will outweigh the benefits. Especially in a
challenging degree such as medicine. Aside
from the obvious challenges faced by a
plethora of textbooks, research articles and
clinical guidelines and the reading challenges
they present there are other ways in which
1.
2.
dyslexia affects medical students:
Terminology – the medical world is full of
complex terminology and jargon. Although I
love the romanticism in naming things in
Greek and Latin it does provide an extra
hurdle. The minefield of cholecystitis,
cholangitis and choledocholithiasis springs
to mind. From my experience it’s not that
these are stumbling blocks, rather that I
needed to learn to be patient with myself
when I get them mixed up yet again.
Short term memory – Short term memory is
an area in which most people in medicine are
particularly gifted. As a result, having
different neuronal pathways which affect
students ability to remember facts in the
short term can be very challenging. From
unsuccessful attempts to cram topics for
exams, to forgetting details for upcoming
PBL’s it can make aspects of university
significantly more challenging. I try and have
a notebook on me for important information
on placement and remain buoyed by the fact
that once I understand something and find a
place for it in my brain it does thankfully stay
there.
Exams – organising my thoughts into the
correct terminology and getting them down
on the page efficiently for markers provides
a challenge. Exam technique is something I
am constantly trying to improve. Thankfully, there does seem to be the beginnings of a
gear shift to improve exam questions and
style to better suit a wider aspect of the
population.
My primary strategies are centred on two
key pillars: firstly, embracing my weaknesses
while leveraging my strengths; and secondly,
seeking out support wherever possible. The
disability services at the university are very
helpful and have provided me with a lot of
assistive technology. In addition I have
benefited from one-to-one tuition helping
me develop adaptive study techniques which
can help me restructure information. This
has taught me to summarise long lists into
categories which I prefer to deal with. This
has all been provided to me quickly and free
of charge for which I am massively grateful.
I am not trying to shout from the rooftops
about difficulties I have faced, rather hoping
to find some people who recognise my
challenges in their own experiences and
have been considering exploring a diagnosis.
People with dyslexia can achieve as much in
medicine as anyone else can and there are
countless examples of this. The importance
as in anyone is recognising where we might
need help and being humble enough to ask
for it.