Dyslexia in medicine

On a recent ENT placement, I was taking ahistory from a patient on the ward duringwhich the patient asked me If I would be ableto explain their diagnosis further to them.During the morning ward round, they hadbeen given a brief explanation of theircondition by a member of the surgical teamand given a patient information leaflet abouttheir condition. The patient confided in me that althoughthey don’t have problems with their vision,they have never felt comfortable reading asthey feel the words can move around thepage. They went on to mention how they arevery embarrassed about struggling to readand feel modern life is very difficult whenyou can’t read. The patient reported abouthow narrowed their life opportunities wereby this. They will only ever eat from onetakeaway and order the same meal each timebecause they don’t know what the otherwords say. Although this is on the extremeend of the spectrum, this patient is clearly amember of the 10% of the population whohave dyslexia.(1) Dyslexia is a learning difficulty which istypically characterised by difficultiesreading, writing, and spelling, despiteaffected individuals having normal levels ofintelligence.(2) In normal physiology thereading pathway includes Broca’s area, theinferior parietotemporal lobe (includingWernicke’s area), the anterior, middle lobeand the left occipitotemporal sulcus. Thesefour areas are vital for phonologicalprocessing and have been shown onfunctional MRI scanning to be far lessactivated in people with dyslexia. This is compensated for by a greater use ofthe alternative anterior systems. Theseanterior systems can enable accuratereading but are unable to support fluent orrapid reading to the same extent as is seen inthe more established reading pathway. (3)People with dyslexia experience significantlyreduced reading and writing speeds,experience problems with reading andproblems with phonation. In addition tothese more classical symptoms these peoplealso experience problems with workingmemory impairments (4) and auditorytemporal processing. (5)Dyslexia is also strongly linked to low selfesteem which is likely to be caused byindividuals at a young age having difficultiesboth inside and outside of school. (3)As dyslexia is typically diagnosed by aneducational psychologist it is not commonlyconsidered to be within the remit ofmedicine. However, it is important to beaware of the struggles which it may causepatients. A quick screening question whichcan also cover patients who don’t have theirreading glasses could be ‘If I were to give youa patient information leaflet would you haveany difficulty reading it’. Doctors and Medical students are constantlybeing asked to consider more and moreissues which may seem to run adjacent tothe practicing of medicine. This isundoubtedly a challenge but patients with abetter understanding of their ownconditions, internal locus of control andbetter relationships with their clinicianshave better outcomes. (6) As 10% of our future patients are likely tohave dyslexia it might be worth having athink about thinking of some ways in whichwe can ensure such patients are as engagedand integrated into their own care as wewould want any of our other patients to be.My experience Having dyslexia is often thought of by manyas being both a gift and a curse. Dyslexiaprovides a lot of advantages in terms oflateral thinking, imagination and problemsolving. The disadvantages are evident:challenges with reading speed—both aloudand silently—writing difficulties, andimpaired short-term memory.The only problem is that in third leveleducation its more likely that the downsideswill outweigh the benefits. Especially in achallenging degree such as medicine. Asidefrom the obvious challenges faced by aplethora of textbooks, research articles andclinical guidelines and the reading challengesthey present there are other ways in which 1.2.dyslexia affects medical students:Terminology – the medical world is full ofcomplex terminology and jargon. Although Ilove the romanticism in naming things inGreek and Latin it does provide an extrahurdle. The minefield of cholecystitis,cholangitis and choledocholithiasis springsto mind. From my experience it’s not thatthese are stumbling blocks, rather that Ineeded to learn to be patient with myselfwhen I get them mixed up yet again.Short term memory – Short term memory isan area in which most people in medicine areparticularly gifted. As a result, havingdifferent neuronal pathways which affectstudents ability to remember facts in theshort term can be very challenging. Fromunsuccessful attempts to cram topics forexams, to forgetting details for upcomingPBL’s it can make aspects of universitysignificantly more challenging. I try and havea notebook on me for important informationon placement and remain buoyed by the factthat once I understand something and find aplace for it in my brain it does thankfully staythere. Exams – organising my thoughts into thecorrect terminology and getting them downon the page efficiently for markers providesa challenge. Exam technique is something Iam constantly trying to improve. Thankfully, there does seem to be the beginnings of agear shift to improve exam questions andstyle to better suit a wider aspect of thepopulation.My primary strategies are centred on twokey pillars: firstly, embracing my weaknesseswhile leveraging my strengths; and secondly,seeking out support wherever possible. Thedisability services at the university are veryhelpful and have provided me with a lot ofassistive technology. In addition I havebenefited from one-to-one tuition helpingme develop adaptive study techniques whichcan help me restructure information. Thishas taught me to summarise long lists intocategories which I prefer to deal with. Thishas all been provided to me quickly and freeof charge for which I am massively grateful.I am not trying to shout from the rooftopsabout difficulties I have faced, rather hopingto find some people who recognise mychallenges in their own experiences andhave been considering exploring a diagnosis.People with dyslexia can achieve as much inmedicine as anyone else can and there arecountless examples of this. The importanceas in anyone is recognising where we mightneed help and being humble enough to askfor it.