The patient who changed everything
She sat across from me, perfectly composed. Professional clothes, steady eye contact, articulate answers. On paper, she was fine.
But she wasn’t fine. She was 42 years old and had spent three decades performing “fine.” She’d been treated for anxiety since her twenties. She’d tried four different antidepressants. She’d been told she was “too sensitive,” that she needed to “stop overthinking,” that her exhaustion was just stress.
It took a 40-minute conversation to get past the mask. Forty minutes where I stopped running through my mental checklist and actually listened. She described a lifetime of feeling like she was watching the world through glass. Of rehearsing conversations in her head before she had them. Of arriving home from work so drained she couldn’t speak for an hour.
She had autism. She was also gifted, funny, and deeply self-aware. She just hadn’t been given the right framework to understand herself.
That consultation changed how I practise medicine. It also broke my heart a little. Because the system I work in would have preferred I see her for six minutes and move on.
A system built for speed, not for people
Let me be honest about what general practice looks like in Australia right now.
Medicare’s fee structure rewards volume. A GP who runs six-minute Level B consultations can bill around $439 per hour. A GP who takes 20 minutes for a Level C consultation earns roughly $255 per hour. The maths is brutal and obvious. The system pushes us to be fast.
The average consultation in Australia is now 19.7 minutes. That is an improvement. But it is still not enough for the conversations that matter most.
When someone walks in carrying decades of unexplained struggle, six minutes is an insult. Even 20 minutes barely scratches the surface. You can write a script in six minutes. You cannot rebuild someone’s understanding of themselves in six minutes.
The RACGP and the AMA both agree the funding model is broken. The RACGP is calling for a 40% increase to Level C and D rebates. The AMA wants a complete redesign to a seven-tier structure. Both organisations recognise that short consultations are a false economy. They lead to more hospital presentations, more mismanaged chronic disease, and more repeated visits that never get to the root problem.
Eighty-one percent of GP clinic owners are now concerned about practice viability. Sixty-nine percent of GPs report burnout. We are being squeezed from every direction. And the patients who suffer most are the ones who need time the most.
Who are we talking about?
Neurodivergent people. Those whose brains work differently. ADHD. Autism. Often both together.
The numbers are bigger than most people realise. Up to 20% of Australian school-age children are estimated to be neurodivergent. Around 800,000 Australians have ADHD. At least 1 in 40 are autistic, and that figure is almost certainly an undercount.
ADHD prescriptions have increased 300% in ten years. Adult diagnoses are driving the rise, not children. Nearly half of people who identify as neurodivergent were only diagnosed after the age of 30.
These are not new conditions. These are people who have always been here. They are just finally being seen.
What I see in the consulting room
The presentations are remarkably consistent once you know what to look for.
A woman in her thirties with treatment-resistant anxiety. She has tried three SSRIs. None worked properly. She describes a constant feeling of being “on edge” that she cannot explain. She is exhausted but cannot sleep. Her relationships are intense and then they collapse.
A man in his forties referred for chronic fatigue. He has had every blood test. Everything is normal. He describes needing to “recover” after social events. He has a successful career but it takes everything he has. He calls in sick more than he should.
A teenager whose school says they are “not trying hard enough.” Their parents are frustrated. The young person sits in my office and cannot explain why they cannot do what everyone else seems to do so easily.
These are not lazy people. They are not anxious people who just need to relax. They are neurodivergent people running on hardware that the world was not designed for. And they have been told, over and over, that the problem is them.
The emotional toll of living undiagnosed
This is where the article gets hard to write. Because the emotional damage of undiagnosed neurodivergence is profound and it accumulates over years.
Masking: the performance that never ends
Masking is the suppression of neurodivergent traits to appear neurotypical. It starts young. It becomes automatic. And it is devastating.
Women mask more than men. Research shows females display consistently higher masking scores. This is partly why women are diagnosed later, if at all. Up to 80% of autistic women may have been misdiagnosed as children.
Masking is the strongest predictor of autistic burnout. It predicts anxiety and depression. People who mask heavily show increased signs of suicidal behaviour.
In my consulting room, masking looks like competence. That is the cruelty of it. The patient presents as “fine” and the GP takes them at face value. A six-minute appointment reinforces the mask. There is no time to go deeper. The patient leaves, having performed wellness for yet another audience.
Rejection sensitive dysphoria
Up to 99% of people with ADHD experience some degree of rejection sensitivity. For 30 to 50%, it is severely disabling.
RSD is not just “being sensitive.” It is an overwhelming emotional response to perceived criticism or rejection. A neutral comment from a colleague can trigger hours of rumination and self-doubt. A friend cancelling plans can feel like a fundamental rejection of who you are.
Recent research argues that RSD is not purely an internal deficit. It is amplified by environments that are hostile or indifferent to neurodivergent needs. When a patient has spent decades in environments that were never designed for their brain, the rejection sensitivity compounds.
Emotional dysregulation
Up to 70% of adults with ADHD experience emotional dysregulation. There is growing evidence that it should be considered a core symptom, not a side effect. Emotional reactions that seem excessive relative to the situation. Rapid, uncontrolled shifts in mood. Difficulty calming down once activated.
This is not a character flaw. This is neurology. And when it is misunderstood, it is treated as a behavioural problem rather than a neurological one.
Alexithymia: when you cannot name what you feel
Nearly half of autistic people have alexithymia. The rate in the general population is under 5%.
Alexithymia means difficulty identifying and describing your own emotions. A patient with alexithymia might not be able to tell you they are anxious. They might describe a “tight feeling in their chest” or say they “don’t feel right” without being able to elaborate.
In a rushed consultation, this looks like vagueness. A GP under time pressure might dismiss it. In a longer conversation, you can work together to decode what the body is saying.
Burnout
Autistic burnout is a recognised syndrome. It results from chronic life stress and a mismatch between expectations and abilities, without adequate support. It is characterised by long-term exhaustion, loss of function, and reduced tolerance to stimulation.
Sixty-nine percent of participants in one study reported at least one episode of autistic burnout. Forty-six percent reported four or more episodes.
Here is the statistic that keeps me up at night: 63% of people currently experiencing autistic burnout reported recent thoughts of suicidal ideation or self-harm.
The suicide risk is real
Autistic adults are up to nine times more likely to die by suicide than the general population. Autistic women face up to 13 times higher risk. People with ADHD have double the suicide risk.
One in five females with both autism and ADHD has attempted suicide at least once.
These numbers are not abstract. These are my patients. And the system gives me six minutes with them.
The double empathy problem: it is not a one-way street
There is a persistent assumption in medicine that communication breakdowns with neurodivergent patients are the patient’s problem. That they have a “social deficit.”
Damian Milton, an autistic autism researcher, reframed this in 2012. His “double empathy problem” proposes that the difficulty is bidirectional. Autistic people struggle to understand non-autistic people. Non-autistic people equally struggle to understand autistic people.
The research backs this up. When autistic people are paired with other autistic people, they communicate effectively. When non-autistic people are paired together, they communicate effectively. It is the mixed pairs that struggle.
In healthcare, this becomes what Shaw and colleagues call a “triple empathy problem.” Three layers of miscommunication:
- Medical culture versus patient culture. Doctors spend years in a system that is alien to those outside it.
- Neurological differences in communication style.
- The power imbalance of the doctor-patient relationship.
Patients in Shaw’s study reported feeling “reduced to a single-dimensional label of autism.” Their own intelligence and self-awareness were “subconsciously considered less valuable or less credible by doctors.”
This is not about bad doctors. Most GPs genuinely care. It is about a system that does not give us the time or training to bridge the gap.
What diagnosis means for identity
Getting a diagnosis as an adult is not a simple event. It is an identity earthquake.
The emotional arc is consistent across the research. First comes relief. Finally, an explanation. Then comes grief. All those years of struggle that could have been different. Then anger. At the systems and people who missed it. Then confusion. If I am not who I thought I was, who am I?
A 2025 study proposed that narrative reconstruction, rather than linear grief stages, best describes how adults process an ADHD diagnosis. It is not about “acceptance” as a final destination. It is about rewriting the story of your life with new information.
Patients tell me things like: “I thought I was lazy my whole life. Turns out my brain just works differently.” Or: “I spent 20 years in therapy for anxiety that was actually autistic burnout.”
The reconstruction is both liberating and painful. You gain self-understanding. You lose the years you will never get back.
Older adults tend to feel the grief more acutely. They express that the diagnosis came too late. Understanding where a patient sits in this emotional journey is critical. A newly diagnosed 25-year-old and a newly diagnosed 55-year-old need very different support.
What good medicine looks like
Here is what I have learned works. None of it is revolutionary. All of it requires time.
Ask about communication preferences at the start. Some patients need written information. Some need verbal. Some need both. Some need you to slow down. Some need you to get to the point. Ask.
Warn before you touch. Physical examination without warning can trigger a sensory response. A simple “I’m going to listen to your chest now” costs nothing and prevents distress.
Believe the patient. When someone tells you they think they might be neurodivergent, take it seriously. Research shows that provider dismissal delays diagnosis by years.
Validate before you problem-solve. Neurodivergent patients have often spent their lives being told their experience is wrong. Hearing “that sounds really difficult” before jumping to solutions builds the therapeutic alliance that makes everything else possible.
Make the environment bearable. Dim the lights if you can. Offer early morning appointments. Let patients wait in their car and text them when you are ready. Remove the sensory assault of the waiting room. Sixty-two percent of autistic adults find phone booking a barrier. Offer text or online booking.
Take the time. Double-book the appointment if needed. The RACGP and 20 other health organisations are fighting for better funding for longer consultations. A Level C consultation generates $338.9 million in annual healthcare system savings compared to repeated short visits that never address the root cause.
The GP as translator
GPs occupy a unique position. We are the first point of contact. We hold the longitudinal relationship. We see the whole person, not just one condition.
For neurodivergent patients, the GP becomes a translator. We translate the patient’s experience into referral letters that specialists will act on. We translate complex medical information back into language the patient can use. We write the NDIS support letters. We advocate for workplace accommodations.
We also translate the patient to themselves. We help them connect decades of unexplained experience to a framework that finally makes sense.
This is good medicine. It is also slow medicine. And it is medicine that the current system does not adequately fund.
What needs to change
The RACGP’s call for a 40% increase to Level C and D rebates is a start. The AMA’s proposed seven-tier structure is a more ambitious redesign. Both would help.
But funding is only part of the problem.
GP training needs to include neurodiversity as a core, mandatory component. Not an optional interest group. Not a single webinar. A fundamental part of how we learn to practise medicine. Education about ADHD is, as Associate Professor Kramer puts it, “badly lacking in both undergraduate and postgraduate medical curricula.”
The diagnostic pathway needs to be accessible. Waiting 4 to 12 months for an ADHD assessment, and paying $600 to $850 for the privilege, is not acceptable. The reforms in NSW and Queensland, allowing trained GPs to diagnose and prescribe for ADHD, are promising. They need to go national.
And the culture of medicine needs to shift. From deficit-based to neurodiversity-affirming. From “what is wrong with you” to “how does your brain work and how can we support it.” The NHMRC has endorsed neurodiversity-affirming guidelines. Now they need to be implemented, not just published.
Why I do this work
I became a GP because I believe in the power of the conversation. I believe that sitting with someone, listening to their story, and helping them understand themselves is the most important thing a doctor can do.
The current system tries to compress that conversation into a billing code. It reduces the most human part of medicine to a time-and-money equation.
Neurodivergent patients remind me every day why I resist that pressure. They teach me to slow down, to listen differently, to question my assumptions. They teach me that good medicine is not fast medicine.
It is honest medicine. It is patient medicine. It is medicine that sees the person, not just the problem.
And it takes as long as it takes.
Dr Sandy is a GP with a special interest in ADHD, autism, and neurodiversity. She practises at My Specialist GP.
References and Further Reading
Key Statistics
- Up to 20% of Australian school-age children are estimated to be neurodivergent (Square Holes, 2025)
- 800,000+ Australians living with ADHD (Murdoch Children’s Research Institute)
- At least 1 in 40 Australians are autistic (Autism Spectrum Australia)
- ADHD prescriptions increased 300% in 10 years, reaching 470,000 individuals by 2022-23
- 49% of neurodivergent people were diagnosed after age 30 (Neurodiversity Directory, 2026)
- Average GP consultation: 19.7 minutes (RACGP Health of the Nation, 2025)
- 81% of GP clinic owners concerned about practice viability (RACGP, 2024)
- 69% of GPs report burnout (RACGP, 2025)
Research Papers
- Arnold et al. (2024). “Barriers to healthcare for Australian autistic adults.” Autism. PMC
- Shaw et al. (2024). “Barriers to healthcare and a ‘triple empathy problem’ may lead to adverse outcomes for autistic adults.” Autism. PMC
- Milton, D. (2012). “On the ontological status of autism: the ‘double empathy problem.’” Disability & Society. Tandfonline
- Pollock & Krupka (2026). “Late bloomers: Exploring the emotional landscape of Australian women’s experiences of a late Autism diagnosis.” Autism.
- French & Cassidy (2026). “Going Through Life on Hard Mode: Late Diagnosis Experience.” Sage Journals.
- Craddock (2026). “Navigating residual diagnostic categories: Women diagnosed with autism and ADHD in adulthood.” Sage Journals.
- Sandland (2025). “Neurodivergent experiences of rejection sensitive dysphoria expose environmental factors.” Sage Journals.
Clinical Guidelines and Reports
- RACGP Health of the Nation 2025. PDF
- RACGP Open Letter on Longer Consultation Funding (March 2026). RACGP
- AMA Modernise Medicare 2025-26 Pre-Budget Submission. AMA
- Australian Senate Community Affairs Committee (2024). Inquiry into ADHD: 284-page report, 15 recommendations. APH
- NHMRC-endorsed guidelines for neurodiversity-affirming practice. InSight+ MJA
Medicare and Policy
- MBS Item 23 (Level B). MBS Online
- MBS Item 36 (Level C). MBS Online
- NSW GP ADHD Prescribing Reforms. NSW Gov
- Queensland GP ADHD Management. RACGP
Patient Resources
- Reframing Autism. reframingautism.org.au
- ADHD Australia. adhdaustralia.org.au
- NAPA Australia (Neurodiversity-Affirming Practice). napaaustralia.org
- B4ND (Before a Neurological Diagnosis). b4nd.org
General health information
This article is general health information only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always speak with a qualified health professional before making any changes to your medication or treatment plan.
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