When a reasonable adjustment is ignored

A Hampshire resident spoke to us about how when a reasonable adjustment is ignored, it can actually create more disability than if no adjustment had been offered at all. Read her experience of contacting the GP to seek medical advice:

I am an autistic adult and because of differences in working memory, processing speed and communication under pressure, I find it much easier to communicate complex medical information in writing.

My GP medical record explicitly record my communication and reasonable adjustment needs, which include written communication as my preferred method of communication and that I have difficulties processing, retaining and articulating information.

When contacting the GP, I completed an eConsult in advance, carefully documenting my symptoms, concerns and the reasons for seeking medical advice. The purpose of the eConsult was to communicate accurately while reducing the cognitive demands of the consultation.

What happened?

When the GP telephoned, rather than using the information I had already provided, they began by asking me to explain why I had requested the appointment and to describe my symptoms verbally.

I found myself having to repeat information that was already documented in the eConsult. Instead of using my written account as the starting point for the consultation, I was expected to retrieve, organise and communicate everything again under the pressure of a telephone conversation.

The consultation became focused on my ability to verbally recall information rather than on discussing the medical issues I had sought help for.

Why was this difficult?

The eConsult was more than an administrative form - it was my communication. By preparing my thoughts in writing beforehand, I had already completed the cognitive work of organising and explaining my concerns.

Having to repeat everything verbally shifted that cognitive load back onto me. For an autistic person, this increases working memory demands, processing pressure and anxiety, making it much harder to communicate accurately.

The clinician already had the information available. I did not as the phone call was made when I was at work without any of the required information in front of me.

How could this have been different?

The GP could have started the consultation by acknowledging that they had read the eConsult and summarising their understanding of the information I had provided.

For example:

"I've read your eConsult and understand you've described three main concerns. I'd like to go through each of those with you and ask a few follow-up questions."

This approach would have used the written information as the framework for the consultation, allowing clarification where needed without requiring me to reconstruct everything from memory.

Learning Point

Reasonable adjustments should reduce barriers, not relocate them.

For many autistic people, written communication is an essential adjustment that reduces cognitive load and enables accurate participation in healthcare. When clinicians ignore information that has already been provided and ask patients to repeat it verbally, they unintentionally recreate the very barriers that the adjustment was designed to remove.

Neuro-affirming healthcare begins by recognising the patient's preferred communication method and using it as the foundation for collaborative, accessible care.

A reasonable adjustment should reduce cognitive load, not move it.

This applies not just to eConsults, but to letters, questionnaires, hospital admissions, pre-assessment forms and virtually every interaction between autistic patients and healthcare professionals.

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All publicly funded health and social care organisations should ask people whether they have any information or communication needs that require support under the Accessible Information Standard.