She Had Already Decided Before I Came In

On diagnostic overshadowing, confirmation bias, and what it costs when doctors stop listening

I want to tell you about an appointment that I knew was over before it began.

I had been referred to (yet another) neurologist. My rheumatologist said I want you to see her to help us figure out your muscle fatigue. I stated, “Only if you recommend the person.” I am exhausted from all the neurologists I see, and I just don’t have it in me to see another one.

I came prepared, which, if you know me, means I came very prepared. I had done the research. I understood the tests available. I knew what I wanted to ask for and why.

I’m autistic. Being thorough, being precise, being what this neurologist decided to call analytical, and attempting to patronize me. That’s how I navigate a world that wasn’t built for me. It’s how I survive appointments where I know I might not be believed.

It turns out I was right to be prepared. I just wasn’t prepared enough for what actually happened.

It sounded like she was listening, scribbling a lot on the paper until she kept saying, “It’s mechanical, not software.” This eventually led to a second appointment, virtually, to be told repeatedly that it’s an endurance issue without any additional testing.

In this second appointment, within the first few minutes, the neurologist used the word “analytical” to describe me.

She was not using it as a compliment. I counted over 20+ times in a 40-minute meeting. She would even shush me to stop talking, using it against me because I was simply trying to understand her point. This came with a shift in tone, the kind that tells you the word is doing other work. The kind that, when you are autistic, and you have spent your whole life watching people decide what your neurology means about your credibility, lands like a verdict.

I kept going. I described my symptoms. I explained the muscle fatigue I had been experiencing. I requested a specific test, a repetitive EMG/NCV study, because I wanted her to see what I was experiencing, not just hear me describe it. I even had videos, but she refused to see them.

She told me what I was experiencing wasn’t mechanical. She wouldn’t order the test because it would be a waste if nothing came of it. She blamed everything on endurance.

Endurance.

I left without answers. However, she did agree with one test, an EMG/NCV test for my right arm, to PROVE to me its carpal tunnel. Obviously, she cares more about proving she is correct than helping me.

Then I read her clinical notes from appointments one and two.

And there it was, proof, in her own documentation, that she had not heard me. Not really. Because the notes didn’t reflect what I had told her. She filled in some of what I said with her own biases. They reflected a conclusion. One that had been shaped, I believe, before I ever sat down in that room, and definitely shaped before the second appointment. [I had no idea that the last neurologist moved to this location and bussiness or I never would have seen her in the first place.]

She had spoken with this colleague. Someone who had seen me before. Someone whose name came up in our conversation in a way that told me everything. The opinion had already been formed and passed along. I fought to be heard in an appointment where the outcome had already been decided.

That is confirmation bias. And in medicine, it causes serious harm.

There is a term for what happened to me, and I want you to know it: diagnostic overshadowing.

It happens when a healthcare provider attributes all a patient’s symptoms to a pre-existing diagnosis or condition without investigation. For disabled patients, it often means that every new symptom, every concern, every request gets filtered through the lens of what the doctor already thinks they know about you.

You come in with muscle weakness. They see autism.

You come in with pain. They see anxiety.

You come in with a carefully researched request for a specific test. They see a difficult patient who thinks they know too much.

And the work, the actual diagnostic work of ruling things out, of investigating, of trying, doesn’t happen.

I want to be clear about something. I am not angry at doctors as people. I know most of them went into medicine because they wanted to help. I know the system they work inside is broken in ways that are not entirely their fault: the 15-minute appointments, the pressure, the volume of patients.

But I need doctors to understand what it costs when they refuse to listen.

It costs us accurate diagnoses. It costs us appropriate treatment. It costs us the experience of feeling like a whole person in a room designed to care for us.

And for disabled patients, especially autistic patients, especially those of us who communicate differently, who process differently, who advocate for ourselves in ways that don’t always look the way you expect, the cost is deterioration. Because we already fight harder to be believed. We already walk in knowing we might have to prove ourselves. We already carry the weight of every appointment that came before this one.

When you decide before we open our mouths, you take something from us that is very hard to get back.

To the doctors and medical professionals reading this:

Your patient researched before they came to see you. They asked for a specific test because they had a reason. They used precise language because precision is how they communicate, not because they’re trying to challenge you.

Being analytical is not a problem.

Advocating for yourself is not a red flag.

Knowing what test you need is not overstepping.

Do the work. Order the test. Come into the room without the conclusion already written.

We are not a diagnosis. We are not a colleague’s second-hand opinion. We are a whole person sitting across from you, asking to be heard.

That should be enough.

To the patients reading this:

I see you.

If you left an appointment feeling like you weren’t heard, you’re not crazy. If a doctor reduced everything you were experiencing to a label, a diagnosis, or someone else’s opinion formed before you walked in, that was not your failure. What you experienced was real. What you felt in that room was real.

This is not a ‘you’ problem. This is a pattern. And knowing that doesn’t make it hurt less, but I hope it makes you feel less alone.

You are allowed to be angry. You are allowed to grieve the care you deserved and didn’t receive.

And you are allowed to fire your doctor and find a new one.

You do not owe loyalty to a provider who has already decided who you are before you open your mouth. You are not stuck. You are not too much. You are a patient who deserves to be fully seen, and that doctor exists.

Don’t stop looking for them.