Áine Mac Grory wonders about the cognitive cost of working in a pharmacy for neurodivergent people
We have become much better at recognising neurodiversity in recent years. Conversations that were once confined to schools and specialist services are now taking place in workplaces, universities and healthcare settings. We are slowly learning that there is no single ‘right’ way for a brain to process information, communicate, or interact with the world.
As pharmacists, we rightly strive to make our pharmacies more welcoming for neurodivergent patients. We think about sensory overload, communication preferences and creating environments that reduce anxiety rather than increase it. Every patient deserves to feel safe, respected and understood.
But there is another conversation that deserves our attention.
What if some of the people behind the pharmacy counter are neurodivergent too?
The reality is that many adults reach their 30s, 40s or 50s before receiving a diagnosis of autism or ADHD, while many others never seek one at all. They have simply spent years adapting to workplaces that were never designed with their way of thinking in mind. Pharmacy may be one of the professions that naturally attracts these individuals. The attention to detail, love of systems, pattern recognition, deep clinical knowledge, and commitment to getting things exactly right are strengths that many neurodivergent people bring in abundance.
Yet modern community pharmacy can also present some of the greatest challenges.
It is difficult to think of another healthcare setting where the sheer number of interruptions is considered normal. A pharmacist may be clinically checking prescriptions while simultaneously answering questions from staff, responding to patients at the medicines counter, taking phone calls from GP practices, managing medicine shortages, supervising vaccinations, and making countless decisions that directly affect patient safety.
Mental Effort
Every interruption comes with a cognitive cost.
For some pharmacists, switching between these demands is simply part of the job. For others, particularly those who are neurodivergent, that constant shifting of attention requires immense mental effort. It may not be visible to colleagues or patients, because years of experience have taught them how to mask the exhaustion that comes with it.
The pharmacist who appears calm and composed may be working extraordinarily hard just to filter out background noise, organise competing priorities, and maintain the level of concentration required to ensure every prescription is safe.
Ironically, the very qualities that make someone an excellent pharmacist can also leave them vulnerable to becoming overwhelmed by the environment in which they work.
None of this should be mistaken for an argument that standards should change.
Patient safety must always remain our highest priority.
But recognising neurodiversity within the profession invites us to ask different questions. Could we design dispensaries that minimise unnecessary interruptions? Could we create quieter spaces for clinically demanding tasks? Could we acknowledge that different communication styles do not equate to different levels of competence? Could managers receive greater awareness of how neurodivergence presents in adults, particularly in highly capable professionals who have spent years developing strategies to cope?
These changes would not only benefit neurodivergent pharmacists. They would improve working conditions for everyone.
There is also a message for the public.
Most patients are kind, patient and appreciative. They understand that healthcare is under pressure and that pharmacists are balancing far more than simply handing over medicines.
Occasionally, however, frustration spills over. A prescription takes longer than expected. A pharmacist pauses before answering a question. Someone appears quieter or less conversational than anticipated.
We are quick to remind ourselves that the person standing in front of us may have an invisible disability or be carrying burdens we cannot see.
It is worth remembering that the same may be true of the person standing behind the counter.
Grace should not be reserved solely for patients.
Inclusion
Healthcare professionals are human beings too. They bring their strengths, challenges, personalities and differences to work every day. Some of those differences may never be formally recognised, yet they shape how individuals experience an increasingly demanding profession.
The conversation around neurodiversity has taught us that inclusion is rarely about lowering expectations. It is about removing unnecessary barriers so people can contribute their strengths.
Community pharmacy has always been built on compassion, professionalism and trust.
Maybe the next step in that journey is recognising that neurodiversity is not only something we support in those we care for. It is something that almost certainly exists within our own profession, quietly contributing to patient care every single day.
If we truly believe that every brain has value, then that belief should extend to the pharmacists caring for our communities as much as it does to the communities themselves.
Is Community Pharmacy Designed for Neurodivergent Minds?
Community pharmacy has always attracted people who care deeply about getting things right.
We are trained to notice the details others might miss. We are expected to spot prescribing anomalies, identify drug interactions, recognise patterns, remember obscure clinical guidance and make safe decisions under pressure. Accuracy is not simply desirable in our profession, it is fundamental to patient safety.
It makes me wonder whether community pharmacy naturally attracts a particular way of thinking.
We do not know how many pharmacists are neurodivergent. Many autistic adults remain undiagnosed until later in life, while others never seek a formal diagnosis at all. ADHD is similarly under-recognised, particularly in professionals who have developed highly effective coping strategies. Therefore, we should be cautious about making assumptions regarding prevalence.
Yet it is difficult to ignore that many characteristics associated with excellent pharmacists overlap with strengths commonly described in neurodivergent cognition.
The capacity to develop deep specialist knowledge or ‘special interests’ in areas such as pharmacology, therapeutics, antimicrobial stewardship or medicines optimisation.
These qualities are celebrated within pharmacy because they make us safer clinicians.
The irony is that the environment in which pharmacists now work often demands almost the opposite.
The pharmacist is expected to remain clinically precise while simultaneously switching between multiple competing demands, maintaining a calm demeanour, communicating effectively with every person who walks through the door, and completing an ever-growing list of administrative tasks.
We have become so accustomed to this environment that we rarely stop to ask a simple question:
Is this actually the best way to work? Or have we normalised a system that asks too much of every pharmacist, particularly those whose brains naturally favour sustained concentration over constant task-switching?
Masking
There is a tendency to equate productivity with interruption.
A busy pharmacy is often considered an efficient pharmacy. A pharmacist who appears endlessly available is viewed positively. Rapid responses, immediate accessibility and continual multitasking have almost become professional expectations.
But cognitive science tells us that every interruption carries a cost.
Each time attention shifts from one complex task to another, the brain must disengage, retain information, reorient itself and resume the original activity. For work requiring high levels of accuracy, these repeated context switches are not trivial inconveniences, they consume cognitive resources.
For many neurodivergent people, that cognitive cost may be even greater.
Autistic people often describe expending significant mental energy filtering sensory information, adapting to changing demands and recovering from unexpected interruptions. None of this is visible from the outside. Patients simply see a calm pharmacist answering questions and checking prescriptions.
What they do not see is the invisible workload occurring alongside the visible one.
This is where masking becomes important.
Masking is often misunderstood as pretending not to be autistic. In reality, it is the continual process of adapting natural behaviours to meet social expectations. It may involve consciously monitoring facial expressions, forcing eye contact, suppressing direct communication styles, rehearsing conversations or hiding signs of sensory overwhelm.
Many healthcare professionals perform emotional labour every day.
Neurodivergent healthcare professionals may be performing an additional layer of cognitive labour that remains almost entirely invisible.
The effort required to appear effortlessly ‘professional’ can itself become exhausting.
‘Different’ does not mean ‘deficient’.
Burnout
Has the profession unknowingly recruited people with exceptional abilities, while simultaneously creating environments that make those abilities harder to sustain?
This raises another question.
Could neurodiversity help explain, at least in part, the extraordinary levels of burnout reported across community pharmacy?
Burnout has become almost synonymous with healthcare. We discuss staffing shortages, increasing workloads, expanding responsibilities and administrative burden with understandable concern. Yet burnout is often framed solely as a consequence of working too hard.
Autistic burnout describes something rather different.
It is the profound physical, cognitive and emotional exhaustion that can result from prolonged masking, chronic sensory overload and sustained efforts to adapt to environments that are fundamentally misaligned with how an individual processes the world. It is often accompanied by reduced executive functioning, diminished capacity to cope with everyday demands, and increased sensitivity to sensory input.
This is not the same as simply feeling tired after a busy week.
It represents a depletion of the resources required simply to function.
That does not mean community pharmacy causes autistic burnout, nor does it mean every pharmacist experiencing burnout is neurodivergent.
The profession frequently celebrates resilience. Perhaps we should also ask why resilience has become such a necessary attribute.
Neuroinclusive workplaces should be about removing unnecessary barriers. Psychological safety for colleagues to disclose neurodivergence without fear of judgement. Leadership that understands the difference between poor performance and cognitive overload.
These are not accommodations that benefit only neurodivergent pharmacists. Every pharmacist thinks more clearly with fewer interruptions. Every pharmacist benefits from environments that support concentration. Every patient benefits when the clinician responsible for their medicines has the cognitive space to exercise sound clinical judgement.
Public
There is another group whose role should not be overlooked: The public.
The overwhelming majority of patients are patient, appreciative and understanding. They recognise that community pharmacy is under immense pressure and that pharmacists are balancing multiple responsibilities simultaneously. The person standing behind the counter may also be carrying invisible demands.
Ultimately, this conversation is not really about autism or ADHD. It is about recognising that human minds are wonderfully diverse. Healthcare has made enormous progress in understanding the needs of patients who think differently. It would be a missed opportunity if we failed to apply those same principles to the professionals delivering care.
We do not yet know how many practising pharmacists are neurodivergent. Indeed, the UK literature acknowledges that reliable prevalence data for neurodivergence among medical professionals remains limited. What is emerging, however, is a growing body of research examining the experiences of neurodivergent healthcare professionals.
A study of 225 autistic doctors by Shaw et al (2023), the majority of whom were based in the UK, found that the average age of formal autism diagnosis was 36. Almost a third had not disclosed their autism to anyone at work, while fewer than half had requested workplace adjustments and only around half of those reported that the adjustments had been implemented. More recent UK research has explored the experiences of autistic doctors transitioning into clinical practice, identifying the unpredictable nature of healthcare environments and challenging workplace interactions as particular sources of difficulty (Keenan, Doherty & Shaw, 2026).
The picture is echoed by the British Medical Association’s 2025 UK-wide survey of disabled and neurodivergent doctors and medical students. Among respondents requiring reasonable adjustments, 73 per cent reported that they had not received all the adjustments they needed.
Pharmacy-specific research remains scarce. A UK study by Kamdar and Sabir (2024) examining community pharmacists’ understanding of neurodiversity identified significant gaps in knowledge, training and neuroinclusive practice. While this research focused primarily on supporting neurodivergent patients rather than neurodivergent pharmacists themselves, it highlights how relatively new this conversation remains within pharmacy.
Should the absence of prevalence data itself make us curious? We cannot currently say how many pharmacists are autistic, have ADHD or are otherwise neurodivergent. But research from our medical colleagues suggests that some healthcare professionals spend substantial portions of their careers working, adapting and masking before their neurodivergence is recognised.
Should resilience compensate for systems that routinely overload attention, fragment concentration and demand continual adaptation? Or should we instead examine whether the systems themselves require redesign?
Community pharmacy has rightly become more aware of the needs of neurodivergent patients. We encourage clearer communication. We recognise sensory sensitivities. We appreciate that not every disability is immediately visible. We increasingly understand that equitable care sometimes requires different approaches rather than identical ones.
It is time to extend that same thinking to the workforce.
Áine is a Superintendent Pharmacist and pharmacy owner with over 18 years of experience working in community pharmacies across Ireland. In 2014, she earned her Master of Pharmacy (MPharm) degree in the UK. Her career journey has encompassed a variety of roles, including locum, support, and supervising, culminating in her recent transition to pharmacy ownership. She is deeply committed to upholding the integrity and vital role of community pharmacy in Ireland, combining her extensive experience with a passion for patient care and professional excellence.
