Twice Exceptional in Medicine: A Case Series of Neurodivergent Physicians.

The term twice-exceptional (2e) describes individuals who combine high intellectual potential with neurodevelopmental or psychiatric conditions that may impair performance in traditional environments. While this concept has been increasingly recognized in education, its relevance to medical training and practice has received little attention. This case series presents five physicians across different stages of training who exemplify twice-exceptionality, highlighting both their cognitive strengths and the barriers they faced in clinical environments. The first case involves a surgical resident with nonverbal learning disorder (NVLD), attention deficit hyperactivity disorder (ADHD), and type 1 diabetes whose superior intellect masked significant executive dysfunction until repeated crises prompted disclosure and pursuit of accommodations. The second case describes a resident with ADHD and perfectionism who, through structured coping strategies and mentorship, thrived in a supportive environment. A third case highlights a senior resident with anxiety and obsessive-compulsive disorder whose perfectionism and rumination undermined efficiency and self-confidence despite positive evaluations. The fourth case involves an attending physician with ADHD and obsessive traits who maintained professional success through compensatory overwork but experienced disorganization, fatigue, and burnout. The fifth case describes another attending physician with ADHD, anxiety, and depression whose intellectual giftedness coexisted with executive dysfunction and impaired self-care, leading to chronic struggles despite ongoing treatment. Across these cases, recurring themes emerge: masking of disability by high achievement, misattribution of neurodivergent struggles as professionalism deficits, and delayed or absent accommodations. While some physicians succeed in supportive environments, others experience isolation, burnout, or attrition when their needs remain unrecognized. These cases underscore the paradox of twice-exceptionality in medicine, where extraordinary potential and hidden vulnerabilities coexist. Greater recognition of this duality is essential to building neurodiversity-affirming environments that move beyond deficit-based models, reduce stigma, and foster structures in which talented but vulnerable physicians can thrive.