How ADHD Presents in Physicians (Neuro-Spicy Month)

It's Neuro-Spicy Month here at Rethink Your Rules!

Jenny's gearing up to present about ADHD at a CME about neurodiversity next month. So it seems like the perfect time to revisit some prior RYR episodes about ADHD. (Especially since they are the most downloaded episodes ever!)

This week, we're going into detail about the signs and symptoms of ADHD in physicians. Understanding how ADHD presents can help us recognize it in ourselves and others, and can help us do a better job of supporting our colleagues.

Mentioned in this Episode:
Neurodiversity: A Conference About People Who Think Differently
Click HERE to register for this free virtual CME event, where you can hear me speak, along with other physician experts in neurodiversity.

Adult ADHD: Resources for Physicians
Jenny's favorite evidence-based resources & simple ADHD self-assessments, curated for physicians.

Understanding attention deficit/hyperactivity disorder in physicians: workplace implications and management strategies
Journal Article by Mammoliti et al

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Need help applying this to your life? Ready for more strategies like this, but personalized to YOU? Set up your free consult and let’s talk about your unique situation and how coaching can help:
https://getcoached.jennyhobbsmd.com/consult
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Everything on this podcast and website is for informational purposes only and should not be used as medical advice. Views are our own, and do not necessarily represent those of our past or present employers or colleagues.

Transcript

Kevin: 0:09

Welcome to Rethink your Rules with Jenny Hobbs MD. A fresh perspective on relationships, success and happiness for high achieving moms.

Jenny: 0:19

This week, I am actually going to be revisiting a topic that is near and dear to my heart, which is ADHD, and even more specifically, thinking about ADHD in women and physicians and in myself and my own journey, and I wanted to bring this topic up again now for a couple of reasons. A few reasons. The first one is that this is one of the most popular episodes when I look back at the downloads of my podcast. And the second reason is that there's some new faces here and you may not even realize that these episodes are buried there that have some really good information about ADHD. And the third reason, and maybe the most exciting, is that I'm actually in the middle of preparing for a really exciting conference where I will be speaking about ADHD in physicians, and I want to be sure that you know about this conference because, although it is a continuing medical education conference that is put on by physicians, and much of the target is physicians and those who work with physicians in the workplace, the conference is actually open to the general public, so anyone is welcome to listen in and, in fact, the topics are very relevant really to anyone who wants to learn more about neurodiversity. So I thought this is a great opportunity to bring back one of the most popular podcasts that I've had and make sure that you have an opportunity to hear it, if you haven't already, and then to also consider joining us for this really cool opportunity to get more information and go even more in depth on this topic. So before I replay the episode in mind, I do want to tell you a bit about this conference. It's kind of unique and kind of cool. It's actually called Neurodiversity a conference about people who think differently, and not only will there be talks on ADHD, like mine, but there also will be talks about autism spectrum disorder and other forms of neurodiversity, and it's a really cool group of physicians, many of whom are neurodiverse themselves, talking about ways that we can work with our neurodiversity strategies for sleep and procrastination and sensory overwhelm and things like that, and then also talking about how we can help our patients who may be neurodiverse. So it's really a very cool eclectic group of people with a lot of practical insight and personal experience.

Jenny: 2:46

And it's entirely virtual and it is actually free. So if you want to show up and watch the CME live from anywhere virtually, you can do that for free and you don't have to be a physician. Now, if you are a physician or someone in the medical field, you can actually apply for CME credits and things like that. It's a truly legit medical education conference and I know for me, the topics that I'm going to be sharing about are things I do speak at when I go to conferences that cost a lot more money than this, and people are there in person, right, and physicians are getting CME credits for it. So it's literally the same content that we would be providing at that type of conference, but it's in a format that is really fun and easily accessible for anyone to attend. So it's a really cool opportunity.

Jenny: 3:32

I'm so grateful that they asked me to be a part of this and I'll just give you the dates so that you're aware of when it's happening. It's going to be this coming June 5th through 7th 2024. And the time is in the evenings, so it can work really nicely around any schedule and, don't worry, I'll put a link in the show notes and everything if you want to check out more about it or register. But again, it's completely free and each evening there's going to be a few speakers and if you decide that you want to have recordings of those speaker talks or if you want to be able to attend a coffee chat with all of us the Saturday afterwards, you really get to know everyone better and explore this in more depth. You can always upgrade to that sort of VIP option.

Jenny: 4:11

That does cost some money, but assuming that you just want to come and get some great information and think more about how you can handle neurodiversity, maybe in yourself or your patients, if you're a clinician of some kind or if you're someone who works with physicians, you know if you're a clinician of some kind or if you're someone who works with physicians, you know. If you're in leadership working with physicians, this is a really great opportunity to get some insight into. You know, when someone's behaving in a certain way that maybe seems problematic or pathologic or frustrating, whether or not there might be an element of neurodiversity there that you would want to be aware of as their employer or someone working in physician leadership. So it's going to be a lot of fun. Again, it's June 5th through 7th 2024, and that's next month, and I'm going to put in the show notes a link that will take you directly to where you can register for that, and that actually is a an affiliate link for me. So I just want to disclose that that will actually offer me, you know kind of credit for you signing up, and if you end up purchasing the VIP thing, I would get a small amount of money for that. If you don't feel comfortable with that for any reason, you'll also be able to find, you know, the conference page and you can just sign up directly there. That's no problem.

Jenny: 5:13

The other thing I will put in the show notes is a link to my resources on ADHD which goes directly to my page and that will provide you a nice free download with lots of information to explore as well. So two different types of links you'll find in the show notes. One is going to be about this really awesome conference called Neurodiversity, a conference about people who think differently, coming up next month in June 2024. And the second link that you are going to see there is a link to my ADHD resources which you can obtain as a free download, and of course, there'll be all the info there to contact and reach out to me if you have any questions. And with that I am going to replay one of my most popular episodes, all about ADHD. So take a listen and I hope that you have as much fun exploring this as I do sharing it. Hey, there it's, jenny. Welcome back to another episode of Rethink your Rules.

Jenny: 6:02

Today I want to share with you some specifics about how ADHD presents in physicians, and even if you are not a physician, I think this will be useful because it's again kind of building on what we did last week sharing a lot of practical real-life examples of how ADHD looks in adults, and so some of these features that I'm going to talk about in the context of a clinical setting or a hospital setting, you could probably picture how they might look in an office place, so workplace setting. So if you work in another career, I also think this could be really useful. If you are a person who works with physicians whether you're a physician leader or a colleague who has some physicians that you're working with who you find challenging or you might be thinking they're kind of unprofessional this is going to be an interesting way for you to maybe take a step back and look at these behavioral or professional issues that you're noticing and just consider the possibility of whether or not there might be some kind of neurobiological basis for why that person is doing that, versus an actual character flaw or personality issue, and I think that you know, in this work that I do, where I'm really trying to empower women who are, you know, too much, or ADHD or neurodiverse these really strong women. I really want to empower them to understand themselves and accept themselves and show up with more confidence. That's a lot of the work that I do as a personal coach, but also the other side of this work that I do as a person who still works in the medical field and as a physician leader myself, is I really want this information out there so that we as leaders and colleagues and coaches for other professionals, can do a better job of supporting them within the institution.

Jenny: 7:56

Right, because, remember, being burned out and miserable in your career is not just due to intrinsic factors like oh, do more yoga, find more time for yourself, change your mindset and everything will be fine. Right, there's really two sides of it. There's the intrinsic work that you do to accept and love yourself and to not be such a perfectionist and all those things, but there's also the extrinsic work that we need to do as a medical community to support our colleagues and our employees, right, so we can't leave that piece out and I kind of wanted to mention that, because one of the critiques that physician coaches get you know is that we are really part of this whole wellness initiative where we're just telling people to work on themselves when the system itself is broken, and I don't actually believe that. I believe part of my job is to also call out the system and act in a way that brings about systemic change. So please listen, even if you don't think you have ADHD or you don't think that this really applies to you, because I do think that the entire system is better off when we are more open-minded about how we can support our colleagues in this way, and there's some really great practical tips here.

Jenny: 9:01

What I'm going to do is go through a fantastic article that I found a couple of years ago, and I will put a link to this in the show notes. It's from the Official Journal of the Canadian Society of Physician Leaders. It's called Understanding Attention Deficit Hyperactivity Disorder in Physicians Workplace Implications and Management Strategies, and the author is Marina Mammoliti, christopher Richards-Bentley, adam Lai and Mary Nguyen, so that information will all be in the show notes. It was from a couple years ago, as I mentioned, 2021. And I love this article.

Jenny: 9:36

I've sent it to so many of my friends and colleagues and clients, because it has these three tables that really summarize how these clinicians who wrote this article have seen ADHD presenting in physicians. And so these are physicians that get referred to them for you know what are thought to be behavioral or professional issues and performance in their job, and then they discover that they have an underlying diagnosis of ADHD that had been previously missed, and so what they did was they went through the symptoms of ADHD and gave very clear examples from the medical field. So I'm just going to actually read through those, because this, I think, is the most important and last week's episode was kind of long, so I want to try to keep this kind of really focused in here. So the first table in this article talks about attention-related symptoms of ADHD and how those present, and so the first one they talk about is making careless mistakes, not having attention to detail, and so the example for a physician might be like making a mistake in your charting or in your orders, maybe gets distracted and orders the wrong dose or the wrong medication. Maybe during an exam they know the material but gets distracted, and so they choose the wrong answer by accident, and I know, for me, as my symptoms have become more significant as I've gotten into perimenopause and, as I've talked about that seems to affect it I noticed that I sometimes do this where I'm going to order a medication and I'm more likely to sort of forget that I was going to order it. That used to never happen to me before, and so I have to be really thoughtful to write it down or I get worried like I just need to do it right away so I don't forget.

Jenny: 11:10

Another one a symptom is has difficulty sustaining attention, and so you might see this physician get distracted while they're, you know, doing their assessment and plan and interacting, asking questions of the patient. So you know, I've seen sometimes I do this I'll ask a question and then I get a little bit distracted. Something catches my eye and then I realize I haven't heard what the patient said. Not because I don't care, but there's just a lot of distractions in the hospital. Another thing that comes up a lot is the physician may appear distracted or bored during rounding with the team or meetings or things like that, and they might be like looking off into space. Another example again you know, people with ADHD tend to not seem to be listening when they're spoken to and so they can look like they're being unprofessional, bored, dismissive, unprofessional. Another thing that is common is failing to follow through on, so the way that would look in a physician might be like not following up on a task that they were assigned in a meeting, or like goals or organizational initiatives that the team gets. They might just not follow through and get it done.

Jenny: 12:13

They might be really poor at tracking their CME, their licensing, their paperwork renewals and I will tell you this is a huge one for me. I am absolutely terrible at this. I used to joke with one of my bosses we had to record our administrative hours and write down how many hours we'd spent on a project so we could get reimbursed for them, and I just would put it off and put it off and put it off and then it would literally take me more time to record the hours. And now I get these emails all the time and it feels like, as medicine becomes more and more corporate, and I have more and more corporations asking me to spend my time on tracking, licensing and reimbursing my money. And there's all these rules about the timeframe after which you can submit hours, right, so they want to avoid fraud, which is important, and of course, getting paid in a timely fashion and having the budget be appropriate for a year is important, and I know that intellectually. But it's incredibly hard for me when I'm not at work doing interesting, intense patient care. It's really hard for me to sit down and sift through email after email and find the deadline and do the administrative drudgery. What I feel like is like a drudgery of recording the CME and so that will just pile and pile up. Same with paperwork. It's very difficult for physicians, and so that will just pile and pile up. Same with paperwork. It's very difficult for physicians.

Jenny: 13:26

Similarly, one of the things about ADHD is avoiding tasks that require sustained mental effort. So again, you know, avoiding things like preparing a PowerPoint for a presentation, delaying doing a grant proposal. So for me, I love presenting, I love talking, I enjoy doing research and I like presenting my research. But the part where I have to sit down by myself and prepare the poster or the slides or the content was so boring and I would always put it off and do it at the last minute and it would be like right on time or like an hour late, you know, and probably could have done a much better job if I started earlier. But just really hard for me to set myself down and focus on that. Same with charting I think I've mentioned I can't remember if I mentioned this last week, but this was one of the big signs that I had ADHD was my workflow at night.

Jenny: 14:14

Because as a nocturnist physician, what would happen is patients would come up on the board and there's three of us. We're sort of going through picking patients from the board that need to be seen, that have a, they're new, they're sick, they're in the ER, they've got some unknown diagnosis, so those would be. I'd be like, oh, I'm so interested, I would go, I would read about them, I would figure out what's going on, get all the orders in, and then my job was to sit down and write down everything and type it into a note. And 13 years into my career career that wasn't all that interesting anymore. It felt, like, you know, just kind of boring and tedious and I would rather look at the list and pick out the next interesting person, right? Or I'd rather get up and chat with my friends, or I'd rather get up and, you know, have a snack, and so, again, that was where for me being able to follow through and get my charting done and focus even though I know it was important was just really hard for me to do, like harder than for other people, and it was funny because I didn't have that problem, you know, when I was a resident or early in my career. But I realized that that's because, early in my career, doing a note, an assessment and plan, all that was a challenge. It was novel, right, and so, remember, people with ADHD are motivated by novelty, challenge things that they find interesting, and so all of that fit the bill for me when I was in training. But now it had become routine, right, and so it was much less interesting, and so I wanted my novelty from looking at a new patient instead of writing up the last patient, another one under this table.

Jenny: 15:43

One here is that people with ADHD tend to lose things that are necessary for tasks and activities, so they might be likely to lose their patient list or charts or, um, lose their laptop or their hospital badge. I know for me I have to have my hospital badge in a specific place in my bag, and when I first started at my job they had two badges. We all got two, so I kept one in my purse so I could get in and out of the building, and I had one clipped to my white coat so I could get around within the building. And then they stopped doing that, so I lost one of the two after like 10 years and I went to go get a replacement and they said, oh, we're not doing replacements anymore, so you just use the one. And so I was supposed to wear it around on my coat and then remember at the end of the day to take it off and put it in my bag and then have it in the bag when I came back in the building and then put it back on my coat.

Jenny: 16:29

And, of course, with all those transitions, I was forever running out the door without my ID, not able to get back in. I typically always forget at least one to two things every time I leave my team room, walk out to my car, have to walk back up, back and forth, things like that, and so actually, this is a happy ending, because our team assistant who's amazing was able to talk to security and she's just one of those people that is good at getting things done, and so she pleaded with them and they gave me a new badge and now I have my one back on my coat and my one in my purse and I don't lose them anymore, right? And so again that gets back to I have to have it in the same place. If I move that card to any other place I'll forget it and I'll be locked out of the building. Another one for this table.

Jenny: 17:11

One of attention-related symptoms for ADHD in physicians getting easily distracted. So when you're in meetings presenting a case, so it might appear to be tangential when speaking or conveying ideas, sometimes their emails, communications, written submissions may be a little bit disjointed or harder for people to follow. And I will say for me this is a lot of people like. When I'm talking to you right here, a lot of people really resonate with what I'm saying and think I'm a really great speaker and they love my ideas and all this. But there are people who sometimes my thoughts and my brain go so quickly and they literally I've heard, I've gotten the feedback before that I seem like you know I have flight of ideas or you know people think I have like a pretty significant mental health disorder and I don't. It all makes sense to me, but sometimes I'm just moving so quickly and seeing so many connections that it's hard for me to slow down and connect the dots for everyone.

Jenny: 18:03

And another part of this easily distracted is you know you might be working on a research paper or an abstract and kind of get in the weeds on one specific detail and go way off kind of down a rabbit hole. That's not relevant and it can really make your work take a little longer. Again, for me, preparing talks, presentations, sometimes even writing my notes at night, I'll get really fixated on one detail of the patient's medical care and I just really want to understand it. So I'll go on up to date and I'm researching, you know, and it may not be the most important thing to get through the night and see other patients and for this patient's care, but it just like kind of niggles at me until I get it all sorted out. And I love it's really satisfying for me to go down that rabbit hole. But obviously I have to weigh that against the fact that I have lots of patients to see and we're not in an environment where that's really something I can do. And so I have to use this ability to say what's most important and stop myself from getting distracted down this rabbit hole, which takes a lot of effort for me to do.

Jenny: 18:58

Another thing, of course, is being forgetful. So ADHD people often, you know, forget that there's a meeting or an obligation or, you know, locking doors, maybe like forgetting to pay insurance or pay tax again, like forgetting these deadlines, forgetting that there's another patient waiting. I would say I'm not as forgetful and this is one of the reasons I didn't really think I had ADHD at first, but I will say that I've noticed that this was something where I was like managing it for myself. So I have a very specific system to remind me when I have things coming up so that I don't forget. And then another one on this attention-related symptoms of ADHD in physicians is being, you know, poorly organized. So, and I like to think of this, even though I, as I mentioned last week, was very organized, there's also this sense with organization of being chronically overwhelmed. Like so many tasks, so many cases, it feels like hard to prioritize and it feels overwhelming and hard to organize one at a time, and this can you know.

Jenny: 19:54

Another one they give an example is difficulty with multiple requests at once, like when you're at the nursing station, and so, as a nocturnist, I get a lot of calls from the ER, from the nurses, you know, on cross-cover hundreds of patients, and so, again, this is something that wasn't so hard for me before. But as I've kind of gotten older and as our census has gotten larger and we also now are asked to do a lot of additional things at the same time, more than we used to be. There's a lot more multitasking, and so that has become more overwhelming for me over time. And having multiple calls at the same time, it feels like I've just noticed it takes me a little longer to sort of plow through each of them, and it's very difficult for me to transition from answering a bunch of nurse phone calls to filling out a thoughtful, sustained mental effort H&P right and so that transition between those two tasks becomes more and more difficult when you have more significant ADHD and, again, not everyone's going to have all those things and you know, as I told my employer when I disclosed my ADHD, I managed to be, you know, provide care that they have all agreed is far above the clinical standard of. You know, I'm very highly regarded as an excellent clinician and excellent at patient care, so these hindrances have not kept me from providing safe, excellent care for many years and being a really, you know, integral part of my team, and I have not required accommodations for that right.

Jenny: 21:21

So this is not to say that everyone who has ADHD is going to be a terrible doctor or is not going to call people back on time or any of that. I want to be clear. These can just be things that can be harder for a person with ADHD to navigate, and you may be working so hard to overcome those additional challenges without knowing that that's what you're doing, that that can lead to more emotional exhaustion and burnout and frustration, and you might feel like something's wrong with you because you can't do that as well as other people, and so it's important to recognize oh okay, this may be something where I'm a little bit more challenged than another person and I can still work on it, but I can work on it from a place of recognizing this isn't just that I am a failure or I am, you know, lazy or I'm not good or things like that. Right, and then the last thing on this list I really like is this idea about someone who is a doctor with ADHD having inattention. What actually can often show up is that they appear angry or unprofessional when they're overwhelmed by cognitive demand, and I can tell you that in my role where I review quality behavioral reports from various physicians, I notice this pretty commonly. When physicians are in a position of balancing a lot of demands and pages and phone calls and expectations, sometimes they are referred to as being angry or rude, and what I often find is that these people typically are women in their 40s and 50s and I suspect have likely undiagnosed ADHD or have begun to have those symptoms from going into perimenopause and having their lower estrogen which affects that. And so I think often the root of this problem is not that this is like a mean person and this does not excuse, of course, acting angry or unprofessional. But if we step back and realize the root of it may be that they are being asked to do too many things at once and it's overwhelming their cognitive demand on top of emotional exhaustion and burnout. Perhaps we could sort out a way to address the root of those problems rather than just shaming and blaming them and saying you're rude and that's unacceptable, and getting defensiveness right, and I have seen this pattern so many times, this idea of angry and unprofessional, and really the root is that their ability to multitask in this system, which arguably is not supporting anyone very well, much less people who have neurodiversity right is being compromised. So that's the end of table one, the attention-related signs of ADHD in physicians, and then we're going to move on to table two.

Jenny: 23:52

So table two is the hyperactivity and impulsivity-related symptoms of ADHD and how those might present in physicians. So the first one here is fidgeting, tapping, hands and feet squirming, and so you can probably imagine what this looks like, right? So people leaving their seat in a situation where everyone else is sitting down and listening to something, maybe, like you know, I mentioned, like I twirl my hair a lot and people often are fidgeting and people think that they're bored because they're squirming around in their seat. It might even be distracting. I had a patient once I was twirling my hair while I was talking to her in the middle of the night in the hospital and she was like that is annoying. She was very bothered by it and I was like I'm sorry, I can't help it, I'm trying.

Jenny: 24:34

Another thing that you might see is someone who is on the go or acts as if driven by a motor, so that's kind of the DSM phrase for it, that type of feeling energetic comes out in physicians is, you know, they might be one of those people that's just really has a hard time relaxing right, taking time off from work, watching TV, sitting on the couch, relaxing with their family.

Jenny: 24:58

Maybe they are really, you know, until you know they're working out a lot, using up a lot of physical energy. Maybe they're working in the ER and they're just always like kind of running around in circles, really busy. They often people like this often will be again like not able to just sit and listen to a meeting, so they're getting snacks, they're eating, they're just constantly moving around can be really seen as disruptive and this can also lead to interrupting because they kind of like get restless and bored. I know for me sometimes in medicine a lot of our meetings are very like focused on a lot of details and I can have a hard time sometimes like waiting for the person to finish talking and describing something in a lot of words because I just get very like restless and wanting to move on.

Jenny: 25:41

And then, you know, I sometimes probably interrupt them because I'm just my brain and my mind are going faster and that can, of course, be seen as very rude, which I recognize and mitigate a lot. And then another thing along with that is like talking excessively or blurting out answers. So again, this shows up in physicians by maybe speaking too much in a meeting and people feel like they are not letting other people have any airtime, making people feel not heard, both patients and colleagues, like people thinking oh, they just only want to hear themselves talk and really kind of changing a boundary or potentially go past the boundary by oversharing or go past the clinic time allotted for the appointment because they're chatty, you know, and you guys can imagine based on my podcast, I don't need to tell you. But so again, picture these people you work with who are often going over patient encounter times or where they are like a little bit too, like the nurses might we've seen this at our hospital nurses write people up because they think they're like a little too casual or talking about things in a place where, like maybe it would feel like it was unprofessional to talk about it. Sometimes people with ADHD just are so busy talking and they're kind of like go, go, go, and they might blurt out something before they realize where they are. And then another big part of ADHD with this hyperactivity is, you know, difficulty, waiting your turn and interrupting and intruding right. And so, again, this can really come across as people saying this patient's impatient, this physician's impatient, they're rude. You know they're self-absorbed, you know they only want to hear their idea, they don't want to listen to our idea. And I will tell you this has I learned about this from my son when he was first diagnosed with ADHD.

Jenny: 27:32

He used to get very angry if he thought of something that he wanted to say and we asked him to wait a minute to tell us. He would get so upset. And what we've learned is that because he literally will forget it, and so he would get so angry if we said wait, and he's trying to wait, he's a little kid, he's, you know, very impulsive, and he would try to wait, not interrupt us. And then we'd say, okay, charlie, what'd you need to say? And then he's like I forgot, I'm so mad, right. And then, as I've learned more about ADHD and I've I've noticed this in myself and other adults too is like we have this idea in our head and we're going to forget it if we don't say it, and so we realize. By the way, I just want to tell you, we realize these are not like polite, professional ways to act, and we most of us do work really hard to mask this and cover it up, particularly women in medicine because we have learned there's no way we got to this point in our career without learning how to like kind of cover some of this up. But when we're tired, we're stressed, you know we're not at our best, et cetera, like sometimes we don't do it perfectly or it takes a lot of energy for us to do and drains our energy, distracting us from other things, right? So it's just something that's good to keep in mind.

Jenny: 28:37

When someone is acting that way is that it's possible that they had underlying ADHD and it's now getting worse over time and they're again again. The cognitive demand and age and all these different things are kind of accumulating to make it a little more difficult than it used to be to suppress these tendencies. And then the table three of this paper is probably my favorite. So it talks about symptoms of ADHD that are not included in the DSM criteria and I mentioned a lot about this in previous episodes that are not included in the DSM criteria and I mentioned a lot about this in previous episodes. There are certain symptoms of ADHD that are not in the official criteria but are very, very commonly seen, and so those other symptoms of ADHD can show up in physicians in really dramatic ways.

Jenny: 29:19

One of these is variability of performance. So ADHD is one of the hallmarks is inconsistency. So when you see a physician with ADHD, their inconsistency looks like being really really good and getting amazing evaluations at one part of their job and then really failing terribly at another part. So this may be like they may have an area of interest, like they're hyper-focused on surgery and working with their hands, so they may do a really good job with that, but some other part of the job may be boring or very difficult for them to focus on, and so they may do very poorly at it. Even if they know that that thing is important, like on a logical level, it's just very hard for them to engage at the same level. And another thing with this is that, you know, this interest-based nervous system that physicians with ADHD have means that they might spend a lot of time on something that they feel is important because it's interesting, it's challenging, it's new right, even if it doesn't carry as great a reward.

Jenny: 30:15

And, by the way, I think this is actually one of the things that makes physicians with ADHD awesome, which is, like, in this modern era, a lot of doctors to be honest sorry if you're not a physician, but the fact is a lot of doctors mostly just care about making their money and going home. How can I build the RVUs and get out of here as soon as possible? And do you know? They want, basically like they want the reward of the finances, right, which makes sense, of course Like why wouldn't you want the better financial reward, the shorter hours, all those things? It's very logical and many physicians are like that, but when you're a physician with ADHD, you're actually not as motivated by the money as you are by these other factors like interest and novelty and urgency, and personally I think we could use a little bit more of that in the modern era. I think that's probably what physicians were a bit more like back before medicine became so corporatized and it was like a calling, where you did things because they were right for your patient right A little bit more.

Jenny: 31:13

And so I know for me this is something that I've noticed makes me very different than my colleagues. I'm not going to just rush through my work because I can make more money and get more reward and get more accolades on our team list of who's the fastest, most efficient, most productive doctor. I'm actually going to spend my energy and my time on things I think are valuable for my patients and interesting and are aligned with what I care about. But again, this can show up where you can be very hyper-focused on something that other people don't understand and they can't figure out how to motivate you. And of course, one of the challenges in working with someone with ADHD is that this is going to look different for everyone. So for some people their hyper-focus might be on surgery or working with their hands, for another person it might be on teaching, for another person it might be on this intellectual challenge or this mystery. You know that's like me. I like the intellectual stuff, and everyone is so different with what motivates and interests them, and so it may just look like, oh, they're just not trying or they don't care, and I'm sure there are some people out there, but most people who've gone through the work of becoming a physician and are this far along in their career. It's not that they just genuinely are a bad person who doesn't care. It's probably more likely it's difficult for them to be motivated in the same way as other people, and so maybe we need to ask the question of why that is, versus just being frustrated by it, right?

Jenny: 32:32

Another part of this table three other symptoms of ADHD as they present in physicians is poor time management. So we talked a lot about that last week. You know being late for meetings and appointments, forgetting how long it's been since a call or a page, while other people wait. I know this happens with me. I'll see a page and I'll think, okay, I'm going to just finish what I'm doing so I don't forget what I was typing in this note here, right? Because again, I'm like I know I'm going to forget this if I don't write it down while my mind is thinking about this patient and then, before I know it, five or ten minutes has gone by and I'm like, oh, I forgot. I had a page I was supposed to be listening to and responding to and I literally just didn't realize that that much time was going by as I was trying to get my thoughts out about my patient in the note and again forgetting how long they've been talking during a meeting and social gathering. Like me, right now, I'm like, oh my gosh, how long is this podcast? I thought it was going to be short, right, forgetting how long the time has gone by.

Jenny: 33:22

And I often have this problem with my presentations. I love speaking and I get good feedback on my speaking, but the thing I always get in trouble for is, like I want I think that I've got the time figured out and then I end up extrapolating too much and going over the time, right, and so if you're seeing that in someone, they may have ADHD that could be treated, which would help them be more effective at getting their points across, and they do have value to offer so we can help them. You know, do a better job of that within the time constraints. Another part of poor time management is overcommitting, right, and this is a huge one. I think I talked about this with myself in many places. But you know saying yes to too many things in meetings and thinking you can do it all and then not, and then kind of like overbooking your schedule, overbooking yourself with appointments, thinking that you have more time than you do, and then the last but not least, is the emotional dysregulation of ADHD, which I've talked about so many times.

Jenny: 34:12

This symptom of ADHD is, in my opinion, one of the most problematic for physicians Because, remember, for physicians, we are in emotional situations that require a lot of emotional regulation all the time. Yet our work is also very cerebral and we've been taught to ignore our emotions. And if you have ADHD, your emotions are very strong and you need to be consciously learning to manage your emotions. And most of us did not learn this from our parents. We did not learn this in school. We certainly didn't learn this in medical school. We were too busy learning all these other practical, logical, scientific things, right. So emotional dysregulation in physicians shows up as being very quick to anger, frustrated. The degree of emotion that they express on the phone, call or whatever is very much out of proportion to the situation, seen as emotional, unpredictable, hot-headed, angry. You know the quote would be like they have a temper. One of the bullet points here is colleagues may be afraid of them. And it's interesting.

Jenny: 35:10

I remember when I read this I was thinking about my evaluations over. You know, years of working here with really good friends and lots of positive feedback. My evaluations typically say Jenny does a great job and, you know, very glowing on many counts, and usually there's always this like one thing that is like, and sometimes she can be a little scary, right, and so I think that I never, ever want to feel like I'm coming across as scary and I never intend that, and I actually feel terrible whenever I think about people thinking that about me. And you know, getting my diagnosis of ADHD really helped me to realize that. Like you know, this is where this comes from. I tend to express a lot of emotion about things and that's just the way that I'm wired and I forget that I'm because I'm wired differently to other people. That sounds like anger when for me, it's just like my passion, my excitement, my urgency, right, and so. So when some, when you're kind of feeling like gosh, this person's really good, but then unpredictably it seems like out of the blue, they sound angry, they attack me, they snap.

Jenny: 36:09

Consider whether this is an emotional dysregulation issue related to ADHD or, as I talked about last week, similar symptoms can come from PTSD or burnout or other causes Another part of emotional dysregulation in physicians is quick mood changes. Another part of emotional dysregulation in physicians is quick mood changes. So what will happen is like there'll be a situation they'll have a really quick mood change, they'll do something inappropriate and then later they feel ashamed and really bad about it, like they think that they are a bad person or a rude person. And then other people because again, we're so busy in the cerebral and not in the emotional world as physicians they just have like no insight and they don't realize how much impact this has on other people, or they're uncomfortable and they don't know how to repair it, because we don't often talk about this and it seems embarrassing or childish, and so it can lead to really a lot of strong words about it. Okay, so that is how ADHD presents in physicians, as outlined in this wonderful article which, as again, as I mentioned, I will put in the show notes, and I just wanted to wrap up with a couple things.

Jenny: 37:20

Remember I know this sounds like gosh these are terrible people, these people with ADHD, but remember, these are your friends and loved ones. They estimate about 5% of people have ADHD, probably more. These tendencies do come out more with age. Often they're unrecognized in women and the people who have ADHD are necessary for our society. I really believe this. It does have its drawbacks, of course, and I truly wish I could be as straightforward and calm and collected and easily motivated by typical rewards as my colleagues. I absolutely wish that all the time. At the same time, the ability that people with ADHD have to think outside the box, to be creative, to be entrepreneurs, to question a system, to think outside the box, to be creative, to be entrepreneurs, to question a system, the bravery, the ability to fail and try again, and the ability even to express emotions, which are important, right, which many people do not have a good ability to do, like.

Jenny: 38:14

I really think that it's important that we recognize there are gifts and strengths that people with ADHD bring, and I actually believe ADHD is likely more common among physicians than in other careers, because many of the qualities that make someone a good physician overlap with ADHD traits, right? So people with ADHD there's an association with giftedness. They love urgency, novel, challenging work, which is, of course, medicine. Right, there's a lot of energy, ability to work hard and not get so tired and overcome that when you're working on something you care about, that hyper-focus, I mean, how do you think people get through these residencies and become surgeons? In fact, I think again, as I mentioned earlier, I think modern medicine needs physicians with ADHD to stay here, because we are the visionaries, we are the ones who have that spirit to not just follow the group and go along with being a low-level, you know, cog in the wheel employee, looking for like how we make a buck and go back home to our families, but we are really passionate, you know, and I think we almost have that more old school sense of medicine and entrepreneurial mindset and vision. And so, yeah, it would medicine would fall apart if everyone was like this.

Jenny: 39:21

But I do think that we should stop demonizing people and labeling them as having a character flaw or a bad personality and shaming and blaming them when it potentially is something that they could learn to accept about themselves and then improve and even treat with medication and therapy and coaching, and so they could overcome some of these weaknesses to allow their strengths to really shine. Ned Halliwell talks about the ADHD brain is like a Ferrari brain with bicycle brakes right, and so if you can get the brakes improved, you have a winner, and so I like to think of that for myself, like I've got so many great ideas and I've got so many great qualities, and sometimes I need to learn to put the brakes on and slow down right, and that is what you can get through medication and coaching. But none of that's going to happen if you are not aware that it's going on, or stuck in stigma and shame and guilt and isolation and thinking that something is just fundamentally wrong with you that can never be changed, or wondering why you aren't like other people right, and so we really need to start by having this atmosphere of acceptance and grace and support and curiosity about why someone's doing what they're doing, rather than just blaming and shaming them, because that allows us to get to the root of the problem and potentially keep this person in medicine doing good work. And remember, any organization is always better when you have different types of people bringing different ideas and different strengths. Right, and we need these people to stay in medicine and we need their strengths and, along those lines, what I also love about this work that I've been doing with ADHD is that it's so applicable for everyone. That I've been doing with ADHD is that it's so applicable for everyone, even if a person doesn't have ADHD, even if it's just a person who is struggling at work, these concepts still apply. Right? The approach is still the same, like obviously it's easier when you understand the symptoms of something like ADHD to recognize it, but let's say you don't know what's going on with someone, right?

Jenny: 41:20

There's a great quote in this article that talks about how to approach that, and I'm just going to read it because I think it's so well said. So they talk about, as with any colleague struggling on the job, it is important to try to understand their perspective rather than judge their behavior. Physician patients that we have had have stated that colleagues have made complaints against them without first seeking to understand. This approach fails to acknowledge the physician as a person with potential mental health issues and increases feelings of guilt and shame. Guilt and shame further impair performance, lead to worsening mental health and create a vicious cycle, and that is true whether the person is in burnout, depression, adhd, autism, ptsd. Whatever the case, you don't know what's under there.

Jenny: 42:04

But if we start by seeking to understand and coming from this empathetic, curious, caring perspective instead of a blaming and shaming and punishing mindset, we are going to see such better results, and I truly believe that if we ever want to slow the rising rates of physician suicide, depression, the number of physicians leaving the field, even the way we're all treating one another, if we want to get to the root of that, it's going to have to start with this approach that's described in this article, and you don't have to be obsessed with ADHD, like I am, to benefit from implementing this kind of mindset as you approach everyone in your workplace. So hopefully I've inspired you to think about this a little differently. And if you are in a position of leadership or simply a physician who's thinking of some colleagues, please be curious, be open. Send them my podcast so they can listen to it and consider if this might be something that applies to them. Consider talking with your organization about how you can do a better job of responding to complaints about physicians in this manner. I'm happy to come speak or share my story if it would help anyone, so just let me know.

Jenny: 43:10

And then the last thing I want to say is, if you're listening to this and you're like, well gosh, that must be nice, but my organization will never understand this and they just want to blame me and I feel like I'm a failure and I don't know where to start, or I don't want to admit that I have ADHD because I'm worried about the stigma. Just reach out, set up a consult, call with me. There'll be a link here. Let's talk about it. Let's talk about what we can do to help you accept and love yourself unconditionally to feel better. We can talk about how you can get your diagnosis, if you think that would be helpful.

Jenny: 43:47

But I will tell you, I have clients who haven't even taken medication, but just working through the mindset piece, the self-acceptance and the strategies that we talk about, they literally tell me within a couple of months they feel like a different person. They feel so much less overwhelmed, so much less alone. And if you've been resonating with what I've been talking about the last couple of episodes, you will fit right in. You are not alone. Nothing is wrong with you. In fact, I think you are probably more brilliant than anyone realizes and I just want to help you realize it so that you stop letting their opinions hold you back. All right With that. I hope you have an amazing weekend and I will be back next week.

Kevin: 44:20

Hi friends, Kevin here, Thanks for listening to one of Jenny's great episodes on ADHD. Don't forget to check out the show notes for links to register for the free virtual CME coming up on June 5th through 7th of this year, 2024. Also in the show notes you'll find links to access Jenny's free ADHD resources. We'll see you next week. We'll see you next week a free consultation. If you found value in what you heard today, please consider subscribing to the podcast and giving us a five-star rating so we can reach even more women like you.