How important is attention span?

[Symmetry11]

I have ADHD but I am not undergoing treatment for that issue due to comorbid conditions. Must psychiatrists have an excellent attention span in order to be effective or can unintentional breaks happen? (Also I plan being on stimulants long before I enter med school.)

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[675015]

I personally don't have a great attention span and I don't find that it

 

[Bartelby]

I know psychiatrists with ADHD and they seem to do fine to me. To answer your question, I believe patient interactions (especially psychotherapy) require pretty intensive and sustained attention, but these interactions are very engaging because you are talking back and putting a lot of thought into what you're hearing so that helps.

 

[thoffen]

It seems inattentive ADHD is actually rather common in psychiatry in my anecdotal experience. People are always able to attend to things that are interesting to them regardless of ADHD.

Personally, I share that diagnosis and had only been in treatment in middle school briefly and then after college when working in a prior career. At that time I discontinued due to headaches which were attributed to stimulants. I actually entered medicine largely with the recognition that in an unstructured work environment when I was given a project with a distant deadline, I was hopeless. However, I realized that I was really productive when I interfaced with the customer (what everyone else hated).

I only got back in treatment in the last year. The more administrative duties I had, the harder it was to stay motivated to stay on top of things, although ultimately I still could. For me, having a human life that I value has always spurred me to get things done in the end.

Where I suffer most is in outside projects, keeping up with reading, and wanting to get engaged in research, etc. But, you have to find what works for you. Being on this forum is a way to expose me to different perspectives and problems in psychiatry than I face in the same patterned work environment that I'm in. Once I get interested, I can then read, discuss, and incorporate what I've learned. It works for me way better than turning on the TV when I'm only half a page into Kaplan and Sadock.

From your story, you're a long way away from being a psychiatrist. And you referenced comorbidities getting in the way of treating your ADHD. That concerns me. There are a lot of steps between where you are now to actually becoming a psychiatrist. A lot of those steps will also be harder on you with ADHD than your clinical work likely would. Even still, becoming a responsible doctor is very challenging and requires a lot of personal growth that a lot of people can't hack regardless of psychiatric diagnoses. Personally, I'm glad I pursued another career first, because I don't believe I would have been able to make it this far without growing up more first.

 

[Rooney124]

Anybody have any advice in this vein for somebody about to enter intern year at a place known to have very intense, high volume off service rotations? Time management and avoiding information overload have always been a struggle as a Med student, and I expect it will only get about 10x harder as an intern with a drastically increased patient load and other real responsibilities.

 

[milesed]

I'd consider it the same as any other mild disability. At least it's easily treatable. I did residency with someone with cerebral palsy and she busted her tail to do all of her work as well as anyone else. It took her longer as her speech, gait were impaired, but she was determined and never complained or asked for special treatment. She really changed the way I thought about my small problems.

 

[Armadillos]

Anybody have any advice in this vein for somebody about to enter intern year at a place known to have very intense, high volume off service rotations? Time management and avoiding information overload have always been a struggle as a Med student, and I expect it will only get about 10x harder as an intern with a drastically increased patient load and other real responsibilities.

Make some sort of organizational method and stick to it to be sure you don't forget to write a note on someone or whatever. If you have a particularly important lab or study to follow up on before you leave I always set a phone alarm to be sure I didn't forget.

I think the most important thing is to try to isolate yourself from excessive stimuli and interruptions somewhat when you need to be really productive. The unfortunate thing is practically that equates to trying to avoid the med students when you really need to get work done

 

[MLT2MT2DO]

Anybody have any advice in this vein for somebody about to enter intern year at a place known to have very intense, high volume off service rotations? Time management and avoiding information overload have always been a struggle as a Med student, and I expect it will only get about 10x harder as an intern with a drastically increased patient load and other real responsibilities.

I actually found my inattentive nature to be a positive, on off-service rotations. Handling multiple patients at a time is actually an ADHDs dream. It's true you need to be somewhat organized is your disorganization but spending 3 minutes a patient spread through 10 patients 15 times a day is much easier than spending single 45 minute blocks 10 times a day.

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[nitemagi]

Create a systematic way of doing X, with an external way to reinforce it and remind you of it. Basically if you can't stay internally directed (like a car without a steering wheel), increase the amount of external structure to help keep you on the road (barriers on the side).

 

[whopper]

There is no specific answer cause attention is highly variable depending on if you like what you're doing. Another problem is ADHD can be highly variable, and psychiatry is highly variable. If you, for example, had hyperactive ADHD, unless your hyperactivity somehow benefited you I would think it needed to be treated for you to be effective. It'd be hard to do good and in-depth psychotherapy with you squirming in your chair.

But if you were an ER psychiatrist that hyperactivity might not be so bad.

 

[Extralong]

I have ADHD but I am not undergoing treatment for that issue due to comorbid conditions. Must psychiatrists have an excellent attention span in order to be effective or can unintentional breaks happen? (Also I plan being on stimulants long before I enter med school.)

In terms of attention span; if you get in and make it through medical school, you'll be fine when it comes to attention span. I would be thinking about med school first and worry about other items later.

 

[NontradCA]

There is no specific answer cause attention is highly variable depending on if you like what you're doing. Another problem is ADHD can be highly variable, and psychiatry is highly variable. If you, for example, had hyperactive ADHD, unless your hyperactivity somehow benefited you I would think it needed to be treated for you to be effective. It'd be hard to do good and in-depth psychotherapy with you squirming in your chair.

But if you were an ER psychiatrist that hyperactivity might not be so bad.

Is it possible to do full time ER psych work?

 

[eli20]

Is it possible to do full time ER psych work?

I know several attendings who do. Obviously it probably limits your geographic area (most likely big-large city) somewhat.

 

[notdeadyet]

But if you were an ER psychiatrist that hyperactivity might not be so bad.

I would definitely disagree with this.

At least at busy places (which are probably the only ones you can really expect full time employment), the challenge with PES work isn't the energy, it's the ability to track multiple things at once that are constantly being reprioritized.

Most close calls and adverse events I've seen in PES settings have been docs losing sight of something. Concentration, multi-tasking, and focus are key.

Emergency psych would not be a place I'd recommend someone with ADHD.


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[whopper]

Is it possible to do full time ER psych work?

I'm on the spectrum for mild inattentive and hyperactive ADHD. It's something I've only come to realize in the last few years. I lived in denial with it because I figured since I did well in college I couldn't have had the disorder. This is incorrect black and white thinking that as you get older you can see past into more correct shades of grey. I don't have enough criteria to meet a real dx of it. I do have, however about 3 criteria in two of the categories (you need 6).

I got the following..
Inattentive
(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
(h) is often easily distracted by extraneous stimuli
(i) is often forgetful in daily activities

Hyperactive
(b) often leaves seat in classroom or in other situations in which remaining seated is expected
(c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
(e) is often "on the go" or often acts as if "driven by a motor"

Now by brute will-power and cause I love psychiatry I was able to overcome Inattentive (f), I was able to overcome inattentive (h) by again loving my job and pretending I was a Starfleet officer in my head doing a job (a Tony Robbins trick), and inattentive (i) was no problem cause nurses reminded me all the time and I kept notes.

Hyperactive if anything was a complete bonus in the ER.

You can work ER full time if you're in a place with a big enough psych infrastructure. Many major cities will have a hospital with an ER that acts as the central intake for psych cases and then diverts the patients to it's own psych unit or other places.

 

[Symmetry11]

Wow! Thank you for the clear breakdown on how you combated these symptoms! I share all of those with you.

I can overcome boredom by just sticking to those subjects I enjoy as well, but I still get distracted. How were you able to overcome that with the Tony Robbins trick? Could you elaborate on that? And I will definitely start taking notes for important things in my life.

Can AD/HD be neurobiologically changed with time by repeating these behaviors? Can this type of plasticity occur?

And are you suggesting that ER psych might actually be a good thing?! I get scared thinking of taking care of acute patients with these symptoms.

 

[whopper]

Turns out that if you enjoy what you're doing your ADHD might not affect you at all. Also turns out that if you are learning what you are doing by operating it instead of just reading it some people with ADHD can overcome it better. E.g. instead of just reading how to treat DKA you actually do it on the field.

IMHO working ER psych is like going to a bar in college. A fight can break out at any time. Fun fun fun! Duck some guy's punch, tell the nurses the inject the patient, hey this is like college again! Many ER docs I know are adrenaline junkies. They thrive off of the pressure. I'm being a little sarcastic. E.g. my last job it took security 20 minutes to show up to the unit (a reason why I left the job).

 

[deleted343839]

Can AD/HD be neurobiologically changed with time by repeating these behaviors? Can this type of plasticity occur?

You can change your behaviors, which will in turn change your neurobiology. We try to sell combined behavior management + pharmacotherapy for kids with ADHD, but adults need it too.

The problem is that, as an adult, the amount time/number of trials required to extinguish some of the behaviors you've formed over the years increases by orders of magnitude compared to what would have been needed as a kid. Often adults give up too early on behavior therapy.

 

[smalltownpsych]

Learning what your cognitive, affective, and interpersonal strengths and weaknesses are and coming up with strategies to maximize your strengths, minimize your weaknesses, use strategies to compensate for weaknesses, and continue to develop both your strengths and your weaknesses would apply to any of us regardless of presence or absence of a dx. I have a patient with adhd and it is causing more serious problems since a recent promotion. We are in the process of figuring that all out right now. It can be helpful to have someone like say a trained psychiatrist and/or psychologist help with that process and if the wheels start coming off, then definitely seek some help.