ADHD/Clumsiness and Neurosurgery

[aluckyguy]

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I'm a medical student on clinical rotations who just completed a rotation in neurosurgery. I got the chance to scrub into a few cases and I loved absolutely every minute of being in the OR. My school's neurosurgery department, from the chair down to the interns, is exceptionally supportive of students, I got along well with the team, and neurosurgery ties in well with my research interests. I worked in the neurosurgery chair's lab last summer and got a first author publication and a poster out of it, so I'm optimistic that with continued effort and some luck, I'll have a decent chance of matching. The field seems like a great fit for me on paper, and I'm willing to put in the work required to make it happen.

That said, I have some concerns about my ability to do this particular job well and I don't feel I can be fully honest with my advisors about them. I have a diagnosis of ADHD (inattentive) and I'm worried about my ability to pursue a career in a field where attention to detail is important and mistakes can have devastating consequences. I'm particularly concerned because of my experiences in research: I worked in a few basic science labs prior to medical school and while I loved the intellectual aspects of the work, I often had difficulty correctly and consistently executing molecular biology experiments. Despite my absolute best efforts to focus and be meticulous about the work, I still made pipetting errors and contaminated cell cultures. My PIs still gave me positive recommendations and were supportive of me because I put in a lot of effort and they appreciated my contributions to the lab in other ways (lit searching, troubleshooting, editing, creating figures,) so I feel it's possible that my research record might be misleading people about my ability to execute complicated, multi-step procedures under pressure with no do-overs.

I assumed there would be some filter in medical school to weed out people who might have the same difficulties I've had, but I'm increasingly worried that there won't be. It's not like you'd be able to tell from how I suction or hold a retractor that I might not be cut out for microsurgery, and I feel like suturing is forgiving enough that I'll be able to scrape by unnoticed. I'm worried that I'm jumping into a career that I'm not cut out for and that no one will realize until I make a terrible mistake that really hurts a patient. I also don't want to rule out a career in neurosurgery prematurely given how much I think I'll like it.

I'd really appreciate some advice on how to think about my specialty options going forward, and especially whether there's any way for me to get a better understanding of whether my deficiencies preclude me from neurosurgery or not. Thanks everyone!

 

[Detailsmatter]

@neusu @mmmcdowe

 

[RJ McReady]

It’s hard to determine from your post exactly what it is you’re worried about. Is it the technical aspects of the specialty? The attention to detail that is required? (I would argue that any specialty requires this and it is not unique to neurosurgery)
Im just a humble MS1 but imo a diagnosis of ADHD doesn’t preclude you from a career in neurosurgery

 

[Detailsmatter]

It’s hard to determine from your post exactly what it is you’re worried about. Is it the technical aspects of the specialty? The attention to detail that is required? (I would argue that any specialty requires this and it is not unique to neurosurgery)
Im just a humble MS1 but imo a diagnosis of ADHD doesn’t preclude you from a career in neurosurgery

the way i read it at first i thought the biggest concern OP had was the clumsiness but now rereading it im not sure. Agree that ADHD in of itself shouldn't bar you from neurosurgery if you get treatment (that probably applies to any specialty)

 

[aluckyguy]

My main concern is my inattention and my past inability to keep lots of details straight during procedural tasks. My issues were things like setting up PCR reactions incorrectly. I'd add the DNA as the last step and sometimes I'd miss a well and accidentally add two different DNA samples to the same well or add the wrong DNA sample to a given well. The volumes were so small that I had little way of knowing I'd made a mistake until I had completed the whole procedure. I'd try again, taking extra care to not screw up the DNA, but then I'd make a different mistake like putting the wrong primers in the reactions. It was just incredibly frustrating and things like that worry me because they're such silly, avoidable mistakes but I just couldn't eliminate them. These mistakes also happened in a much more relaxed context than the OR, and the consequences in the OR are likely to be way worse than just wasting reagents. I'm worried issues like these will come back to bite me if I do surgery.

I'm in treatment for the ADHD and I'm definitely in better control of it now than I was back when I made those mistakes, but I guess it's still hard for me, knowing that I've had issues with precision and focus in the past, to enter a surgical field with confidence. It's hard to commit to such a difficult path when I have doubts about whether I'll be good enough to do it, even though I'm getting treated for ADHD now and I wasn't before.

This feels kind of like when I tore an ACL in high school. My recovery went well but I had doubts that I'd be able to play as well as before and regaining confidence in my abilities was a difficult process. At least in that situation, I had practices where I could test out my knee, put it through the same things it would go through during a real game, and regain confidence that way. As I practiced more, I felt better and better about the strength of my knee and I eventually stopped worrying about it. But those were physical concerns, my concerns with surgery are mental. If my knee felt good in an intense practice, no reason why it wouldn't be fine in a game too, but it seems hard to simulate operating on a real person. It seems like I won't be able to test out my surgical skills well enough to gain confidence about my aptitude for it until I've already committed to a surgical residency.

 

[longhaul3]

I'm not sure anyone here can give you a satisfying answer. The list of conditions that absolutely disqualify someone from becoming a neurosurgeon is probably longer than in any other specialty, but it's still short. Things like refractory epilepsy, blindness, intractable movement disorders, severe ataxia, quadriplegia, etc. Probably some neuromuscular disorders like myotonic dystrophy and a short list of psychiatric disorders involving psychosis. Absence of hands (though I know neurosurgeons with < 10 fingers).

The rest is up to the individual. I agree that unless you are egregiously bad, you won't be able to know your innate ability to perform surgery as a med student. What I do know is that most people who make it to surgery residency are teachable. Not knowing you at all, I still suspect that if you have what it takes to match in neurosurgery, you can make it.

 

[JoaoMoutinho]

My main concern is my inattention and my past inability to keep lots of details straight during procedural tasks. My issues were things like setting up PCR reactions incorrectly. I'd add the DNA as the last step and sometimes I'd miss a well and accidentally add two different DNA samples to the same well or add the wrong DNA sample to a given well. The volumes were so small that I had little way of knowing I'd made a mistake until I had completed the whole procedure. I'd try again, taking extra care to not screw up the DNA, but then I'd make a different mistake like putting the wrong primers in the reactions. It was just incredibly frustrating and things like that worry me because they're such silly, avoidable mistakes but I just couldn't eliminate them. These mistakes also happened in a much more relaxed context than the OR, and the consequences in the OR are likely to be way worse than just wasting reagents. I'm worried issues like these will come back to bite me if I do surgery.

I'm in treatment for the ADHD and I'm definitely in better control of it now than I was back when I made those mistakes, but I guess it's still hard for me, knowing that I've had issues with precision and focus in the past, to enter a surgical field with confidence. It's hard to commit to such a difficult path when I have doubts about whether I'll be good enough to do it, even though I'm getting treated for ADHD now and I wasn't before.

This feels kind of like when I tore an ACL in high school. My recovery went well but I had doubts that I'd be able to play as well as before and regaining confidence in my abilities was a difficult process. At least in that situation, I had practices where I could test out my knee, put it through the same things it would go through during a real game, and regain confidence that way. As I practiced more, I felt better and better about the strength of my knee and I eventually stopped worrying about it. But those were physical concerns, my concerns with surgery are mental. If my knee felt good in an intense practice, no reason why it wouldn't be fine in a game too, but it seems hard to simulate operating on a real person. It seems like I won't be able to test out my surgical skills well enough to gain confidence about my aptitude for it until I've already committed to a surgical residency.

Not a surgeon so can't speak for surgery, but I can relate to your lab experience and offer some advice on how I learned to avoid careless mistakes during experiments. It doesn't sound like you're doing bench research anymore, but I believe the same general principles apply in a number of settings.


TL;DR at the beginning: I plan everything out and talk myself through it, verifying at each step while in progress. When I get flustered or rushed I make mistakes, so I lay everything out in advance as much as I can.


1) I write out every step including every detail. I type out the entire protocol, color code it, and include all the volumes for each reagent, etc. I print this and have it taped in front of my face or within arm's reach. During the experiment I frequently refer back to my protocol.

2) I have ruined multiple experiments like what you described with your PCR. I learned to develop a system to stop ruining them. Various things I've done to keep track during tedious pipetting include:
Plate layout as mentioned above, with marking of completed wells.
Sharpie on the plate itself where possible to clearly demarcate sections
System for when to cap/uncap different reagents or samples so I know if I just drew from it and where to go next
*Say each sample out loud as I draw it, say the well it goes into as I find it, then say them both again as I add the sample to the well
*Singing a song to the time of my pipetting– if my hands feel out of sync with my voice I stop what I'm doing and double check

*People have made fun of me for doing these, but they don't make fun of my data

3) I make a checklist of all of the equipment I need beforehand and show up to the lab early to make sure that it is all out and ready to go.

If this sounds like a lot of work, it is–at the beginning. I still make mistakes from time to time, but not like I used to. With practice I gained efficiency and confidence. I'd rather be slow and do it well than be faster and have to redo the experiment, which is then actually slow.

Again, not a surgeon, but I'd be willing to bet that many of the good ones learned to plan things out and developed a system to work through them methodically.

 

[mmmcdowe]

Appropriately treatedADHD should not prevent you from practicing neurosurgery. If you can do well enough on the usmle and mcat then I would argue you clearly have sufficient adaptive focus to be both a doctor and a neurosurgeon from a purely attention standpoint. What I would be more preoccupied with however is the medication that you are on. It will probably not come as too much of a surprise that abuse of stimulants is a real thing in surgery and neurosurgery. Therefore it will be very important that you keep very clear control of any stimulants that you may take for your medical needs and make sure that there is a clear and very well documented paper trail regarding your prescription. This is not the type of prescription your daddy or co resident should be writing for you.