ADHD in med school ...

[DD214_DOC]

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... I'm sure there are others out there. What are some strategies, other than meds, to help make studying more efficient? I began to struggle in the second term of my first year. The doc thought I may have OSA due to my symptoms, so I went down that route. I did end up being diagnosed with MILD OSA, thinking the symptoms were a little too severe in proportional to the severity of the apnea. Regardless, I ended up barely passing first year and going on to second.

Once second year started, and after 2-3 months of successful control of my apnea, things did not really improve, neither academically nor symptomatically. I went back to the neurologist who did my sleep stuff because I thought the device quit working. A take-home device showed that it did not. He referred me to a shrink.

I was unfortunately diagnosed with inattentive subtype ADHD with mild depression. His explanation of the symptoms and "personality" of the ADDer made sense of my entire life, so I have no doubt of the diagnosis. I am currently trying out Adderall XR 30mg bid. The first dose works really well, but wears off quickly. THe second dose doesn't seem to do much.

So what other things can I do to minimize the effects and stay in school? I'm trying to adapt the information we learn and put them into a context that comes easy to me, such as problems to solve. I get the videos of the lectures and watch them on my own time so that I can go back or pause if I get distracted.

What else can I do? This is the first time I have not been in a position of comfort and I'm obviously concerned. Because of my strengths, probably from the way my dopamine-deprived brain works, I have no doubt I will kick butt in clinicals and residency. Unfortunately MSI and MSII are everything that ADDers suck at.

 

[Terpskins99]

Don't have OSA or ADHD, but some advice for you...

I firmly believe the first year of medical is far more difficult to get through than MS2 year. If you were able to get past MS1, then remind yourself that you should be well prepared to tackle MS2. So thats the first thing. Keep your head up.

Second, even though I don't have ADHD (at least, I don't think I do), I did have a lot of difficulty staying focused and studying for extended periods of time. I got around this by finding a great study partner to get together with regularly and schedule topics to review ahead of time. This way I felt accountable for material to read up on. Also, having someone with you to study with provides a personal watchdog of sorts to keep your attention from wandering.

Third, change things up by studying in different ways. For me, I love to surf the net (and read SDN all night)... so I would combine it with my studying, by taking pseudo-breaks in my studying every once in a while to surf wikipedia/emedicine for anything related to what I was studying (I usually kept a talley of things that I wanted to look up as I studied). Or just surf solid review sites (pathguy.com or my favorite: webpath!).

 

[Punchap]

I got around this by finding a great study partner to get together with regularly and schedule topics to review ahead of time. This way I felt accountable for material to read up on. Also, having someone with you to study with provides a personal watchdog of sorts to keep your attention from wandering.

Good idea! I've always had trouble following through with my study plans...I like that this method makes you accountable. Hmm...I will try this next year.👍

 

[PeeWee137]

i heard about this on the news, my details may be a bit fuzzy but...
there was a recent study done on pre-schoolers with ADHD. (i know you arent in pre-school but hear me out). diagnosing kids this young is a controversy in and of itself, and prescribing them meds is a whole other problem. so the study involved no meds, one group the parents were given guidelines on how to handle their kids behavior, and the other parents got home visits from a counselor of some sort who gave them a really rigid protocol to follow that involved alot of positive reinforcement. the latter group improved greatly on behavior tests.
anyway - so i think you need to set small study goals for yourself and then give yourself rewards for completing them. after you read one chapter/one powerpoint, you get to watch one simpsons episode. something to that effect. i did this for myself alot cause i have the HARDEST time focusing, especially when the topic was boring to me. one of my docs told me i had mild ADD, whatever that is, but a trial of adderall just gave me the shakes so i stopped taking anything. and its really important to take frequent breaks. sometimes i would take a break and do push-ups or sit-ups or jumping jacks. no one's mind can concentrate on anything for that long.

 

[Coxsuckie Virus]

Hello fellow ADDer,

I too was diagnosed with ADHD at a later stage in life. I doubt I would have been able to get into medical school without proper treatment, however, so I give you a lot of props for getting this far.

Treatments for the disease include stimulants, which I see you are on, but you are on a pretty high dose, and because tolerance is an issue with these meds, i understand where you're coming from when you say that they wear off throughout the day. Try to take a lower dose. When I first started on these meds, they had me up to 90 mg a day, but I took control because I didn't like what it was doing to my mind and my body.

I guess what I'll do is just describe what my days in school were like and how I got through my classes and how I took control of my treatment regimen to get through everything.

First off, I don't take Adderall although I have "borrowed" some from people and found that it was quite affective, but the "crash" is somewhat tough to get through at the end of the day. My prescribed medication, one of which I highly recommend is 10 mg of Dexedrine (dextroamphetamine, a component of the cocktail that makes up adderall) Sustained Release capsules first thing in the AM. I'll often take one more at noon or so to get me through the rest of the day so that the first dose doesn't wear off. I find that if I take a second dose after the first is already tapered down to "nothing," The second is relatively ineffective. So take the second pill a little before you'd expect your first dose to wear off to maintain a steady state.

My script is bid, so I get 60 a month, but I don't use that many, which makes obtaining scritps less of a hassle as I don't visit the doc every month on the dot, more like every month and a half to two months. Another tip with the medication, and you may be advised not to do this, butI do and find it effective, and that is to NOT take your meds on days you don't plan on studying. IE, boring class half days, days off, things that don't require tedious attention. I would often take a week off. This, I find, makes the medication more affective when I do take it, and helps me keep a good "bank" of meds for the times when I'll be taking 2 or 3 a day for a few days straight. So in essence, take drug holidays. You may be able to appreciate this as you'll find your taking less drug, less often, and only when you need it.

One of the great plastic surgeons in my area, is actually mentioned in a book called ADD Success Stories. He took a similar approach to the medication, and he DOESN'T take it when he's performing surgery. Only when he's doing tedius crap work, like chart updates, billing, etc. But you must understand that you DON'T have a disease. Your brain is just wired for a more stimulating environment than the general population. You can HYPERFOCUS where others cannot, and because of this, normal hum drum stuff is too boring for you to maintain attention on. You'd rather play games or socialize. I know what it's like, beleive me. And that's why you're given stimulants.

You don't operate slower than everyone else, you operate faster, so with a stimulant, effort is no longer needed to focus on "nonstimulating" stuff. The medication puts your brain in the zone it would be in in a hyperfocus situation, without you having to activate it yourself. If you're like me, you get bored quick, but you do great work until you give up on something. The meds keep your brain switched on when you'd normally turn it off subconciously, shut the book, and go watch Oprah while eating bon bons.

ADHD is something that you need personal experience in dealing with if you're diagnosed at an older age. You have to know yourself, how your body deals with things, and how you learn on or off meds. It becomes a balance, but once you figure it out, your grades will stay high, you'll be knowledgeable, articulate, and do great work anywhere you put your effort, and no one will ever think or say your adhd is a learning disorder moreso than it is a blessing... Welcome to the club! 🙂

 

[BitingPlates]

Hello fellow ADDer,

I too was diagnosed with ADHD at a later stage in life. I doubt I would have been able to get into medical school without proper treatment, however, so I give you a lot of props for getting this far.

Treatments for the disease include stimulants, which I see you are on, but you are on a pretty high dose, and because tolerance is an issue with these meds, i understand where you're coming from when you say that they wear off throughout the day. Try to take a lower dose. When I first started on these meds, they had me up to 90 mg a day, but I took control because I didn't like what it was doing to my mind and my body.

I guess what I'll do is just describe what my days in school were like and how I got through my classes and how I took control of my treatment regimen to get through everything.

First off, I don't take Adderall although I have "borrowed" some from people and found that it was quite affective, but the "crash" is somewhat tough to get through at the end of the day. My prescribed medication, one of which I highly recommend is 10 mg of Dexedrine (dextroamphetamine, a component of the cocktail that makes up adderall) Sustained Release capsules first thing in the AM. I'll often take one more at noon or so to get me through the rest of the day so that the first dose doesn't wear off. I find that if I take a second dose after the first is already tapered down to "nothing," The second is relatively ineffective. So take the second pill a little before you'd expect your first dose to wear off to maintain a steady state.

My script is bid, so I get 60 a month, but I don't use that many, which makes obtaining scritps less of a hassle as I don't visit the doc every month on the dot, more like every month and a half to two months. Another tip with the medication, and you may be advised not to do this, butI do and find it effective, and that is to NOT take your meds on days you don't plan on studying. IE, boring class half days, days off, things that don't require tedious attention. I would often take a week off. This, I find, makes the medication more affective when I do take it, and helps me keep a good "bank" of meds for the times when I'll be taking 2 or 3 a day for a few days straight. So in essence, take drug holidays. You may be able to appreciate this as you'll find your taking less drug, less often, and only when you need it.

One of the great plastic surgeons in my area, is actually mentioned in a book called ADD Success Stories. He took a similar approach to the medication, and he DOESN'T take it when he's performing surgery. Only when he's doing tedius crap work, like chart updates, billing, etc. But you must understand that you DON'T have a disease. Your brain is just wired for a more stimulating environment than the general population. You can HYPERFOCUS where others cannot, and because of this, normal hum drum stuff is too boring for you to maintain attention on. You'd rather play games or socialize. I know what it's like, beleive me. And that's why you're given stimulants.

You don't operate slower than everyone else, you operate faster, so with a stimulant, effort is no longer needed to focus on "nonstimulating" stuff. The medication puts your brain in the zone it would be in in a hyperfocus situation, without you having to activate it yourself. If you're like me, you get bored quick, but you do great work until you give up on something. The meds keep your brain switched on when you'd normally turn it off subconciously, shut the book, and go watch Oprah while eating bon bons.

ADHD is something that you need personal experience in dealing with if you're diagnosed at an older age. You have to know yourself, how your body deals with things, and how you learn on or off meds. It becomes a balance, but once you figure it out, your grades will stay high, you'll be knowledgeable, articulate, and do great work anywhere you put your effort, and no one will ever think or say your adhd is a learning disorder moreso than it is a blessing... Welcome to the club! 🙂

Well said

 

[DD214_DOC]

I've been doing a lot of reading, and several things I question.

Supposedly, people with ADD are pretty good at solving problems. However, I also found research contradicting this, basically concluding that people with ADD suck at problem solving.

Performance is usually not related to effort, limiting the ADD person's ability to control success and failure.

Others.


I actually had to stop because it was depressing. I know many people get through medical school with ADD, but how do they cope? How can you solve problems on a physio exam when you suck at problem solving? Why study 10 hours a day for 3 weeks, only to show up and bomb the exam because you couldn't remember anything? Basically, how do we deal with it, because the meds only do so much.

I presume there to also be individual variation in the manifestation of the disorder, so maybe it's possible to be pretty good at solving problems and still have ADD.

 

[Meatwad]

Wow, this thread's freaking me out... I'm starting to think I have ADHD or something. Coxsuckie VIrus' post, specifically the part about hyperfocusing on some things and not being interested in broader things, seemed eerily familiar to me.

 

[DD214_DOC]

Wow, this thread's freaking me out... I'm starting to think I have ADHD or something. Coxsuckie VIrus' post, specifically the part about hyperfocusing on some things and not being interested in broader things, seemed eerily familiar to me.

It's important to keep in mind that everyone experiences ADHD-like symptoms on occasion. It's not until the symptoms are persistent and pervasive, and have an adverse effect in multiple domains (school, work, home, etc) that ADHD can be considered.

What's really interesting is how being gifted confounds the presentation and diagnosis of ADHD, because many of the typical cognitive functions normally imparied in ADHD people are either intact, or still function at a reasonable level.

 

[holdsteady]

Sorry for a double post... I erased this one but needed to have some characters for it to be saved.

 

[holdsteady]

i'm a first year trying to figure out how to succeed in med school. It's going allright, but not great so far. I was also a late diagnosis (at the end of undergrad). Somebody touched on the cognitave factors of adhd... and I think a lot of med students with ADHD are very bright people that coped well when younger. As for me, I was able to cope with school and stay near the top of my class through high school with ADHD; it came easy and didn't warrent much effort. In college things got harder as I went to a competitive school- more conceptual difficulty and volume, plus a higher concentration of bright students. I still did well, but my success relative to others wasnt' as good. Here... it's gotten even tougher. Everybody in med school is very bright- and they don't have the focus issues. I'm trying to figure my brain out so that I can make this work. I take adderall, but the tolerance is factoring in. Right now I'm prescribed 10 mg 2x/ day- but I'm taking it 3-4 depending on exam load.

A bit long winded, but I definetly understand the frustrations of others and share them myself. I'm confident I can pass; but starting to wonder how my transcripts will look at the end. The biggest issue for me is accepting that I may be a mediochre student for the first time in my life.

 

[Cancer Man]

i'm a first year trying to figure out how to succeed in med school. It's going allright, but not great so far. I was also a late diagnosis (at the end of undergrad). Somebody touched on the cognitave factors of adhd... and I think a lot of med students with ADHD are very bright people that coped well when younger. As for me, I was able to cope with school and stay near the top of my class through high school with ADHD; it came easy and didn't warrent much effort. In college things got harder as I went to a competitive school- more conceptual difficulty and volume, plus a higher concentration of bright students. I still did well, but my success relative to others wasnt' as good. Here... it's gotten even tougher. Everybody in med school is very bright- and they don't have the focus issues. I'm trying to figure my brain out so that I can make this work. I take adderall, but the tolerance is factoring in. Right now I'm prescribed 10 mg 2x/ day- but I'm taking it 3-4 depending on exam load.

A bit long winded, but I definetly understand the frustrations of others and share them myself. I'm confident I can pass; but starting to wonder how my transcripts will look at the end. The biggest issue for me is accepting that I may be a mediochre student for the first time in my life.

I was diagnoses about half way through first year. High school was easy for me too. Not much effort requred. College wasn't too bad. The heavy lab load during engineering school actually made ADD a bit of an advantage. Also the logical analysis and math really fit well for me. Going to medical school and shifting to almost rote memorization was a challenge to say the least. I'm on a similar prescription.

Here are some things I have found to help with the focus issue.
#1 - hard workout in the morning before class. The endorphin release coupled with ritalin really helps.

#2 - Sit up front and center. This way there is not as much stuff in your peripheral fields to grab your attention.

#3 - If you you use a laptop, un-install all the games and make it more difficult to access the Internet or email.

#4 - Ask questions in class (IF your professors will tolerate it.) This way you stay engaged in the lecture.

#5 - Talk to whoever handles the ADA accommodations. Take your exams in a private room, free of random noise and distractions. You may know the material better than the gunner who gets an A, but if you can't focus on the test, your grade will go into the toilet.

That's all I got right now. If I think of anything else, I'll post it. good luck. You probably won't have any problems when you get on rotations. you will actually be doing things and not just sitting in a classroom.

 

[not 2 late]

I was diagnoses about half way through first year. High school was easy for me too. Not much effort requred. College wasn't too bad. The heavy lab load during engineering school actually made ADD a bit of an advantage. Also the logical analysis and math really fit well for me. Going to medical school and shifting to almost rote memorization was a challenge to say the least. I'm on a similar prescription.

Here are some things I have found to help with the focus issue.
#1 - hard workout in the morning before class. The endorphin release coupled with ritalin really helps.

#2 - Sit up front and center. This way there is not as much stuff in your peripheral fields to grab your attention.

#3 - If you you use a laptop, un-install all the games and make it more difficult to access the Internet or email.

#4 - Ask questions in class (IF your professors will tolerate it.) This way you stay engaged in the lecture.

#5 - Talk to whoever handles the ADA accommodations. Take your exams in a private room, free of random noise and distractions. You may know the material better than the gunner who gets an A, but if you can't focus on the test, your grade will go into the toilet.

That's all I got right now. If I think of anything else, I'll post it. good luck. You probably won't have any problems when you get on rotations. you will actually be doing things and not just sitting in a classroom.

I work as a school psychologist so I have extensive experience in diagnosing and counseling those who have attention deficits. This guy I've quoted is right on target. Add the following to the above mentioned and you'll survive! 1. get into a solid study group 2. put yourself on a predictable, routine studying schedules with specific time/locations.....time management is a big problem with those who have attention deficits 3. break down your work into manageable chunks....figure out your maximum time, then break for a few minutes. 4. stay organized...it's one of the biggest problems individuals with attention deficits have 5. stay off excessive coffee, sugary/high carb foods so that you don't get crashes 6. use Breath Right strips....they've done wonders for my sleep. 7. ask your doctor about other medication options.....there are so many more choices now and not all of them are stimulants...some SSRI's do wonders for attention issues because they alleviate anxiety which often manifests as attention problems......finding the right meds is a game of darts....it's all about those various neurotransmitters and receptor sites 8. try yogo, meditation...you'd be surprised how helpful it can be 9. if you feel you need special accommodations, ask your school to determine if you're eligible under Section 504...any institution that is partially federally funded needs to comply with this law and allow for "reasonable" accommodations to "level the playing field" 10. I'm not in med school, but I've done graduate work and it does get easier...not so much because of the content...more so because you've developed better study skills and the material is more clincial than just theoretical. 11. find a small fidgety toy to exert your energy

There is no magical solution. Meds alone can't do it, but sometimes changing habits is just not enough. Don't be discouraged. I know a fabulous pediatrician who's totally ADHD. Monitor yourself for signs of depression.....this condition is often misdiagnosed as ADD especially in boys. (signs are changes in sleep & appetite, moodiness, apathy,low energy, body aches, and loss of interest in things that you enjoyed before.) Good luck. You'll do great.

 

[worryman]

Hi,

Im a first year that was just diagnosed with ADHD. I am trying wellbutrin, because I was a little reluctant to go on amphetamines.
My state's licensing board asks if youve been diagnosed with a mental illness in the past 7 years. Do I now need to check this box? Im not entirely sure ADHD constitutes mental illness in this context.

 

[AmoryBlaine]

I was diagnoses about half way through first year. High school was easy for me too. Not much effort requred. College wasn't too bad. The heavy lab load during engineering school actually made ADD a bit of an advantage. Also the logical analysis and math really fit well for me. Going to medical school and shifting to almost rote memorization was a challenge to say the least. I'm on a similar prescription.

Here are some things I have found to help with the focus issue.
#1 - hard workout in the morning before class. The endorphin release coupled with ritalin really helps.

#2 - Sit up front and center. This way there is not as much stuff in your peripheral fields to grab your attention.

#3 - If you you use a laptop, un-install all the games and make it more difficult to access the Internet or email.

#4 - Ask questions in class (IF your professors will tolerate it.) This way you stay engaged in the lecture.

#5 - Talk to whoever handles the ADA accommodations. Take your exams in a private room, free of random noise and distractions. You may know the material better than the gunner who gets an A, but if you can't focus on the test, your grade will go into the toilet.

That's all I got right now. If I think of anything else, I'll post it. good luck. You probably won't have any problems when you get on rotations. you will actually be doing things and not just sitting in a classroom.

I would like to jump in and make a single point: you don't get to do this as a doctor. In a clinical setting you may know the material better than this gunner as well, but the ADA doesn't have any power in the ICU.

 

[DD214_DOC]

Just a follow up, I broke 90% on my last exam and an 87% on the second.

😀


As far as what Amy pointed out, this is true and not true. I think an environment filled with lots of highly-stimulating things is heaven for the ADHD person, while an environment filled with lots of low-stimulating things is torture. There's a big difference between having lots of cool, interesting things going on and having people walking back and forth and someone tapping his pencil.

As for the more time thing, I don't get extended time so I'm not worried about it.

 

[Cancer Man]

I would like to jump in and make a single point: you don't get to do this as a doctor. In a clinical setting you may know the material better than this gunner as well, but the ADA doesn't have any power in the ICU.

That's a exceptionally good point. I was focusing more on the classroom during the first two years. I've never really had a problem with ADD in the clinical environment. Actually doing things and seeing how what I learned before applied made everything make more sense for me.

For someone just entering the gate though, you have to get through years one and two before you can start three and four.

Thanks for bringing that up Amory

 

[AmoryBlaine]

That's a exceptionally good point. I was focusing more on the classroom during the first two years. I've never really had a problem with ADD in the clinical environment. Actually doing things and seeing how what I learned before applied made everything make more sense for me.

For someone just entering the gate though, you have to get through years one and two before you can start three and four.

Thanks for bringing that up Amory

Eh, as I have said before in previous threads many, if you are going to claim ADHD you can't really have your cake and eat it too. Below are the DSM criteria for ADHD, how someone can meet these criteria and then be a good clinician is difficult to imagine.

The standard response is "my ADHD is only a problem when I have to study" to which an intelligent person might ask if they too get to be "ADHD" and take meds to help them focus when faced with a subject less-than-interesting to them.



Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Often forgetful in daily activities.

 

[DD214_DOC]

Eh, as I have said before in previous threads many, if you are going to claim ADHD you can't really have your cake and eat it too. Below are the DSM criteria for ADHD, how someone can meet these criteria and then be a good clinician is difficult to imagine.

The standard response is "my ADHD is only a problem when I have to study" to which an intelligent person might ask if they too get to be "ADHD" and take meds to help them focus when faced with a subject less-than-interesting to them.



Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Often forgetful in daily activities.

I think this is a stupid statement and evidence that you don't really understand ADHD.

Plenty of successful and respected physicians have ADHD, including Goljan. Fish for it and you will find psychiatrists, surgeons, IM docs, etc who openly admit to having ADHD without any compromise in their clinical competency. In fact, many of them are actually exceptional physicians, and some of the things that come with having ADHD actually make these types of patients better at the skills necessary for clinical thinking.

As I have been told by practicing docs with ADHD, they typically only pop the meds to get through the mundane boring things like paperwork.

 

[Cancer Man]

I think this is a stupid statement and evidence that you don't really understand ADHD.

Plenty of successful and respected physicians have ADHD, including Goljan. Fish for it and you will find psychiatrists, surgeons, IM docs, etc who openly admit to having ADHD without any compromise in their clinical competency. In fact, many of them are actually exceptional physicians, and some of the things that come with having ADHD actually make these types of patients better at the skills necessary for clinical thinking.

As I have been told by practicing docs with ADHD, they typically only pop the meds to get through the mundane boring things like paperwork.

I must concur with HooahDOc. It would seem that you lack a fundamental understanding of ADD/ADHD. You quoted the DSM. I am assuming you are referring to version 4. It's a very interesting book as are it's previous editions. Please keep in mind that statistics is it's proverbial middle name and that you can prove anything with statistics. The DSM 3 classified homosexuality as a mental disorder. The DSM 4 says it is normal behavior. I wonder what the DSM 5 will say... The previous statement was not meant to kick start a war or be discriminatory in any way. It just shows that the book has changed.

You also mentioned that many people "claim" to have ADD/ADHD. Hopefully you will not be as closed minded in clinical practice. You also mentioned that you didn't see how someone with ADD/ADHD could practice clinical medicine. I personally know a thoracic surgeon with it and he does fine work. You listed several criteria. Please keep in mind that often does not equal always and that those are some pretty general statements.

 

[AmoryBlaine]

I think this is a stupid statement and evidence that you don't really understand ADHD.

Plenty of successful and respected physicians have ADHD, including Goljan. Fish for it and you will find psychiatrists, surgeons, IM docs, etc who openly admit to having ADHD without any compromise in their clinical competency. In fact, many of them are actually exceptional physicians, and some of the things that come with having ADHD actually make these types of patients better at the skills necessary for clinical thinking.

As I have been told by practicing docs with ADHD, they typically only pop the meds to get through the mundane boring things like paperwork.

1. It is pretty hard for someone with a mental illness to judge whether or not said mental illness is affecting their "clinical competency."

2. I agree that the DSM is fraught with peril/controversy, but you two are going to be doctors -- you don't get to just throw diagnoses around based on "gut feelings."

"I don't like to study biochem" does not equal "I have ADD"

3. I would argue that I understand ADD very well. I know people who have it who are entirely crippled from an academic standpoint. They don't take meds to go from a C- to an A, they take meds so they don't lose their minds in the classroom.

4. I might also argue that I understand ADD very well in that many people keep the diagnosis "on reserve" to wave as necessary. When told that they have to study for a test they "have attention deficit and need meds." But any suggestion that attention deficit disorder might affect their clinical performance is met with hostility and scorn.

 

[Cancer Man]

1. It is pretty hard for someone with a mental illness to judge whether or not said mental illness is affecting their "clinical competency."

2. I agree that the DSM is fraught with peril/controversy, but you two are going to be doctors -- you don't get to just throw diagnoses around based on "gut feelings."

"I don't like to study biochem" does not equal "I have ADD"

3. I would argue that I understand ADD very well. I know people who have it who are entirely crippled from an academic standpoint. They don't take meds to go from a C- to an A, they take meds so they don't lose their minds in the classroom.

4. I might also argue that I understand ADD very well in that many people keep the diagnosis "on reserve" to wave as necessary. When told that they have to study for a test they "have attention deficit and need meds." But any suggestion that attention deficit disorder might affect their clinical performance is met with hostility and scorn.

Fascinating... I've never heard ADD categorized as a mental illness before. Learning disability yes, but never a mental illness. These are two vastly different concepts. I do agree that people with a mental illness are too close to objectively evaluate how it is affecting their job performance. Nobody wants to think that there is something wrong with them.

I also agree that the medical art (not science mind you) doesn't allow us as physicians to toss diagnoses around like on an episode of "House MD." However, as all of us know, many diseases do not fit all parameters of a particular symptom list. Many times, it is a judgment call based off of a differential.

I once read an article stating that ADD is one of the most over-diagnosed illnesses in this country. Many people think that a kid that is hyperactive has ADD. Even though it is perfectly normal for a little kid to have loads of energy. I also agree that it is often used unethically and unprofessionally as a stop gap measure for academic problems that arise. I haven't seen it, but I have heard of it. As far as the double-sided response goes, it's an unfortunate fact of our society that we have to deal with as professionals.

Medical school is hard. It's not meant to be easy. There is a lot we have to learn in a short amount of time. Those who actually do have ADD, like myself, need something to level the playing field just a little. Those who don't and say they do, concern me (ethics). As far as the clinical competency goes. I haven't gotten any complaints yet.

I appreciate your comments. This is becoming a very stimulating discussion.

 

[worryman]

Hi,

I posted this above, but not one answered....
Im a first year that was just diagnosed with ADHD. I am trying wellbutrin, because I was a little reluctant to go on amphetamines.
My state's licensing board asks if youve been treated with a mental illness in the past 7 years. Do I now need to check this box? Im not entirely sure ADHD constitutes mental illness in this context.

 

[DD214_DOC]

I have spent lots of time I otherwise shouldn't have reading ADHD research articles on pubmed and various other sources.

I'm not going to waste more time with specific details, but progress is being made in the search for a cause of the set of symptoms, a term I use intentionally. ADHD, currently, merely describes a set of symptoms and is not associated with a specific etiology. Its characteristics overlap with several other medical conditions as well as things related merely to personality. The "defining" feature of ADHD is not really hyperactivity, inattention, poor performance, but really the inability of the patient to voluntarily shift his attention.

Most of the research points to genetic polymorphisms that result in Gi coupled protein receptors in certain areas of the brain that do not function efficiently, therefore the brain's ability to shut off certain stimuli is compromised. When inhibitory systems are inhibited, you can guess what happens ...

However, research has not only implicated the D2-like DRD4 receptors and DAT genes. Investigators have also uncovered certain patients with deficiencies in norepinephrine and sertonin transmitter systems. It could very well be that ADHD is really a problem with the entire system in which an transmitter imbalance occurs, leading to the manifestation of the different subtypes. Given that inattentive subtype ADHD is very closely resembles major depressive disorder, this is not an unlikely plausibility.

The interesting thing is that a particular subtype of ADHD, the inattentive subtype, may actually be an entirely different creature in its own right. Only time and further research will tell.

I did read somewhere, though, that lots of changes to ADHD classification are coming in DSM V.

Back to the discussion, though. In the past few weeks, I have found it to be very interesting that, with successful treatment, my grades have surpassed everyone's. Treatment has allowed me to fully utilize my innate abilities.

As far as the clinical deficiency garbage, I will tell you this. Most people I talk to in my class as well as at other schools don't have one clue how to think clinically. They can regurgitate information they've read from a book like the best of them, which may often translate into good grades, but ask them a question that requires understanding and they fall apart.

 

[worryman]

Is everyone ignoring my question on purpose?

 

[DD214_DOC]

Is everyone ignoring my question on purpose?

I don't know the answer, but given there are thousands of practicing docs with ADHD I don't think it's an issue either way.

 

[Cancer Man]

I don't think anyone really knows the answer either. I take my ritalin just to level the playing field. While my grades may not be the best, I'm holding my own with my colleagues.

I also know people who fall apart when asked clinical questions. I wish I could be a fly on the wall when they are getting drilled by a resident or attending. They are absolutely fantastic when when it comes to puking up minutia on multiple choice tests (hallmark trait of the school) and they get fantastic grades. However when asked a "How does this apply" question, they have no clue. The transition from theory to practice is an area in which many of us find challenging.

HooahDOc's research does spark some thought and questions. I would research it more on your own. However, I personally do not believe that ADD/ADHD is a mental illness. From my point of view, it's more of a learning issue.