ADHD specialties!

[Atlas]

Can anyone think of specialties that would suit a person with ADHD (besides EM)? Any thoughts and more importantly your reasoning why would be greatly appreciated! Thanks.

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[Megalofyia]

Any that you find interesting and keep your attention. Kind like how the kid with ADHD can play video games for hours or read comic books from begining to end cause they are into it.

 

[Orange Julius]

Can anyone think of specialties that would suit a person with ADHD (besides EM)? Any thoughts and more importantly your reasoning why would be greatly appreciated! Thanks.

Pediatrics. Kids always love goofy ******s.

 

[2006MD]

Can anyone think of specialties that would suit a person with ADHD (besides EM)? Any thoughts and more importantly your reasoning why would be greatly appreciated! Thanks.

How about pathology..they go through slides very quickly and are quirky people. 😉

 

[PublicHealth]

Psychiatry!

 

[Atlas]

Peds...haha "goofy ******s"...that might just fit!! Maybe a peds-sub??? I've thought about path...prob is that I'm color blind so I'd probably really suck as a pathologist. Psych...no thanks. Not for me. I've thought about Ophtho, ENT, and GI recently. What do you think? Do they fit the ADHD person very well??

 

[Sinnman]

I think ENT is probably out. Nothing would drive you crazier than spending 5 hours dissecting out a tough thyroid or longer with a laryngectomy/radical neck.

 

[f_w]

Ophtho is out with ADHD. After you opened someones eye, you can't just drop your tools and walk off if you get bored/frustrated.

Stick with EM. ADHD is a job requirement (but it is definitely not a place for someone with other pathology such as OCD for example).

 

[emtp6811]

Stick with EM. ADHD is a job requirement (but it is definitely not a place for someone with other pathology such as OCD for example).

BEG TO DIFFER!! Studies have been done that show that well more than 90% of those practicing EM show strong signs of OCD. That percentage is even higher in paramedics. In my experience, this is DEFINITELY true!

 

[Bernardo_11]

Do surgery or a subspecialty thereof. Most of the time you will be forced to concentrate with the procedure at hand. That will help you to weed out any of the noises going on around you. Just like video games, doing laproscopic surgery (ie. working your fine motor skills like crazy) would be a great way to stimulate your attention, concentration, and focus. Psych, peds, path, and most of the other specialties listed above become extremely tedious and involves writing tons of long, drawn out notes. Best to do something that is extremely procedural based and allows you to focus on one task at a time. EM can be way too scattered and the multi-tasking involve can be challenging for a person who has problems maintaining concentration and focus.

Nardo,
Behavior/Developmental Pediatric Fellow

 

[Megalofyia]

Do surgery or a subspecialty thereof. Most of the time you will be forced to concentrate with the procedure at hand. That will help you to weed out any of the noises going on around you. Just like video games, doing laproscopic surgery (ie. working your fine motor skills like crazy) would be a great way to stimulate your attention, concentration, and focus. Psych, peds, path, and most of the other specialties listed above become extremely tedious and involves writing tons of long, drawn out notes. Best to do something that is extremely procedural based and allows you to focus on one task at a time. EM can be way too scattered and the multi-tasking involve can be challenging for a person who has problems maintaining concentration and focus.

Nardo,
Behavior/Developmental Pediatric Fellow

👍

 

[Atlas]

Ophtho is out with ADHD. After you opened someones eye, you can't just drop your tools and walk off if you get bored/frustrated.

Stick with EM. ADHD is a job requirement (but it is definitely not a place for someone with other pathology such as OCD for example).

Ophtho is one of only a couple surgical fields that can do a case in less than an hour...more like 20 mins. I like that! Same with ENT. I'm on ENT right now. Even the residents are bustin' out T and A's in 20-30 mins. The longest I was in there was 45 mins. General Surgery sucked for me. I hated going everyday. Probably not the best way for me to spend the next 5 years of my life. ER is one that would fit. Anybody have insight on GI? Any other thoughts?

Thanks

 

[Atlas]

There is Anes/PMR/Neuro Pain Management! Lots of procedures, quick patient turnover, etc. Any thoughts?

 

[rugtrousers]

There is Anes/PMR/Neuro Pain Management! Lots of procedures, quick patient turnover, etc. Any thoughts?

To get through anesthesia training, you have to do a lot of general OR cases, which in a stable patient may involve being attentive and doing little for hours on end. Not so good for the ADHDer I think.

 

[f_w]

20 minutes on a standard case if things go smooth. The problem is not the time for individual cases, it is the inability to keep your attention focussed if things don't go so well.

 

[Atlas]

To get through anesthesia training, you have to do a lot of general OR cases, which in a stable patient may involve being attentive and doing little for hours on end. Not so good for the ADHDer I think.

What about neuro or PM&R?

 

[Orange Julius]

Do surgery or a subspecialty thereof. Most of the time you will be forced to concentrate with the procedure at hand. That will help you to weed out any of the noises going on around you. Just like video games, doing laproscopic surgery (ie. working your fine motor skills like crazy) would be a great way to stimulate your attention, concentration, and focus. Psych, peds, path, and most of the other specialties listed above become extremely tedious and involves writing tons of long, drawn out notes. Best to do something that is extremely procedural based and allows you to focus on one task at a time. EM can be way too scattered and the multi-tasking involve can be challenging for a person who has problems maintaining concentration and focus.

Nardo,
Behavior/Developmental Pediatric Fellow

This is very true. 👍

 

[Bernardo_11]

Ophtho is one of only a couple surgical fields that can do a case in less than an hour...more like 20 mins. I like that! Same with ENT. I'm on ENT right now. Even the residents are bustin' out T and A's in 20-30 mins. The longest I was in there was 45 mins. General Surgery sucked for me. I hated going everyday. Probably not the best way for me to spend the next 5 years of my life. ER is one that would fit. Anybody have insight on GI? Any other thoughts?

Thanks

You see though, it's not the length of time the procedure takes that can make a person with ADHD weary. Indeed, you can see them propped up in front of a video game for hours on end just as long as it piques his interest and there is enough stimulation to stay on the task at hand. So most people with ADHD could do a 5 hour general surgery case just as long as there is no multi-tasking involved and the person can be fully absorbed in the procedure. Remember, its way different being the person DOING or ASSISTING the actual procedure from being a 3rd yr medical student retractor. Driving the laproscope on the other hand would be much easier in that you play a key role in the procedure. Also stimulation and focus are increased since you'e watching the whole procedure on the monitor.

EM is a specialty involved with a ton of multitasking. You may have to be in the middle of 10 patients working them up at the same time. It would be EASY to lose your focus in that specialty and would be difficult for one who has ADHD.

GI, is procedural when doing scopes and what not. But remember that there can be long tedious writeups as well as long out patient work-ups. That could be challenging if you have a hard time focusing on unstimulating tasks.

My advice would be to do a general surgery sub-internship where you may get to be first assist in a lot of simple procedures. I bet you will see a difference in the degree of focus you have in doing the case yourself rather than being a student retractor.

Nardo
DB peds fellow

 

[needsadvice]

i agree with megalofyia.

 

[siimpleton]

Ophtho is out with ADHD. After you opened someones eye, you can't just drop your tools and walk off if you get bored/frustrated.

Stick with EM. ADHD is a job requirement (but it is definitely not a place for someone with other pathology such as OCD for example).

On a simmilar note. EM has been my number one interest for a while and I know it fits my personality like a glove. I was recently diagnosed with ADHD and was considering taking accomadations for the USMLE. Do you think EM residency program would look down upon thes "accomadations" (since they are reported with your score) and not see that in fact it is ADHD that is the reason for why I would do so well in EM (just not well on reading and written exams)?

 

[BKN]

I just have to say this. An ADHD EM physician is usually a disaster. They can't prioritize and they're too distractable in an extremely distracting environment. They fail to do things that need to be done immediately; they putter around doing things that can wait.

Oh and as for the question. Yes, any EM PD is going to be extremely cautious about MLE scores with accomodations. To be any good at EM, you have to be able to retrieve info quickly from your brain or your peripheral brains.

Sorry,
BKN EM PD

 

[f_w]

I just have to say this. An ADHD EM physician is usually a disaster.

I guess sarcasm doesn't get accross so easily in the written format. I mentioned it as a job requirement because so many of the ED docs I had to deal with over the years seem to have attention issues.
(we had one ED doc with raging ADHD. If she worked the busy 3-11 evening shift , it would take the night shift until about 2 am until they managed to tie up all the loose ends she left behind. she had a pattern of working up everyone for anything but in the process forgot to follow up on things or discharge the patients.)

 

[BKN]

I guess sarcasm doesn't get accross so easily in the written format.

No, I understood you were kidding. It didn't appear that everyone did.

 

[NRAI2001]

Does anyone know why they banned adderall in Canada?

 

[DropkickMurphy]

I just have to say this. An ADHD EM physician is usually a disaster. They can't prioritize and they're too distractable in an extremely distracting environment. They fail to do things that need to be done immediately; they putter around doing things that can wait.

Oh and as for the question. Yes, any EM PD is going to be extremely cautious about MLE scores with accomodations. To be any good at EM, you have to be able to retrieve info quickly from your brain or your peripheral brains.

Sorry,
BKN EM PD

But what about those of us who have ADHD and can retrieve information quickly? I've had it for so long, and have worked in time sensitive areas of medicine so I've learned to use it to my advantage (at least according to docs I've worked with)

BEG TO DIFFER!! Studies have been done that show that well more than 90% of those practicing EM show strong signs of OCD. That percentage is even higher in paramedics. In my experience, this is DEFINITELY true!

Here's one to wrap your brain around: I was also diagnosed as having obsessive compulsive tendencies; yeah, that's right, two different psychiatrists (I thought the first one was FOS) have told me I have a condition that hinders my ability to concentrate, but I have an obsessive component to my personality when it comes to work and school. I'm still trying to figure that one out. Don't think about it too long or blood will shoot out your nose.


BKN, What other fields do you recommend for ADHD'ers such as myself if not EM?

 

[siimpleton]

I think some of you are generalizing all those with ADD to be the same. Just because one of us fails at one thing and excells at another doesn't mean that is true for all. We all have our strengths and weakness and that is wound up with the ADD to form a distinct outcome for each person. For example, I read a post by someone stating that they needed to study alone to get their work done. For me it is the exact opposite. If I study alone I get nothing done. If I study in a busy cafeteria, I am much more productive. We are all distracted by different things, and for many, including myself, the distraction comes from being understimulated. This is why MANY people with ADD move towards jobs in Newsrooms and ERs (you can find this nearly quoted word for word in ADD textbooks). By being stimulated, the ADD essentially goes away for that period of time. I have been "on the go" my whole life and this is where I excell, and I would strongly disagree with the notion that someone with ADD would not do well in an ER. (Of course thats not to say that everyone with ADD would do well.) I do however appreciate the advice that accomadation would not look good on an application. May I ask what specialty you are in? For those who are wondering what specialty to choose, my advice as a fellow student would be simple as to say... see what excites you in clinicals, if excitement is what you need. For some, surgery is a huge rush...for others it is boring...and thats based on personality, not the presence of ADD.

 

[yaah]

There is definitely at least one attending pathologist here who has ADHD. Can't sit still. Gets up and takes breaks, gets distracted. he signs out cases quickly because he has a good eye and a lot of experience. But I don't know how he got through residency dealing with other pathologists, because as a resident you have to work at the speed of whoever you are with, and sometimes this includes plodders.

 

[BKN]

But what about those of us who have ADHD and can retrieve information quickly? I've had it for so long, and have worked in time sensitive areas of medicine so I've learned to use it to my advantage (at least according to docs I've worked with)

P, I don't want to say that you can't do it. Nor do I want to say that most EPs don't exhibit some of that trait. What I am saying is that those who truly have the full blown disorder usually can't do it.

Here's one to wrap your brain around: I was also diagnosed as having obsessive compulsive tendencies; yeah, that's right, two different psychiatrists (I thought the first one was FOS) have told me I have a condition that hinders my ability to concentrate, but I have an obsessive component to my personality when it comes to work and school. I'm still trying to figure that one out. Don't think about it too long or blood will shoot out your nose.

Same opinion as above. Doctors routinely talk about the value of being obsessive-compulsive to be sure that you get everything done. Without question that's true, but they're not talking about the disease. Those with a true OCD are as crippled in the ED as an ADHD.

BKN, What other fields do you recommend for ADHD'ers such as myself if not EM?

Before you give up the notion, do a rotation early in your 4th year in an academic ED. Tell your supervising faculty you are trying to decide between EM and ___, and you'd like their honest opinion about your ability to multitask and to be a good EP. Listen to their feed back at the end of the month.

If the vedict is 👎 , I suggest you do something that allows you to take one task at a time, which is most other specialties.

BTW, I share a certain cynicism about psychiatric diagnoses. I think that they are frequently handed out rather liberally. This is because 1) they want to help and 2) the insurance companies won't pay unless a diagnosis is attached. Therefore the DSM keeps expanding with ever more weird divisions. Adult and child ADHD are the fad diagnoses of the moment. I believe a lot of people carrying the diagnosis don't actually have it. I suspect if Canada banned adderall, the reason was that they were afraid that every normally rambunctious boy in the country was going to be hooked on amphetamines.

But the real ones are a problem. I've buried two "ADHD" residents who used stimulants, legal and illegal for their disease. The circadian upset and the constant adrenalin of the ER made them worse. It was painful and a waste. I don't want to do it again.

 

[BKN]

May I ask what specialty you are in?

Concentrate! 🙂 As it says in this thread, and really all over SDN, I'm an program director in emergency medicine. I've been in academics for 22 years, and as the post above indicates, our program learned about this the hard way.

I guess I'll change my profile so it identifies me. I hang around and post because I think I may have something to offer. But as many others have said, guard your anonymity here.

 

[Sohalia]

What about neuro or PM&R?

I don't actually have ADD, but I get bored quickly and like to dabble. I'll be doing PM&R + research. I think PM&R might be a good fit for people like me because it is very general in a sense. Peds to geriatrics, msk to sci/tbi, lots of medicine to very little. I love research also. I love to be alone in my lab programming and whatnot. Research allows to do whatever you want whenever you want. Case in point, it's like 2 am and I'll be abstracting some papers in a minute... 👍

 

[NRAI2001]

But the real ones are a problem. I've buried two "ADHD" residents who used stimulants, legal and illegal for their disease. The circadian upset and the constant adrenalin of the ER made them worse. It was painful and a waste. I don't want to do it again.

"Buried" them as in fired?

 

[kamikaze]

I was wondering if I have to inform the PD that I have ADHD when I start my residency in July.? any oppinions?

 

[McDoctor]

I was wondering if I have to inform the PD that I have ADHD when I start my residency in July.? any oppinions?

You will undergo a pre-employment physical to ensure you are medically fit to perform your duties just like at any other job. I don't think you should feel any obligation to disclose personal medical conditions to anyone other than the individual who is performing you pre-employment physical.
just my opinion.

 

[f_w]

At various points in your career, you will be asked (at times under oath) whether you have any medical or psychiatric conditions that might affect your fitness to practice medicine. And whatever you do at that point, don't lie (a medical condition if properly treated will not keep you from getting a medical license, credentials getting yanked for lying on an application can do long-term damage to your career.)

But no, you don't have to tell your residency director unsolicited that you have ADHD. But if that 'application for priviledges as a housestaff physician' asks you about medical or psychiatric conditions, don't lie.
- If you state your condition, all it will mean is that you have to provide a letter from your treating physician stating that you are under treatment and that you are able to fullfill the duties of your job.
- If you lie about it, you might get away with it for a long time. But if things go wrong and someone goes back and finds out that you lied, you are exposed to excessive liability and disciplinary action.

 

[la gringa]

i'm doing EM (matched into a 2-4, doing my prelim year), and i'd agree with BKN... while certain characteristics people associate with ADHD are helpful in the ED like energy, switching tasks, etc... the disorder would be a disaster. i say i'm "functional adhd" because i can ably do more than one thing and switch back and forth when i want to. that's not adhd... if anything it's just a personality type and hell, to some it's a disorder (makes it tough to be doing a medicine year!!!).

 

[NRAI2001]

At various points in your career, you will be asked (at times under oath) whether you have any medical or psychiatric conditions that might affect your fitness to practice medicine. And whatever you do at that point, don't lie (a medical condition if properly treated will not keep you from getting a medical license, credentials getting yanked for lying on an application can do long-term damage to your career.)

Isn't "conditions that affect your ability to perform" a very ambiguous and subjective question? You may not feel it will effect your abilities in medicine?

 

[ORBITAL BEBOP]

Ophtho is one of only a couple surgical fields that can do a case in less than an hour...more like 20 mins. I like that! Same with ENT. I'm on ENT right now. Even the residents are bustin' out T and A's in 20-30 mins. The longest I was in there was 45 mins. General Surgery sucked for me. I hated going everyday. Probably not the best way for me to spend the next 5 years of my life. ER is one that would fit. Anybody have insight on GI? Any other thoughts?

Thanks

Ophtho also has very long surgeries involving the retina and congenital malformations. Plus, no shaking of your hands or losing focus!

 

[f_w]

Isn't "conditions that affect your ability to perform" a very ambiguous and subjective question? You may not feel it will effect your abilities in medicine?

The manic patient also doesn't think that there is anything wrong with him.

If you believe that ADHD is a real psychiatric condition, (it does 'require' medication after all), I would think that you are obliged to disclose it if

 

[Bernardo_11]

Most of the people here have probably misinterpreted me and others saying certain specialties are a virtual "no-no" because of their ADHD condition. That is far from the truth. When it comes to the treatment and control of this condition there are two very important things to consider when one is doing work. Interest and Aptitude. ADHD has been basically bread and butter for me in this fellowship and I have seen a range of how badly a child's productivity is compromised. I have seen some children with ADHD maintain B's in their report cards. They were able to overcome their symptoms mainly through their sheer smarts (I'm sure this matches the description for those ADHD'ers who have acheived and made it into medical school). Proper treatment unleashes the full potential in alot of these kids. Other children are basically "zombiefied" playing video games. Despite their ADHD, it's their interest in the task that hand that overcomes this lack in focus.

I am probably a lifelong ADHD'er myself. DeeBee peds is something quite interesting to me. Despite all the long, tedious notes and 1 hour long visits, I'm pretty functional but I do have to keep myself in check when it comes to distrability- especially after clinic when I'm doing write-ups.

Folks, no matter what medical specialty you enter, multi-tasking is going to be needed to some degree. ER though, as I remember, was one of my more challenging rotations in my peds residency. Mainly because you have to keep track of the lab values and details of every one of your patients you've worked up. I otherwise enjoyed the rotation and appreciate what I've learned, but I knew that Peds ER would not be the most "natural" fit for me.

And so I'm simply saying, if you have ADHD and you want to go into a multi-tasking havy specialty like ER, you will already have one strike against you. If you are able to overcome this with interest and aptitude, all the power to you. Realize though that this fit may not be the most natural, so you'll have to work harder than the average resident if you want to do well in this particular field.

Nardo

 

[BKN]

"Buried" them as in fired?

No.

 

[emidesu]

I think Hallowell and Ratey have some things to say about specialties. Also perhaps thom Hartmann?

 

[NRAI2001]

No.

Buried as in they died?

 

[kungfufishing]

?

 

[kungfufishing]

no, sand castles.
how many other kinds of buried are there?

 

[c diddy]

Nothing beats derm for ADHD. A new patient Q 10 minutes and quick, focused, superficial procedures and surgeries are the mainstay of the field. Derms don't write long notes, rarely do inpatient medicine, and have plenty of time off for directing their attention toward other things in life.

 

[ORBITAL BEBOP]

The manic patient also doesn't think that there is anything wrong with him.

If you believe that ADHD is a real psychiatric condition, (it does 'require' medication after all), I would think that you are obliged to disclose it if

What diseases are you supposed to put on your licensing application? For example, if you have well controlled depression under a physicians care, and it has not affected you in 10 years, then does it need to be revealed?

 

[medgator]

Ophtho is one of only a couple surgical fields that can do a case in less than an hour...more like 20 mins. I like that! Same with ENT. I'm on ENT right now. Even the residents are bustin' out T and A's in 20-30 mins. The longest I was in there was 45 mins. General Surgery sucked for me. I hated going everyday. Probably not the best way for me to spend the next 5 years of my life. ER is one that would fit. Anybody have insight on GI? Any other thoughts?

Thanks

GI can be pretty procedural.... and generally quick procedures at that. Upper and lower endoscopies, ERCPs, Liver Bx's etc. Might be a good ADHD fit for someone who is procedure oriented??

 

[mysophobe]

I feel I need to make a comment on the surgery option. I have ADHD, and when I'm in the OR, I find myself feeling like I want to stab myself in the neck just so I can get the hell out of the room for 2 minutes. I'm not talking about boring cases, either. I LOVE surgery and every aspect of it, but standing in the OR for longer than 10 or 20 minutes drives me nuts. If you really have ADHD, I don't think surgery is the best option for you, unless the intellectual stimulation can overcome the problem. But, I find surgery very stimulating, and it still gets to me.

Just my $0.02.

 

[Bernardo_11]

I feel I need to make a comment on the surgery option. I have ADHD, and when I'm in the OR, I find myself feeling like I want to stab myself in the neck just so I can get the hell out of the room for 2 minutes. I'm not talking about boring cases, either. I LOVE surgery and every aspect of it, but standing in the OR for longer than 10 or 20 minutes drives me nuts. If you really have ADHD, I don't think surgery is the best option for you, unless the intellectual stimulation can overcome the problem. But, I find surgery very stimulating, and it still gets to me.

Just my $0.02.

Interesting. If I may ask, are you a surgery resident or a medical student? I ask only because I would think there's a clear difference between being first assisst, as in residency vs being the typical med student retractor (not as stimulating).

 

[mysophobe]

No, I'm an RNFA planning to go to med school. When I was in school, I definitely loved it, and when I first started it wasn't as bad. I probably exaggerated it a little, because I DO go to work everyday and do it. I just feel very antsy and anxious most of the time when I'm not immensely distracted by other stuff.

I don't just water ski on retractors and camera drive either; in fact, I usually let the surgeon camera drive with one hand and I hold the other two graspers (lap chole; we don't do too many other lap procedures). I cut tissue, use the bovie, suture, put dressings on, etc., etc.

I was thinking about it last night, and I think a more prominent cause of my problem is my history of panic attacks. I've had one in the OR before, and now as soon as the surgery starts I have to fight off the feeling. More than once, I've felt like I was going to pass out, but I never have, and it hasn't really affected my performance.

Actually, the only specialty I actually feel relaxed in is orthopedics. Doing total knees all day keeps me totally relaxed. I never even get close to having a panic attack, and I don't get bored. I just don't think. It's weird.

Sorry for the long rambling, I'm just bored to tears, and I think I'm on the verge of a breakthrough.