It is ADHD Awareness Month, and I often find myself reflecting on my own diagnosis of attention deficit hyperactivity disorder (ADHD), and the challenges and strengths it's brought to my life.
However, what I have frequently found is ADHD is often discussed in terms of its impairments.
Struggling to concentrate.
Forgetfulness.
Emotional dysregulation, and a predisposition to depression.
Problems with sleep.
Difficulties meeting potential at school, work and beyond.
The list goes on and on, and when I was diagnosed with ADHD in my second year of medical school, I quickly found that we rarely balance it with anything positive. I am now in my seventh and final year of medical school and will graduate next year. However, at the time of my diagnosis in my second year, I was on academic probation and already very aware of my weaknesses. Although I now have a diagnosis that explains some of my difficulties, the D for “deficit” in ADHD overshadowed all the other letters for me.
Before my diagnosis, I was already worried I wasn’t suited for a medical career. However, reading online about ADHD after my diagnosis made me feel like I had been officially labelled as unsuitable.
Most importantly, I struggled to find examples of doctors who succeeded with ADHD. Some people with ADHD do make statements online such as “ADHD is my superpower”, but that has always felt a bit unbalanced and too far in the other direction for me. I had heard that some people with ADHD claimed it made them more creative or spontaneous, and I wondered if there were any strengths of having ADHD as a doctor.
I figured that ADHD must have some strengths – otherwise, why would it still be genetically pervasive, if it was 100% disadvantageous? I’m now coming to the end of my time at medical school, and going into my seventh and final year, I think I’ve finally found some of those elusive positives to having a neurodevelopmental condition.
My impulsivity has got me into trouble at times - rushed work at school, booking flights to Paris on a whim, and once famously catching a hot iron with an outstretched palm. However, ADHD traits of impulsivity and distractability are thought to be partially due to novelty-seeking and exploratory behaviours also seen in ADHD.
To highlight the positives of these features, novel, stimulating experiences can help those with ADHD learn and increase memory. As medicine is an ever-evolving field, with a clinical environment that is constantly changing, this experience is beneficial for my ADHD brain. A medical career involves constant learning, and this abundance of new experiences and knowledge keeps me engaged.
For example, the variety of moving between different patients and performing different tasks on a ward shift is appealing to me, particularly as I dislike being stuck on one task at a time.
On the other hand, ADHD makes learning things that don’t relate to my interests, such as anatomy, much harder, as I frequently lose concentration and find it hard to focus. However, I find studying things that relate to my interests, such as psychiatry, much easier to study and thus often spend hours engaging in this.
Whilst it is true for all people that it is easier to focus on things you are interested in, those with ADHD can sometimes feel this to a much stronger effect. This experience is called hyperfocus, ‘a phenomenon that reflects one’s complete absorption in a task, to a point where a person appears to completely ignore or ‘tune out’ everything else’.
For example, I can hyperfocus on an area of interest for hours at a time, often forgetting to do things like eat or drink. Looking at the positive side of this experience, ADHD can help me learn about things I’m interested in deeply, and this can translate into better competency for my future career.
Another strength I have found is having insight into the lived experience of neurodivergent patients, which can lead to increased understanding and improved care. Neurodiversity is a model which originally arose from the autistic community, with the term neurodivergent serving as an identity for those who considered themselves as neurologically “different”, often due to conditions like ADHD, dyslexia and autism.
Doctors with lived experience of neurodivergence could have an understanding and empathy for their neurodivergent patients, which is different to those without this experience.
For example, some parts of accessing healthcare, such as phoning to make an appointment or sitting in a waiting room, can seem straightforward to neurotypical doctors. However, these seemingly straightforward tasks might be overwhelming and create barriers for a patient who is neurodivergent. I have spoken to several patients with ADHD who have been discharged from a service after forgetting one appointment, something I too can relate to.
Recognising barriers is important for implementing change to better serve this patient group. Doctors with lived experience have unique insights and, therefore, may feel more motivated to make changes that improve care for neurodivergent patients.
So, how many doctors could potentially be bringing these neurodivergent strengths to the medical profession?
Whilst there isn’t any reliable data on the prevalence of neurodivergence in doctors, 3-4% of adults are estimated to have ADHD, and this number is likely to be an underestimation due to difficulties in accurately identifying ADHD in some populations, such as women. Additionally, some studies have suggested that neurodivergent people might actually be overrepresented in STEM fields, including medicine, precisely because of these skill sets.
However, stigma is unfortunately also likely to prevent doctors from sharing that they have ADHD. In a 2020 survey by the BMA, only 36% of respondents felt comfortable disclosing their disability at work, whilst a troubling 77% were fearful of discrimination. A recent review found that over half of medical literature on ADHD contained stigmatising language, and in the UK Doctors subreddit, I have sadly read disparaging comments about neurodivergence.
Would you feel comfortable disclosing that you had ADHD, if there was a chance your colleague next to you had stated “ADHD is a fake diagnosis” online?
I have had to learn to be resilient to comments on placement like “Why would you want to scrub in? You’re always distracted in teaching, so you probably won’t concentrate on the operation.” Comments such as these indicate a lack of understanding about ADHD.
Whilst there are strengths of having ADHD in medicine, I have experienced two main barriers to these strengths being more widely recognised.
The first barrier is recognition and understanding of ADHD in the workplace. Greater recognition and staff knowledge of ADHD is something we all would benefit from - whether you have ADHD or not. The second barrier is recognising ADHD in ourselves, and understanding what this means in terms of the positive traits it brings, and the areas where one might struggle.
In a positive step forward, it was announced in March this year that the NHS is launching a cross-sector ADHD task force to boost care for patients living with ADHD. The new taskforce will bring experts together from a wide range of sectors, including the NHS, education and justice, to “better understand the challenges affecting those with ADHD, and help provide a joined up approach in response to concerns around rising demand”.
I greatly look forward to seeing the outcome of this new taskforce.