I agree. I am not an ADHD specialist, nor do I have ADHD, but i’ve seen a few adults with ADHD that had other problems as well. Now these were people who were working full time and had at least a high school education, if not s/w more.
Almost all of them used stimulants on a prn basis, and had done so since adolescence. If they were diagn…
I agree. I am not an ADHD specialist, nor do I have ADHD, but i’ve seen a few adults with ADHD that had other problems as well. Now these were people who were working full time and had at least a high school education, if not s/w more.
Almost all of them used stimulants on a prn basis, and had done so since adolescence. If they were diagnosed during childhood, they had been maintained on a regular dosage schedule during that time. This undoubtedly helped them to learn the basics in math, language and science.
The ones who opted to use stimulants on a prn basis would often increase their dose (that is, return to the schedule as prescribed) when schedules or demands were tight. After the pressure was off, most returned to prn use. In my “cohort”, none abused the stimulants—or developed tolerance (which wouldn’t be expected any way). All of them had found ways to make their ADHD work for them. These folks can have a “hyper-focus” which is the ability to concentrate to the exclusion of almost everything else. This can have its advantages. Generally, they excel at computers.
Where they run into problems is with close working or love relationships. They tend to be s/w unreliable in keeping promises. I saw at least one man who, upon taking Adderall , began to notice things in his “surround”—like the trash that needed to be taken out or the dirty dishes that needed to be washed. He began to do these things to the surprise and pleasure of his wife. He had to stop the Adderall but apparently had incorporated these learned behaviors because he continued to do them. The positive reaction from his wife was probably a powerful reinforcement.
Generally, I’d say, they aren’t stellar in the empathy dept., at least initially. They can be remiss in engaging in sexual behavior—they seem to “forget” about it, which can cause problems if they’re in a relationship.
So, I don’t understand why this student had to be accommodated. Using the medication (as prescribed) creates its own accommodation.
I think there may be a tendency to grant students accommodations that they don’t strictly need.
A woman in my residency group was deaf but could hear with aids. She said she needed a fixed number of hours of sleep. She said she developed vertigo if she didn’t get the required sleep. She didn’t drive and would persuade others to take her places. I began to suspect that her “helpers” felt guilty if they didn’t help her, given that she had a disability. When she slept, even on call, she’d take out her aids, and thus couldn’t be reached. The university accommodated her somewhat by installing special telephones and allowing her to work reduced hours, especially during internship. One day, she came to me quite upset. Her two “proctors” in a family medicine rotation had failed her saying that she couldn’t or didn’t do the work. I became upset on her behalf b/c I still liked her then.
In giving it more consideration, tho’, I thought that if she couldn’t/wouldn’t do basic assessment tasks, then how could she function as a physician?
We had a falling out over her manipulation, and I believe she did finish. Her goal was to work with deaf children and perhaps that’s what she did. I may sound like a bigot, especially in these heightened anti-semitic times, but she was Jewish and played that card well. She took Saturdays off, although, to my knowledge, she was not Orthodox. I believe one of her parents was a Holocaust survivor and she claimed generational trauma from that.
In thinking about her situation now, I wonder if she would have a better fit in a less demanding field. She could teach in a deaf school or even become a clinical psychologist for the deaf. The demands to become a Ph.D psychologist are less arduous—at least physically.
Where I’m going with this is to discuss the difficulty admission committees have in selecting candidates for medical school. Gone are the days when only healthy white men (and the occasional woman) were admitted. Perhaps this contributed to some of the distortions in the field, and the resulting skewed life balance.
Some have argued essentially that there should be no balance at least in training, when staying an extra hour or two allowed one the experience of placing a Swann-Ganz, or the experience of resecting an aortic aneurysm. Maybe true, but does the need for Swan Ganz catheters or the need for a resection of an aortic aneurysm always happen late at night?
I’ve had more than my share of “peak” experiences, and they do seem to happen at odd hours. What’s more, what happened is intensely burned into my memory. For instance, I will never forget how to place a chest tube or intubate someone. So I do have some sympathy for this POV. But are such experiences essential to becoming a competent physician? IDK.
Physicians all fall on the obsessive-compulsive spectrum which is a mostly good thing. Don’t you want a somewhat obsessive physician? I do.
But the extremes of that and another common medical trait, perfectionism, can cause big trouble in other areas of the physician’s life. The high suicide/divorce rate among physicians has undoubtedly contributed to the notion of “work life balance,” and once that is established, you are pretty well down the road toward various accommodations.
This is, obviously, a slippery slope in both directions. Being overly harsh and restrictive can result in exclusion of persons of varied experience and backgrounds.
Being too loose results in ridiculous, manipulated (out of guilt?) accommodations.
Also, racism and sexism do well in restricted environments. IQ, for instance is NOT a test of global intelligence but rather a test of mental capacity. Other more specific IQ tests can further hone in on nascent abilities in math, science and language. Also, the various IQ tests (Stanford-Binet, the Weschler Adult Intelligence Scale) have long been known to be culturally biased.
Alternative ways of looking at phenomena are not tolerated in medicine as it stands. Perhaps a knowledge of indigenous healing methods (there was a Navajo in my med school class) or cultural inflences and methods
I agree. I am not an ADHD specialist, nor do I have ADHD, but i’ve seen a few adults with ADHD that had other problems as well. Now these were people who were working full time and had at least a high school education, if not s/w more.
Almost all of them used stimulants on a prn basis, and had done so since adolescence. If they were diagnosed during childhood, they had been maintained on a regular dosage schedule during that time. This undoubtedly helped them to learn the basics in math, language and science.
The ones who opted to use stimulants on a prn basis would often increase their dose (that is, return to the schedule as prescribed) when schedules or demands were tight. After the pressure was off, most returned to prn use. In my “cohort”, none abused the stimulants—or developed tolerance (which wouldn’t be expected any way). All of them had found ways to make their ADHD work for them. These folks can have a “hyper-focus” which is the ability to concentrate to the exclusion of almost everything else. This can have its advantages. Generally, they excel at computers.
Where they run into problems is with close working or love relationships. They tend to be s/w unreliable in keeping promises. I saw at least one man who, upon taking Adderall , began to notice things in his “surround”—like the trash that needed to be taken out or the dirty dishes that needed to be washed. He began to do these things to the surprise and pleasure of his wife. He had to stop the Adderall but apparently had incorporated these learned behaviors because he continued to do them. The positive reaction from his wife was probably a powerful reinforcement.
Generally, I’d say, they aren’t stellar in the empathy dept., at least initially. They can be remiss in engaging in sexual behavior—they seem to “forget” about it, which can cause problems if they’re in a relationship.
So, I don’t understand why this student had to be accommodated. Using the medication (as prescribed) creates its own accommodation.
I think there may be a tendency to grant students accommodations that they don’t strictly need.
A woman in my residency group was deaf but could hear with aids. She said she needed a fixed number of hours of sleep. She said she developed vertigo if she didn’t get the required sleep. She didn’t drive and would persuade others to take her places. I began to suspect that her “helpers” felt guilty if they didn’t help her, given that she had a disability. When she slept, even on call, she’d take out her aids, and thus couldn’t be reached. The university accommodated her somewhat by installing special telephones and allowing her to work reduced hours, especially during internship. One day, she came to me quite upset. Her two “proctors” in a family medicine rotation had failed her saying that she couldn’t or didn’t do the work. I became upset on her behalf b/c I still liked her then.
In giving it more consideration, tho’, I thought that if she couldn’t/wouldn’t do basic assessment tasks, then how could she function as a physician?
We had a falling out over her manipulation, and I believe she did finish. Her goal was to work with deaf children and perhaps that’s what she did. I may sound like a bigot, especially in these heightened anti-semitic times, but she was Jewish and played that card well. She took Saturdays off, although, to my knowledge, she was not Orthodox. I believe one of her parents was a Holocaust survivor and she claimed generational trauma from that.
In thinking about her situation now, I wonder if she would have a better fit in a less demanding field. She could teach in a deaf school or even become a clinical psychologist for the deaf. The demands to become a Ph.D psychologist are less arduous—at least physically.
Where I’m going with this is to discuss the difficulty admission committees have in selecting candidates for medical school. Gone are the days when only healthy white men (and the occasional woman) were admitted. Perhaps this contributed to some of the distortions in the field, and the resulting skewed life balance.
Some have argued essentially that there should be no balance at least in training, when staying an extra hour or two allowed one the experience of placing a Swann-Ganz, or the experience of resecting an aortic aneurysm. Maybe true, but does the need for Swan Ganz catheters or the need for a resection of an aortic aneurysm always happen late at night?
I’ve had more than my share of “peak” experiences, and they do seem to happen at odd hours. What’s more, what happened is intensely burned into my memory. For instance, I will never forget how to place a chest tube or intubate someone. So I do have some sympathy for this POV. But are such experiences essential to becoming a competent physician? IDK.
Physicians all fall on the obsessive-compulsive spectrum which is a mostly good thing. Don’t you want a somewhat obsessive physician? I do.
But the extremes of that and another common medical trait, perfectionism, can cause big trouble in other areas of the physician’s life. The high suicide/divorce rate among physicians has undoubtedly contributed to the notion of “work life balance,” and once that is established, you are pretty well down the road toward various accommodations.
This is, obviously, a slippery slope in both directions. Being overly harsh and restrictive can result in exclusion of persons of varied experience and backgrounds.
Being too loose results in ridiculous, manipulated (out of guilt?) accommodations.
Also, racism and sexism do well in restricted environments. IQ, for instance is NOT a test of global intelligence but rather a test of mental capacity. Other more specific IQ tests can further hone in on nascent abilities in math, science and language. Also, the various IQ tests (Stanford-Binet, the Weschler Adult Intelligence Scale) have long been known to be culturally biased.
Alternative ways of looking at phenomena are not tolerated in medicine as it stands. Perhaps a knowledge of indigenous healing methods (there was a Navajo in my med school class) or cultural inflences and methods
(Continued) would broaden medicine leaving us less dependent on Big Pharma.
As always, we should not risk throwing the various babies out with the bath water.