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Category Archives: General Practice

“I don’t believe in labelling kids….”

Today I gave a presentation about ADHD for my group of GP registrars. Just this morning I joked that instead of giving a presentation I should have filmed myself trying to make the presentation and just show that. By this time I am permanently off my meds and I think the max focus time for this presentation was 5 minutes. 

Still impressive that I managed to make something coherent out of it. Suppose it’s one of the things I learned it 29 years of ADHD: the skill to make a rough draft for a project in less than 10 minutes.

Anyhow. 

So these are a bunch of doctors. 

I was just running through some basic stuff. 

And two of them didn’t really believe in helping these kids by ‘labelling’ them. After all, if pedagogic measures can help some? 

I tried to explain that if pedagogical measures solve the problem there is no ADHD. That these kids need more guidance. That you help them to understand themselves and to deal with their relative impairments. Yes but doesn’t everyone have their issues? We all have to learn to deal with our issues. Yes, but you all don’t end up screwing up your life because of it. Aren’t they just lazy? No. 

Honestly, from one of them it made sense. She was in my mentor group and I feel like I get it now.

She doesn’t want to get it. 

Makes sense why my trying to explain my ADHD issues in mentor group didn’t help much. She wanted to hear that I use it as an excuse. She didn’t care that I only offered as an explanation while I struggled on to make things right. 

There wasn’t time for much of a discussion. 

I’m not really sure if I really was going to put in the effort. If people don’t want to hear they don’t want to hear. 

TDH reminded me that it didn’t matter because I know the truth.

Because to be honest, it’s hard not to take it personally despite the fact that I didn’t mention my own ADHD to the general group.

Then I was thinking. 

Perhaps I’d rather have ADHD than a mind that works like that. 

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Update on the school situation

I haven’t posted much about it lately, and what I have posted was mainly very emotional and very frustrated.

Long story short:
I have been placed into a group that started half a year later, so basically, I’m already finishing half a year later than planned originally. This brings me on an education duration of just under 10 years, post secondary school. Given that it takes 9 years if everything goes smoothly…. taking 9 months longer doesn’t matter that much I suppose. The difference between the old group, the one I couldn’t manage studying in, and this one is enormous. It makes me a bit angry still: had I been placed in a different group to begin with, things would have been different. Had this been an option over half a year ago, when I told the mentors this wasn’t working for me, things would have been different.
But they are what they are now, and I’m just relieved that I am now in a position where I can actually learn something. I no longer have to go to extremes to read a bunch of text I can’t focus on, or sit through 3-hour sessions and receive a negative evaluation because I didn’t respond enthusiastically to a discussion about some detail after 2,5 hours of being unable to focus any more. The pace is a lot higher, and there is a lot less emphasis on theoretical details… and a lot more emphasis on what we’re going to do with this. What makes the difference, you may ask… Well… the students.
I do still find uni days long… It’s still too much interaction with a chair. I don’t think that will change. But it’s better now.

I’ve also switched to a different practice and a different preceptor. It’s different. Nothing personal towards the previous one, to be honest, I know she tried and I tried and we kept on missing each other’s point and we kept on confusing each other… It just really didn’t work, and that was horribly stressful. New place is bigger, more organised, and just different. I now have a male preceptor, who was hand-picked for me because he is very experienced as a preceptor. He is. Just not sure what that says about me.

The whole situation has had more of an impact on me than I’d like, and I’m still working on regaining my confidence and de-stressing. Small things freak me out, (small things were the problem last time!)… I worry a lot more, find myself more anxious than I normally am. Of course, some things latched onto some of my ‘issues’, and I have to deal with that too. Not fun. But I’ll be OK in the end.

I’ll also see how it goes with training now.

And guess what? They even have a pic of the doctor set I used to have as a kid on the internet!

 

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Energy

I wonder if this is a typical ADHD thing, or if it’s just something everyone deals with to some extent….

Just a little observation of mine lately:

It’s almost as if I have a certain threshold to pass before I’m fully ‘switched on’. For example: my time-per-patient has recently been changed from 20 minutes to 15 minutes. The result? I’m seeing most patients within 10 minutes (the actual allotted time per patient I’m supposed to be working towards). And I use the rest of the time to deal with other patient-care related stuff. Funniest part of all? I go home with more energy. 

Sometimes it’s like my brain has a sort of a flat-wave ‘zone’: not enough stimuli, and I find it hard to keep my brain ‘functioning’ well and sometimes I even struggle to kick start it. Perhaps it’s the stress-and-ADHD thing. You know, that ‘when the going get tough, the tough get going’ thing. I need to be challenged. If I get bored, I switch off. Get me switched on and I can do twice what ‘normal’ people can do. (Sometimes in half the time, like when I studied for the acute care exam) 

The only problem is: it can be equally hard to switch off by myself once I’m switched on, so I need to be careful in order to prevent burning myself out. 

Sometimes, I suppose, my brain seriously does not want to be phoned out of bed for THAT… I think all doc’s who have ever been on call know what I mean. 

 
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Posted by on September 9, 2014 in adult ADHD, General Practice

 

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Studying.

 

All WOW moments under pressure set aside – that’s not a viable long-term solution- I still feel like I have no idea how to do this.

I have absolutely no idea why most higher education is set up like this:
Lots of theory, based on what someone else thinks is interesting.
Everything has to be done in a certain -not really efficient and rather unpractical- way. Maybe that’s because many intelligent people seem to live in their cognition.
Translating theory to practice is very very complicated for most.
Bonus points for pointlessly using big words.
Pictures and graphs are for babies.

I really really don’t know.

And I really don’t understand how these people LEARN much. Some do, and are very snooty about it. Good for you, now what else do you have to offer?

 

Give me access to clinical practice and a library with PubMed access, give me some rough guidelines and maybe some coaching and I’ll rock your socks off.

Force me to march to the beat of someone else’s drum, force me to read a bunch of texts, to do assignments of which I see no point.. and I get stuck. It becomes torture.

I’ve tried my best to read the mandatory prep reading. I’ve spent hours trying different ways. I haven’t learned much from it.

I was so excited to be let into this programme, I almost -or no I actually did- hit my head against a lamp when jumping up and down out of sheer joy when they let me in. I really love the work bit, I love primary care.

Two months and a bit into the programme I am completely disappointed. I find my mood taking a drastic plunge on Thursday evening because free time means study time (and chores time). I hate both so much I don’t know if yelling or crying is the best response. Studying is torture. I spend all weekend trying to get myself to do something extremely boring and looking forward to Tuesday evening, when class day is over. The others enjoy the break from the practice, I dread Tuesdays because it means going to class, (sitting still, listening, more boring info). I haven’t learned much outside of simply working. I find myself not giving a fuck about most of the assignments. These people have a way of ruining anything that could be interesting. (I thought it would be interesting to sort out and present stuff about knee examination, nice and practical. I also figured we’d all get to do that, so why not do something I find interesting. So I agreed to do it. And then discovered the question was ‘what is the scientific background of the examination of the knee. Snore. Why would I WANT to present that???? ).

I have no idea what to do.

I tried looking up study tips for ADHD, none of them really solves the problem: only snore-minded people can follow this course.

It’s not worth my sanity.

I have no idea where this is going to end. I know this: I am planning to do the bare minimum and not read the prep. I don’t care. I’m wasting my time trying to do it their way, they won’t let me do it my way. I’ll see where it ends. The only really shitty bit is that I have a half-finished degree; just finishing med school and nothing else doesn’t really get you anywhere. I mean, I can work as a doctor, but I always need a supervisor. And that’s going to be less fun when I’m 40.

It’s not worth my sanity, it’s not worth my relationship.

I should never have gone to med school. I should have done some form of uni of applied sciences, finish at 22 and just get on with doing what I do best: the actual thing. It doesn’t matter that I may have a lot to offer, it doesn’t matter that IQ-wise I may (or may not) qualify for Mensa. It doesn’t matter that I can be a very good doctor, ADHD or no ADHD.

The way to get there is not for people like me, it’s for more of the same sort of people. I hate society.

And I need more time to ‘play’ in order to keep on functioning.

 

The troubles of ADHD and going back to uni…

I’ve been in the specialist training programme for two weeks now, and while it’s pretty serious stuff, I can’t help but find myself funny sometimes…. I’m just trying to manage and make it work with my alternative mind…

* Today I got startled by the same prank dummy three times. When I see an elderly person on the floor, my first response is Safety-ABCDE…  So essentially I almost resuscitated a dummy filled with toilet paper three times.

* Then, when I was supposed to use a test patient at the out-of-hours-service intro course, I actually managed to open a real patient file. Hey, how was I supposed to know Testington (altered name but you get the point) was a real name?

* I’ve spent two hours trying to read the assignment. I started panicking when it required me to read ‘chapter this and this’ in a book on communication skills. I still don’t know exactly what the assignment is, my plain text retention is that low. And then I got frustrated when, at the end, they mentioned the system used at my uni. All this frustration for something I already know. 

* I still haven’t gotten round to reading a book about talking.

* Step 1 in my assignment was: reread literature and notes from med school on communication skills. Communication skills was a do-class at my uni, and while we had literature I suppose it was all in the uni library. I may have looked at it because ‘you will be doing a simulation of a bad news convo tomorrow and we’ll be filming you’ is pretty motivating to look for a few tips if you’re in second year. I threw out all my lecture notes because I moved a few times in between. But, always keen, I dug into my cellar box. No lecture notes, no hidden and forgotten literature. What I did find was an evaluation booklet for my Internal Medicine clinical rotation….

* Speaking of communication skills, I find watching Scrubs quite useful.

* Speaking of lectures, I think I was pretty bad at attending those anyway.

* Meanwhile I’ve figured out about 5 creative ways to examine children who are bent on not being examined.

* I got myself a new planner, as I already lost overview of my small one.

* Apparently my ‘if all else fails please read instructions’ approach scares others in my group. I suppose it does require, ahem, a special kind of mind. We did a learning style test, and I was all in the ‘experience’ learning corner. Yes, I may jump in first, but that doesn’t mean I’m not observing and thinking WHILE jumping. My IQ can keep up with my ADHD if required, remember? And thanks to hyperfocus I can learn more in 5 minutes than others can in 20, linking it to all of my senses if I’ve just experienced the problem.

* Channeling my ADHD actually makes for a few brilliant differential diagnoses. And a doctor who is razor sharp in case of emergency (adrenalin still beats concerta by far!).

* That being said, I’m on new territory for me. I’ve spent most of my career so far dealing with extremes. I’m insecure, and I find myself being truly surprised when people ‘buy’ it because I’m still wondering if I’ve missed something….

But, what I do find absolutely fantastic is that I’m not the only one in this job who isn’t perfect. I’m not the only one who doesn’t have all the answers, in fact, I’ve been told that I’ll never outgrow the occasional foot-in-mouth-moment in general practice. It’s a combination of run-of-the-mill things, surprises, personal stories, puzzles, brilliant ideas and what-the-hell moments. Definitely not for the faint-hearted. It’s guts, grace and genius combined.

 

 
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Posted by on March 17, 2014 in ADHD, General Practice, Work

 

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