Doctors with ADHD

[00:00:00] Rachel: Have you ever secretly suspected you may be neurodivergent? Lots of doctors are. In fact, it may be one of the things that makes you particularly good in your role, but any strength also has its shadow side and it’s not uncommon for us to find life challenging in other areas, even if it’s easier in some.

[00:00:17] Rachel: I myself have ADHD, diagnosed in the last five years and after the initial shock, I’ve lost counter the aha moments that I’ve had, and I’ve finally begun to understand fully what makes me tick, what my secret superpowers are, and what my personal kryptonite is, mainly boring tasks and household organizations.

[00:00:36] Rachel: So being a mom of three as well as running a training organization and getting a weekly podcast out is challenging, to say the least, but I’ve learned that there are some time tested strategies and things I must do to function well with ADHD.

[00:00:50] Rachel: So in this episode of You Are Not a Frog, recorded, in partnership with the Physicians Mums Group, UK Facebook Group, Dr. Sarah Goulding and I discussed how our diagnosis of ADHD has affected us, how it’s helped us make sense of our lifelong struggles and the particular issues it’s thrown up for us both when working as doctors and juggling everything that comes with being a medical mum. We also share our top tips for functioning well with ADHD and enjoying life.

[00:01:16] Rachel: But before we dive into the episode, I’d love to introduce you to Dr. Nazia Askari. She’s the powerhouse behind PMGUK and she’s not just a consultant radiologist, she’s a true visionary who sometimes manages to balance an intense medical career and raising two young girls and running one of the most successful online communities for doctor mums in the UK.

[00:01:36] Rachel: Now, PMGUK is not just a Facebook group, it’s a movement. Under Nazia’s leadership, it’s grown into a thriving and supportive space where thousands of female doctors can connect and share and lift each other up. And she’s represented the group nationally to ensure voices are heard at the highest level.

[00:01:53] Rachel: She’s really built something special, and she’s really passionate about creating real and honest conversations about the challenges of being a doctor and a mom. And that’s exactly why this episode is so important. Nazia.

[00:02:05] Nazia: Thank you, Rachel, for that introduction. You know what? I have to come to your show more often. Uh, that’s definitely, that’s definitely going to, uh, put up my wellbeing score, honestly. Um,

[00:02:17] Nazia: Rachel, you never shy away from tough conversations. And that’s what I like, you know? That is life. We want real people, real conversations, uh, real community. And, um, you know, thank you for this, uh, this episode It is raw, it is honest, it is insightful. In the podcast, Sarah talks about, uh, diagnosis and the shame and the guilt which comes with the diagnosis. I can talk about this podcast a lot. So I think we’ll put it back to the audience. Uh, they should listen to it and, uh, you know, hopefully they will like it as much as I do.

[00:02:54] Rachel: Let’s dive into the episode.​

[00:02:57] Rachel: If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog

[00:03:11]

[00:03:15] Sarah: I’m Sarah Goulding. I’m a portfolio GP with a running total of seven jobs, currently, mostly in medical education and doctor wellbeing.

[00:03:24] Rachel: You are a doctor. A mum with ADHD, and so am I. And the fact that you have seven jobs, is that a slight reflection of that or is that just something

[00:03:34] Sarah: It was very much a well, duh, once I realized and I went for an eighth one yesterday, so,

[00:03:42] Rachel: So not only do you, uh, have 8 jobs, you also have like probably three extra days in the week that us mere mortals don’t have, presumably.

[00:03:48] Sarah: Well, I think we’ll come to that. In terms of efficiency and effectiveness, I think there’s a lot of room for maneuver on that, but yeah. So variety gives me spice. What can I say?

[00:04:01] Rachel: well e Exactly. Now I think we need to start off with a bit of disclaimer because. I dunno about you, but even with ADHD I’m getting really fed up with the ADHD bandwagon. Uh, and it does feel like every, every person in his dog at the moment is either pursuing an ADHD diagnosis, got an ADHD diagnosis, um, and you know, I think both of us have only very recently been diagnosed when actually for me it was when one of my children, we were wondering about it and then suddenly the penny dropped that ooh, maybe that, maybe that is me.

[00:04:32] Rachel: And it was hilarious when I went to my consultant, she was like, oh, that is so common, so common in women that they’ve struggled all their lives and then one of their children gets diagnosed and they suddenly go, oh, oh no. And, and you recognize those traits in yourself. What, what led you to getting a diagnosis?

[00:04:48] Sarah: I, I struggle to remember the exact thing, but it was, it was around a period about two and a half years ago where suddenly it was in the press more. There were articles particularly relating to women of a certain age, IE forties and onwards who was suddenly finding life was really difficult and they couldn’t really understand why.

[00:05:10] Sarah: And obviously there’s been this tidal wave of understanding around the menopause, but there were women who realized that actually it was a lot more than that, and that their ability to function in life had always been an issue. And there were some things that had always fit for me, like in my family, my mom and I would joke about having a butterfly brain and how things were boring and wasn’t it fun to be a bit zany and all over the place and yeah, yeah, of course. I skimm read who doesn’t,

[00:05:41] Rachel: Yeah. Right.

[00:05:41] Sarah: Exactly what, why would you read all of the boring description bit? That’s not the fun bit. So I’m a voracious reader, but if you ask me what percentage of the book I read, I don’t think I’ve ever, other than med school actually finished a nonfiction book because I just don’t have the capacity to, even if I do.

[00:05:59] Sarah: And everybody in the family would mock me because I would leave all the kitchen doors open when I was doing stuff in the kitchen, because once I’d left that cupboard, it was dead to me. And I would walk into doorways because I was more focused on what was happening the other side of the doorway than actually getting through it safely.

[00:06:15] Sarah: So I thought I’ll just do it, and I started the process. Um. And was kind of blown away when they said, yeah, you’ve got severe inattentive, ADHD, and actually that was a really difficult process for me and I had not anticipated that at all.

[00:06:31] Sarah: And yes, I do have a child who has ADHD as well. Um, and that was part of the reason I was like, well, if I do, he most certainly does, and he has extra requirements in that. He has type one diabetes.

[00:06:44] Rachel: Do you think it’s generally, it definitely is more prevalent these days, or do you think just with diagnosing it more,?

[00:06:51] Sarah: the analogy that I’ve come up with is that this is the new menopause. It’s always been in existence, there have always been people who are built a certain way. Functional MRI scanners will show us that our brains work differently. There must have been an evolutionary advantage for us to be neurodivergent, and yet there are people who struggle a lot more than others. So I, I think it’s just revealing what was always there personally.

[00:07:20] Sarah: And it’s difficult. I think it has made the process of. Understanding oneself and feeling okay with our diagnosis so much harder, because there’s so much stigma around it. And I did find that hard and it, and I think again, it’s common in the diagnosis process to doubt yourself. Oh, well maybe it’s just because everyone’s getting diagnosed. But I very strongly believe that it is a thing. I’ve done lots of reading around it. and the process of starting on medication we may come to in terms of what that can reveal sometimes or not.

[00:07:54] Sarah: People have always been struggling. You know the, the population in prisons, it is disproportionately filled with people with ADHD who don’t have impulse control, who have dopamine, who may not have been able to stay in schools or jobs. There’s a much higher proportion of people out of work who are neurodivergent. So there’s just so much evidence and I think it’s lazy to say, aren’t we all a bit? And that’s a whole other conversation.

[00:08:20] Sarah: For me, it, it feels, if somebody says that, okay. If that’s a question mark, go and find the answer because no, we aren’t all a bit, and no, it’s, it’s always been here. If you go back to childhood, when I look at my reports, my mom sort of said, you have to do this thing where you ask your parents and likely your parents are also ragingly neurodivergent in one way or another, so they see it all as normal. And I said to my mom, wasn’t I chucked out of uh, preschool ‘ cause I was climbing all the furniture and nobody would have me around ’cause I was destroying stuff? She said, yeah, you were very bored and you got happier, the further along you got in development, the happier you got.

[00:09:02] Sarah: I went right, and then I looked at all of my reports and they all went Sarah could do really well if she would just settle down. Sarah could, if she would just stop chatting or distracting the other children. But because I was in inverted commas, bright, and yes, I was one of the talented and gifted, um, as we, as we often are as medics, um, you go under the radar and, and they just think you need to settle down and behave better and become a, you know, perfectly behaved good girl, which I did.

[00:09:30] Rachel: My recollection is always being labeled very Naugh, a bit naughty or prec. Precocious and like, you know, one of those kids that they’re not quite sweet and demure, but they’re always like questioning stuff or, I remember eating a conquer just to see what the reaction would be because I think I knew that, but when I was about four.

[00:09:47] Rachel: But always being labeled as tactless, always chattering in class, always sort of trying to disrupt. But yes, as you get older and because you want to be good, you really want to be good, so then you become quite acquiescent. and, and, and, and working hard, but you’ve always got in the background that you are actually not very good, that you’re always upsetting people, that you’re always doing stuff that’s wrong or getting, getting told off, or you know that adults find you a bit tricky.

[00:10:11] Sarah: The piece around internal self-criticism has been huge for me in terms of understanding, okay, not everybody has a constant running thread of oh, well, you haven’t done that, therefore, you are a bit rubbish. Okay, you struggled with this. Why aren’t you better at that? And I thought everybody had that, but they really don’t. And when I became a coach and I started to understand my thoughts better and know that I am not, my thoughts and my thoughts may not be real, that helped.

[00:10:43] Sarah: But then the ADHD diagnosis going, you are beating yourself up for not being neurotypical, actually. And the bit for women is that we often are diagnosed with the inattentive because the hyperactivity shows up mentally. And people don’t have a window into that, so they only see the behaviors and how we respond, and only we can know what’s going on, but we may not pick up how difficult that is.

[00:11:09] Rachel: And I think that that sort of criticism, it just carries on, doesn’t it? In into adulthood. I remember, you know, always being criticized for not doing Christmas cards. That like, oh, you’re too lazy to do Christmas cards. You don’t want to do them. Or, I remember being labeled, or ra you know, lazy ’cause Rachel needs her sleep. And God, I remember in junior doctor years when, you’re the same age as me ish, aren’t you? So, like, we genuinely did that, those 120 weeks, ’cause a European working time directive hadn’t come in, feeling so tired. I felt physically sick and just having to sleep and sleep and sleep and sleep.

[00:11:45] Rachel: My colleague didn’t seem, I mean, yes, they struggled with being tired, but they weren’t so tired that they felt ill, and I almost left so many times just ’cause I could not cope with the sleep deprivation. But all my life has been, oh, Rachel’s lazy, you can’t get her outta bed. Actually, you know that people with ADHD really, really need need their sleep.

[00:12:01] Rachel: So you get labeled lazy sometimes you get laid, labeled a bit disruptive. I remember being told by consultant, well, Rachel, you know, you’ve got lots of good ideas, but you need to actually finish something. When you start something, you need to finish it.

[00:12:12] Rachel: And it wasn’t till I was reading a book about women with ADHD that I, I read about the fact that they find so many things really difficult. And one of the things that they are ashamed about and that they hate doing is that it was an American book holiday cards. I was like, that’s me. Who’d have thought that, like, that is like a, a trait that all over the world women are being criticized because they don’t like writing Christmas cards? Or they just, the thought of getting themselves, ’cause the thought of having to buy them all then find all the addresses, then sit down and write them, to me it’s just like, well, even though I really would love to catch up with people, just, it was that, that having to organize it just felt like such a drag. So I just ended up thinking, oh, I’m just not gonna do it. But then feeling constantly guilty, but then getting criticized as if, or feeling shame that there is something wrong with me because I just can’t, that process feels too awkward.

[00:13:02] Rachel: And I also remember, so this is quite good therapy for me, Sarah, thank you. But, you know, sitting at, you know, in a group of mums, um, about, you know, 10, 15 years ago and, and one of them was on their day off and it’s like, what you gonna do today? She said, it’s so wonderful. I’m gonna organize my daughter’s party. Her daughter was five. I’m, I’m gonna spend the whole day getting party bags together and doing the decorations and putting the, and it’s just so I get to do this for a week. It’s gonna be, and I remember thinking, uh, like my idea of hell organizing a child’s party, ’cause you’ve got to get the invite. You gotta do the party, but cake. You gotta cook the cake.

[00:13:37] Rachel: I remember giving my child a. One year a shop bought cake and she just looked at it and went, mummy, it’s bought. Like, even though I’d been on call that week, I was pregnant. It was just like, I mean, it was, I look back now and go, you’re lucky you’ve even got a cake, love. But I felt all, you know, this idea of organizing this child I did was my idea of hell and being able to just outsource that and, and get it. I mean

[00:13:58] Sarah: the thing about making cakes, which is an absolute disaster for me, is having to follow a recipe and really get the ingredients

[00:14:06] Rachel: It’s get getting the ingredients in the first place, isn’t it?

[00:14:08] Sarah: Well, I had the ingredients, but then I’d, I, I’d, I find it very hard to really focus and take in the information. I famously made an totally inedible, puttanesca sauce when I was feeling keen. And I used two tablespoons of chili flakes rather than two teaspoons. I find following a recipe incredibly hard, and parties was definitely part of it.

[00:14:30] Sarah: The thing that I found hardest about being a young to small kids that my friends didn’t seem to struggle with was just, what do you do in a day and how do I make that happen? Because people seem to just get on and do stuff. They seem to have a routine that they just followed, and I would wake up and go, oh, there’s all this time, I’ve got a child or two children, what do I do?

[00:14:56] Sarah: And this feeling of dread, and when’s my husband going to get home? Because I do not know how I would cope as a, as a solo parent. And, and how am I going to fill that time? Because I know that there’ll be some downtime where they have a sleep. At some point I’m gonna have to make them a meal. How do I do it? And what I, I didn’t have the get up and go, okay, I’m gonna do this unless I had, you know, one of the, one of the the toddler groups that you’d go to, one of the music groups or you’d go to the gym. I, I found it incredibly hard to know what to do and I. And I still do, if I have an empty day for leisure, how do I fill that? And I felt a lot of shame around it.

[00:15:35] Sarah: And I think, uh, one of the processes for me, now that I’m much further down the line of integrating this as an understanding of myself is going yeah, there’s a, there’s a huge societal pressure to do everything the same. And this is true, you know, when we talk, we’ve talked lots of times before about what it looks like to be a doctor and moving through training. It’s huge as a mom, and you get the guilt before you even have the baby. There’s all of that. What are you doing when you are pregnant? What are you doing to get pregnant? What are your plans when you are the other side of being pregnant?

[00:16:08] Sarah: And a lot of that requires a lot of executive function, discipline, routine, all of which are not my strong points, and with ADHD can be very difficult. We, we struggle like crazy to follow a routine and be disciplined, because it doesn’t give us dopamine and we don’t get the hit when we’ve done it.

[00:16:29] Rachel: It’s ringing so true for me. And the, the problem is when you’re a mom and you’re also working as a doctor, you don’t have kids and send them off to school or send them to nursery. There’s all the, the parents’ evening and the forms that need to go in and the amount of times we forgot swimming kit and I hadn’t signed the form for the school trip, or I hadn’t paid them money for the school trip or I hadn’t booked the, the, the parent consultations that you know how to book.

[00:16:51] Rachel: And I hadn’t, you know, and the amount of emails we get every day from the school and the other mums are constantly saying, oh yeah, well it was in the newsletter. Like, who reads newsletters from school? ’cause no one’s got time.

[00:17:01] Rachel: I think it might be quite useful just at this point to bring in something that I read that has been incredibly helpful for me. And this is the concept of the Butler.

[00:17:09] Rachel: It was in a, another book about ADHD. So most people, neurotypical people have a functioning prefrontal cortex, and I think with people with ADHD that for some reason or another, the prefrontal cortex isn’t functioning as brilliantly as it could do, which is why they struggle with this, the organization and the decision making sometimes.

[00:17:28] Rachel: Now, this book was likening the prefrontal cortex to a butler that will go and open the door, say, here’s your organi, here’s your cups of tea, and just organize the household. The problem is we don’t really have a very functioning butler, or if we do is without having a fag behind in, in the stable block, you know

[00:17:44] Rachel: and so we don’t rely on being organized and executive functioning to get stuff done. We rely on the scallywag and that going, oh shit, it’s late. That amygdala, oh my God, I’ve got a deadline. Which is why actually people with ADHD, we are brilliant in a crisis because we can really mobilize ourselves and we can be really flexible we don’t mind too much things aren’t done way in advance. We can, we can be mobilized by this, by this. Well, it’s, our amygdala response isn’t, it’s by the, the, the threat of not, of not having it done.

[00:18:18] Rachel: The problem is when we are constantly relying on that threat of it not having done response, it means your life is full of anxiety and, and, and adrenaline. And as my consultant put it, she said, when people with ADHD have anxiety, you know, most other people with anxiety, they’re worrying about stuff that might not happen, they’re ruminating, they’re catastrophizing with me. She said, to be honest, Rachel, it’s fair enough anxiety. ’cause you’re constantly anxious, you’re gonna drop a ball, because you are.

[00:18:47] Rachel: Which then brings me back to how the frick of we managed to, uh, function as a doctor? Because actually I remember, you know, uh, in house jobs, at the time, the main function of a junior house officer, I think was just organizing everybody and keeping, you know, you had to keep meticulous lists of all the patients and what they needed. And I had to be totally obsession about these lists that I was keeping.

[00:19:09] Rachel: So then I had this idea that I was really good at organizing. I was and ’cause I was quite productive, and often people with ADHD have a lot of ideas that they do. So they often, if, if they’re not in prison, they’re running companies or they’re, they’re running stuff. ‘Cause actually they often are people that have vision for things, that can seal opportunities, that can connect stuff.

[00:19:31] Rachel: But it’s very, there, there is a real cost to that. And the cost to then having to keep stuff incredibly organized at work, which you absolutely have to ’cause patient’s lives depends on, you know, that’s a bit of an exaggeration perhaps, but some, they really do is that it just feels like so much effort. Then you’ve got sort of nothing left to organize yourself out of working in the home. Now that’s what I’ve experienced. I dunno about you.

[00:19:53] Sarah: Yeah, I was reflecting when you talked about your junior doctor experience. I felt the opposite. I felt actually I was running on anxiety all of the time and I did really well. So I got all of the positive feedback stuff. I didn’t drop the ball because I was absolutely terrified, uh, a high percentage of the time. And actually that kept my attention and it meant that when I was out of work, I actually didn’t sleep loads because my little mere cat brain was constantly on alert and I had this whole totally unhealthy sleep when you’re dead mantra, because I really needed to get some fun outside of work in order to keep going.

[00:20:31] Sarah: And I think you, you can see why people with ADHD are also more likely to have issues with addiction, because we are, we are looking for these things that give us a boost or we, we find it easier to pick up a habit that’s unhealthy and keep doing it ’cause you’re getting these little hits of dopamine.

[00:20:51] Sarah: I think for me, when I became a GP partner was when the wheels fell off because there were just such a volume of things to do. Actually, I felt anxious every day I went into work, unless I was too tired to feel it. And then I just felt dread, and then I would get home and I would have nothing less left at home. Um, and my husband would say, how bad can it be? It’s only a couple of days and then it’s the weekend. And, and actually knowing now what I do makes so much sense as to why I burned out six years ago, because of course my brain wouldn’t be happy in that situation. And how I’ve crafted my career without knowing this about my brain, a career that feels sustainable and enjoyable. I’ve, I’ve done it because I’ve, I’ve found ways that work for me and things that do make my brain feel happy, and that are lighter on admin.

[00:21:42] Sarah: But absolutely. I’m always running that, Okay, what am I about to cook up? What do I need to do? And I was also going to come back to the bit about motherhood, I think that bit where kids return to school at the beginning of the school year, it’s a horror to me, and when I talk to my husband, he can’t understand it, but all the other moms do, neurodivergent or not. It feels that there’s just suddenly a huge increase on things that you can get wrong. And if you have children at different schools with different blooming email systems and IT things, and they’re always changing them, and then you have to go onto a new website and get new passwords.

[00:22:22] Sarah: I find it a tremendously stressful time, and because I have a flexible portfolio, I can reduce the amount of work I do around there, but I still find it really stressful. And that’s not including all the gear that you have to buy and the uniform. And what if, as my daughter just did, she decides the skirt that you bought halfway through the holidays is too long. And actually she would like a new one, thanks very much. And yeah,

[00:22:45] Rachel: Or mum, can you hear it for me? And you can think, I can’t remember where the flip I left my sewing kit. No idea.

[00:22:50] Sarah: knows that I won’t do that. I don’t even iron Rachel.

[00:22:53] Rachel: Oh God. Ironing. No, that’s, that’s another whole thing. I, that’s, uh, that makes me feel really good to hear you say that. ‘Cause we are recording this on the 11th of September and I, the last couple of weeks I’ve been feeling really, really awful. And I’ve talked to people, they’re like, yeah, Rachel, you are like this every single year in September. I mean, partly because we have three birthdays in my family in September, all in a row. Partly because it’s, it’s, it’s that going back to school thing.

[00:23:18] Rachel: And actually for me, the summer holidays are a nightmare because the kids are all around and, you know, it’s wonderful that they’re around, but someone has to organize something for them to do, and this is where I’m gonna be really sexist here, mostly the emotional load of organizing the children falls to the mums. In my experience, even if the dads help out a little bit, the backstop, the default parent tends to be the mum. And I can’t even begin to think what it must be like parenting solo. Um, so those listeners who are doing that, you know, you deserve million different medals.

[00:23:53] Rachel: Because when you feel like the default parent and, and, and the guys, they’re great and they do help out and they’ll say, yeah, I help out. And they’ll do stuff, but they don’t take the overall ticket tape of what is going on quite a lot.

[00:24:04] Rachel: And if, if you’re one of those guys, that does, brilliant. But in my experience, it is very rarely equal. Often because the guys working full time and the, and the mum is often reduced their work when they’ve had children to maybe three or four days a week. And somehow that means that then they then get the entire responsibility for organizing the children.

[00:24:24] Rachel: And for me, it’s not the doing stuff, it’s the remembering to do stuff that’s the real problem. And the typical mother role has been nurturing, organizing. The typical dad role. It’s often fun, spontaneous, do something the kids, well, frankly, that’s, that suits me a little bit better, the fun, the fun, spontaneous. But then I find myself being anything but fun when I’m thinking, well, what am I gonna do with you on holiday? Ah, and why is it always me that has to book the, the camps and the clubs and everything and everything like that? And yeah.

[00:24:53] Sarah: I think what we should say is that, and there’s been a bit of difference between you and I, not everybody with ADHD is the same, and we will all have different things that we struggle with more than others.

[00:25:05] Sarah: For me, I find meetings to be a particular type of hell. Teams, meetings I would’ve thought would be better because I can sit and fiddle around in the background, but actually I find it really hard to give it my attention. Any meeting beyond about 20 minutes, I find physically and mentally uncomfortable, in terms of having to stay still in terms of giving it my full attention in terms of not interrupting people.

[00:25:34] Sarah: We, I’m very good at spotting patterns and my brain is very nimble, so I’m very good at going okay, yes, and now what? And coming up with ideas and solutions. But if I’m going to sit through somebody giving me the full version of and why. My little prefrontal cortex says, oh, you know what, Sarah, just jump in

[00:25:55] Rachel: I’ve got that. Let’s move on. Let’s move on. yeah,

[00:25:57] Sarah: Under. Or if somebody’s telling me a story and I’m like, I don’t need to know all of this detail so I can come across as rude and blunt and certainly oversharing, and I will come away from a meeting thinking you should have shut up a lot more.

[00:26:11] Rachel: Yeah, I get that as well. So I’ve learned to sort of sit on my, sit in my hands. It’s interesting, you, you talk about you can’t do more than 20 minutes in a meeting. Sometimes I get really bored, but often what I do is hyperfocus. And this is why sometimes you don’t recognize it because, one of my kids who has ADHD can massively hyperfocus, you get into art for an entire day or you know, taught herself to play guitar in a week, really well, you know, just off YouTube, ’cause when she’s interested in something, hyper focus.

[00:26:40] Rachel: So when we are interested in something, you nail down, you focus, you literally forget, forget everything else. That’s, I think, part of the reason that we’re often a little bit time blind. Um, or I can find myself just, okay, I’m, I’m gonna cook here at six, and then at like quarter to seven, I’m still doing that thing because I’m, I’m, I’m in hyper focus.

[00:26:57] Rachel: That does mean that I’m in meeting some of my team and it’s like gone on for an hour and a half and I’m not in the zone and I can see they’re all sort of glazed over and it’s like everybody, so you sort of forget that other, other people need a break.

[00:27:08] Rachel: But then there’s the opposite of if I’m got to do stuff I don’t really want to do, it’s those intrusive thoughts that come in. I’m trying to focus on a spreadsheet, say, and, and, and actually all I’m just wanting to pick up my phone and wanting to do this. I’m feel very scattered. And it’s because the default mode network hasn’t been turned off. And have you heard the theory about the focus mode and the default mode and the task positive network and stuff?

[00:27:36] Rachel: Well, this is another thing my wonderful consultants told me. Imagine you’ve got a csaw and our brains have two modes of functioning. One is when you are really focused on something, your focus mode, so the pointy end to focus mode that’s gone down on my seesaw. Your task positive network is engaged and you are fully focused on something, you’ve got very linear brainwaves.

[00:27:54] Rachel: And then when you stop and you have a cup of tea and look out the window, what happens is your default mode network kicks in instead of your task positive network. And so the cecil’s gone the other way. You’re in default mode, and this is why it’s so important for everybody to take breaks, because your default mode network, it connects across your hemispheres, you start getting much more creative, you have different ideas, you solve problems. So you’ve gotta have breaks. Otherwise, you won’t be activating your default mode network.

[00:28:19] Rachel: Now, the problem with people with ADHD is, it is there’s a faulty Cecil, there’s a faulty switch. So if your task po positive network is engaged, your, your default by network is also engaged. And so you, you, you’re not, you haven’t switched it off. And so you’ve constantly got these intrusive thoughts while you’re trying to, trying to focus on that task that you’re doing.

[00:28:40] Rachel: And I, my understanding is as well as sort of increasing dopamine and stuff, that might be one of the ways the medication actually works is by helping switch off the default mode network so you can actually focus.

[00:28:51] Sarah: I, I think the concept of being efficient and what that means, I think can look very differently to lots of different people and certainly I. I think there are lots of tasks. Trying to go through a task list is impossible for me, and I know that I might not even get any of those done ’cause I’ll come up with something else different that seems interesting to me. And I go, oh, well I haven’t done those bits that really, I feel a lot of resistance to, but I’ve done that. And then you get the anxiety.

[00:29:22] Sarah: I explain to people sometimes that I find it incredibly hard just to send one email if it’s a work email. For some reason there’s a lot of resistance to it, and, and I think I’ve only realized now how much that has affected my work life overall and where I’ve ended up. My GP jobs, so my, my portfolio are locum jobs that involve no admin at all, and that’s very deliberate. So I do those jobs, I go home and my other jobs do have s and more admin. Um, but it’s finding that balance.

[00:29:56] Rachel: I think it’s balanced in in all of this. So, I mean, we talked about a lot of the issues with ADHD, but, and I’m gonna move in a second to talk about some of the solutions that we found and things that really help. But let’s not just focus on all the issues. ‘Cause actually I don’t think I’d have it any other way because I like the way my brain works and it does allow me to do what I do.

[00:30:16] Rachel: The things that I think aDHD has given me. Um, but really interested to hear what you think it’s given you is, you’ve already mentioned that ability to connect ideas quite quickly. So I’m able to talk to someone on a podcast, go, oh, that’s interesting you said that. I heard that over there from the, that person. It’s completely different, unrelated fields, but maybe those two will go together. And remember models and things that I found. Interesting in the past and, and genuinely be interested in lots and lots of different things, which is why I sort of call myself a curator of ideas so that I can like, share them, share them with other people.

[00:30:48] Rachel: And then there is that ability to hyperfocus and get a lot done with the right systems, we’ll talk about systems and stuff in a minute, but, I think that’s what it’s given me. What, what’s it given you?

[00:30:59] Sarah: It’s given me huge amounts of courage to do different new things. There’s this evolutionary concept that. ADHDers are still around because we were the people that were willing to be explorers to go and do the dangerous thing, to try the berry that perhaps you shouldn’t, because actually that concept of something new and different. And change I find energizing, and I’m quite comfortable doing that.

[00:31:25] Sarah: So I’ve tried a lot of different things and I remain very open to that. And I know some people find that incredibly uncomfortable, but actually that’s, that’s a real strength of mine, and a reason why I’ve ended up with a career that’s so very different to what a lot of my colleagues have. But I love it. I absolutely love it, and I feel that I could carry on doing that.

[00:31:49] Sarah: Because I’m taking in a lot of inputs quite often, I can often read a room very well that can come with a downside. So in terms of my ability to read people and understand their emotions and really connect on a much deeper level, I genuinely think ADHD has helped with that.

[00:32:07] Sarah: For me, my hyperfocus is when I’m talking with people in a way of helping them, which is why I’ve ended up in a lot of supportive roles.

[00:32:17] Rachel: There are some coping mechanisms and coping strategies and stuff aren’t there for this? What, Sarah, over the years have you found to be really helpful for you?

[00:32:27] Sarah: For me, exercise makes a huge difference in terms of my quality of focus, my energy. Um, while I’m doing that exercise, particularly when I used to be doing a lot of high intensity, my favorite class is body combat. So I’m punching and kicking people, hopefully not me, but sometimes it happens. Um, I can’t think about anything else, so I’m giving it my full attention and the ability to focus after that is just phenomenal, and I really notice if I don’t.

[00:32:59] Sarah: Now what I’m also having to balance that with is slower energy exercise. ‘Cause as you get older you get a bit more creaky, but also allowing my brain to work in that lower energy form of exercise. So that’s, that’s one that I’ve always done. I’ve always been a sort of Duracell bunny. I will run around the house to do stuff ’cause it’s boring going up and down stairs. So I will do things that build up my battery, but also give me something.

[00:33:26] Rachel: Totally. Really, it’s really, really important for people with ADHD just to get moving, and I find that as well.

[00:33:33] Rachel: Things that have helped me, well, first of all, I think I’d say this self-compassion. When I was first diagnosed, I felt an incredible amount of, well, I sort of went through the grief cycle. I felt I was like. This idea that I thought I was neurotypical, suddenly there was something wrong with me. I was like, oh my God, what? What’s happened? Felt really upset, like a, a grief and like a loss.

[00:33:52] Rachel: But then I felt very angry because I looked back all of my life and went that’s why, that’s why that was happening. Why didn’t anybody recognize it? That poor little girl who was just criticized all the time, this was what was going on for me and, you know, bit angry and then a bit of shame. And I realized that the, the predominant emotion that women with ADHD feel apparently is shame, because we can’t do this in the same way that a good mom can do it or we can’t, you know, I think maybe guys with ADHD don’t feel quite so much shame. They feel like brilliant entrepreneurs, those ones that are really successful, you know, ‘ cause they’ve got the backup.

[00:34:30] Rachel: So I felt shame. I felt anger, but then actually I found it really helpful ’cause I could then feel some self-compassion. I can go. That’s why, that’s why I’m feeling like that, that’s why it’s important to me and, and. ADHD, it’s not an excuse, it’s not an excuse for bad behavior or anything like that, but it is a reason, it’s a reason why we do behave in, in certain ways.

[00:34:52] Rachel: And so for me, understanding myself, that’s been quite helpful. And I hopefully for other people, understanding that when I don’t finish jobs and I’m a bit messy, it might drive them mad. But actually there’s a reason for that. It’s not just me, it’s not me being lazy, which I think is, is been put down to in the past.

[00:35:09] Rachel: And then. What I realized that I developed over the years and actually what ADHD has given me, it’s this podcast and the work that I do now, which is helping doctors and people in high stress jobs work happier and beat burnout because that’s what I needed myself, which is probably why I was so obsessed with systems and time management and all that sort of thing.

[00:35:30] Rachel: ‘Cause I’d ask people go, you know, how do you manage my di your diary? And they’re like, well, I don’t really need, I don’t really have a diary. I’m like, how can you not have a diary? Like literally, how can you have a diary? Because unless I put something in immediately, I’m gonna forget about it. So I’ve had to develop systems, I’ve had to develop automations, which has really helped.

[00:35:47] Rachel: So for example, Sarah, you’ve booked to come on this podcast, you would’ve got an email from me, which had a just a signature saying here’s the link to Calendly link to book the podcast. Here’s the Riverside link for recording. Here’s the guest form. You can fill out your details. It’s all there. It’s all been set up. I press one button and it goes to you.

[00:36:05] Rachel: Now, if every time I wanted to book someone on the podcast, I had to remember to send them the recording link and then had to run and send the guest form, this podcast would not exist. But because there’s some automations and there’s things like, you know, when I go and get my hair cut, I always book the next time, because otherwise I will forget, you know? So you just hack your brain. So things are happening automatically, which is why, and this is a bit of a, like a, um, dichotomy. So you don’t like having your day filled up with the routines. I hate that. I hate knowing, having my day planned out. However, having a regular routine is really helpful. Like having a circuit training class every Friday morning for me is helpful. And then having a regular meetup with friends, ’cause otherwise I would, that wouldn’t happen. It’s just in the diary.

[00:36:46] Rachel: Some sort of routine to the week. It’s helpful, but not a really rigid routine because variety, like you said, when you find variety in life, variety in your work, now that could be within one role and there’s plenty of roles within healthcare where you get a variety in within one role, or maybe you have to cross your own role where you’re getting that variety for yourself. That’s been, that’s been really, really important.

[00:37:07] Rachel: Um, but for me. I’m working on this at the moment, is getting a system so that all those tasks, all those things that are in my head, that I’m so worried about dropping, all those balls that I’m worried about dropping, get written down somewhere in one place. Therefore, I’m not worrying about it ’cause I know it’s there and I know I’m gonna go and look, look at it and do it. That has been incredibly helpful and maybe we will do another podcast at, at some point about the systems that work for people with a, with ADHD or helpful. In fact, they’re helpful for anybody, whether you’ve got ADHD or not.

[00:37:40] Rachel: Um, the other thing I was thinking about meetings, and I stopped doing this, but I’m gonna reinstate it after this podcast, is when people picking calls for me, I often jump on teams calls and stuff, but actually I was doing it as a phone call and walking around the park as I talk to them. That was brilliant. I’m gonna do that again. ’cause actually I focus so much better on the conversation when I’m walking around as opposed to staring at a a screen. You’re nodding at me.

[00:38:03] Sarah: Yeah, I actually, I, some of the coaching idea I do as walking coaching, I did one yesterday because actually the quality of how you think is so different when you’re not in front of a screen and you can just think more laterally, and that’s something that I do very well. But also in terms of supporting other people, because often, you’ll find this, I’m sure, people who burn out, people are struggling in their careers. I’m now asking a hundred percent of the people I speak to. Is there a suggestion that you might be neurodivergent? Do you have a diagnosis? Because so many of us that don’t fit the mold, actually there’s probably a reason, and actually, I definitely am not saying that I’ve got this all sorted. I am not a great one for systems,. Rachel, I’ll start something and go, this is amazing, and then two days later I’ll go, oh yeah, look, there’s

[00:38:51] Rachel: Oh, I can list you every single to-do list system I’ve, I’ve used, however, Graham Kot, that’s the podcast to listen to when he was on here, the productivity ninja. Has, he’s rocked my world and I now use his email system.

[00:39:03] Sarah: The other one that I was going to say that has worked very powerfully for me is body doubling. The ability to contact a colleague, a friend, or just have a set time where you go, let’s do some stuff that we’re both avoiding and, and that could be on a Zoom or it could be on a phone call. And just that ability to have somebody else there helps ground me and settle, and it’s been incredibly useful.

[00:39:30] Rachel: so I know somebody that literally, she, she works from home and there is an app that you can go onto where there are people who will just sit on Zoom while you work. It’s totally bonkers. But I found out recently I’ve just, ’cause I’ve now joined a coworking space and I get so much more done when I’m there. Con’t know anybody there, but I’ve sit there and there’s other people around and it’s just bizarrely.

[00:39:50] Rachel: I think, ’cause you’ve got the distraction and the. The stuff going on. So your brain, no. Your brain’s sort of kept busy, but then you can hyperfocus it’s, it’s a weird thing. I’d love to know how that works, sort of neuroscientifically. What about backup and support?

[00:40:04] Sarah: For me, I think as you said, when when I got my diagnosis, I, I was kind of the walking embodiment of the exploding head emoji. Um. I was absolutely overwhelmed by shame and guilt and it, and it really threw me. And I did have some counseling actually about it to help me understand that where, where that shame and guilt was coming from. And then I think it can take up to 18 months to kind of integrate that.

[00:40:31] Sarah: And now I’ve, I’ve outed myself on social media, both personally and professionally being neurodivergent. And a bit like my process with burnout, I’ve been really open with people and that I meet and say, yeah, I’ve got ADHD and therefore X, Y, Z., or do you think you could be because I am and I only just found out.

[00:40:54] Sarah: And for me, the wearing it overtly really helps, because I can say to people, and I said this to someone the other day, actually over the summer holidays, I really struggled with feelings of not being good enough because I struggled with this thing and that ability to share with other people, what are the things that you struggle with and can you help me?

[00:41:17] Sarah: And people like helping, they like knowing, and I think it’s a really useful piece of information so they don’t just think oh, Sarah’s really impulsive and rude. They might think that, but they might also go, ah, yes, but I have this piece of information.

[00:41:30] Sarah: So in terms of backup, it’s really helped At home, my husband, knowing he gets mu, he’s a very ordered person who’s very tidy, so he’s very different to me. So he now comes at my messiness and disorganization with a completely different mindset because he has that compassion towards me and that has made our interactions very different, and I can say to him I’m finding it really hard, this process. Can you help me work out what’s going on? Or let me puzzle this out myself?

[00:42:02] Sarah: Because actually we are very good problem solvers. If you give me a space in which to talk it through, I can go, oh yes. Well of course I was feeling guilt and shame because of that. That’s because I wasn’t good at that and therefore I think I’m rubbish at everything. Okay, fine. I can put that back in its cupboard. So for me, that’s been very powerful.

[00:42:20] Rachel: Think people that get you and understand you, so, so powerful one. One of my best friends, she often will just send me a note going just to remind you that this is coming up. Have you clocked it? In, you know, in the same social circle with friends and stuff like that. That’s been really helpful. And I’m just thinking what else would be helpful if, you know, just getting other mums from the same school, just to, I say, look, I’ve got ADHD, can you just flag up if something comes through the email that I really shouldn’t, I really shouldn’t miss here? You’re not delegating responsibility, but you’re just, you’re just getting a bit of a bit of help, just a little bit of a nudge that can be really helpful.

[00:42:55] Rachel: But I think people that really get you and one of the things I think moms in particular often do is feel a lot of guilt and shame about getting help around the house. Particularly in the UK, no idea why, but you know, I’ve had some people even feel shame about getting a cleaner when they’re working full time. And that’s bonkers, isn’t it? So don’t feel guilty or, or shame that you need help around the house, you need help more than perhaps neurotypical people do. If you can afford help, get as much help as you can get cleaner. If you like your clothes to behind get an ironing service.

[00:43:30] Rachel: I’ve got a mailbox subscription. Yes, it’s really expensive, but it means that three or four days a week, I don’t have to think about what we’re, I don’t have to plan anything. I just get, I actually quite like cooking. I hate the planning and buying ingredients. I don’t have to think about it. I just get the box. It’s, it’s brilliant. So do what you can to take that emotional load off you. There’s no shame in that. And if you can afford it, get, get an assistant. There are lots of virtual assistants you can get. There’ll be people at your work. You can maybe have a, a, a chat with one of the admin and say that I actually need more assistance in this. Is that something you can help me with? There’s no sham in that. And what that does is free your brain up to focus on the things that you do, do really well.

[00:44:10] Rachel: And this is generally good advice to anyone, isn’t it? Whether you are neurodivergent or not. Get help. Work in your zone of genius. Do the things you love. Things are gonna be better for everybody.

[00:44:20] Sarah: Definitely and, and have a look at what are you doing at work and are there bits where you went? ‘Cause there’ll be people listening to this who may have a diagnosis or are questioning it. If I, if it is true that I have ADHD, let’s look at what I am doing and where I’m struggling with a compassionate mind and go, what could change here?

[00:44:39] Sarah: ‘Cause it might be that you’ve taken on being rotor coordinator and actually that’s the worst job on earth for you. The idea makes me feel sick. That would be dreadful. And actually what you’d really like to do is be pastoral lead or looking after staff problems or some,

[00:44:53] Rachel: Party girl. Party Lee. That’d be mine. I’ll be social

[00:44:57] Sarah: Social secretary. social, um, and trying to find things that, where there there’s less resistance. It feels more in your comfort. Absolutely.

[00:45:05] Rachel: from what we’ve talked about, if you had to distill that, and I, I realize it’s gonna be hard for us with ADHD into three sort of top, top tips, what would they be?

[00:45:14] Sarah: I think if you are considering getting diagnosed, I would strongly recommend it. Because unless you ask that question, you don’t know, and then you’ve got the information to understand yourself and help you translate a way of working in the world that suits you better.

[00:45:31] Sarah: I think considering where are the points in your life that feel easy? And where are the things that you, not just enjoy chasing the fun, shiny thing, but what are the things that come naturally to you and how can you do more of that in terms of reducing the barriers? And have a look at where you are spending your energy, because it can be very easy to do things because we feel we should, and this whole script of Be Perfect, be gifted. We’ve often followed this pathway of. You’re clever and talented, therefore you have to do X, Y, Z. But actually, is that really what you want? And you’re interested in? Could you be a broader, more fulfilled version of yourself with ADHD alongside that potentially?

[00:46:16] Rachel: My tips would be number one, exercise, definitely really important. Uh, number two, get help. Get help do, do not think you’ve gotta do everything just ’cause that’s what mums do. You can, you know, get a party organizer if you want to. Get a, get a mailbox, get a clean get, get people to take that off your, off your back.

[00:46:35] Rachel: As, as doctors, we are oftentimes poor and we do have a little bit more free cash maybe to spend on, on getting help. So I would say spend your money on getting help rather than nice clothes or shiny things. You know, get, get the help that you need to help you function in this world.

[00:46:51] Rachel: Um, and number three, find some systems that work for you and then, and then use them. That, it might hurt your ADHD brain at, at the, at first to get those systems in place. But once you’ve got them in place, they will be, they will be your savior as much as you can get as much out of your brain as you can and onto a, a system or something. At least you know where everything is or you can refer to it, that has been really helpful for me. And maybe we can have a, another podcast talking about those systems.

[00:47:18] Rachel: And Sarah, you said, you know, get. Get diagnosed if you, if you think you have. And I think that’s really important that, if you even think you might have, then go and see someone go and talk to someone about it.

[00:47:28] Rachel: It, it’s a spectrum. And just ’cause you have a diagnosis doesn’t mean you have to take medication, ’cause there’s lots of other things you can do. Although, I must say, somebody told me that medication for ADHD is the most effective psychiatric medication that there is in terms of efficacy, in terms of all the, all the different things. And I found that it’s worked really well and most people that I’ve spoken to find that it’s worked really well.

[00:47:50] Rachel: But you may not want to take medication. I think there’s also a lot of things that you can do to help in terms of diet and looking at your blood sugar and all that sort of stuff. I haven’t, we haven’t started touching on, but I think there is. There’s lots of stuff and read about it. There’s some absolutely brilliant books out there that you can read. There’s lots of podcasts about ADHD. There’s podcasts about women with ADHD.

[00:48:11] Rachel: Uh, maybe we should start podcast about doctors with ADHD, Sarah,

[00:48:16] Sarah: and we haven’t even gone onto the perimenopausal aspect of it.

[00:48:19] Rachel: God, the menopause and ADHD? Yeah, my psychiatrist says that the menopausal brain goes very ADHD. So if you’ve already got ADHD or, or you are got a small amount of ADHD, ’cause as we know, it’s a spectrum just like anything else. When you hit menopause, it often gets much, much worse. And that’s certainly what me and Sarah have found.

[00:48:39] Rachel: So, you know, often this is the age that we are getting diagnosed ’cause we’ve actually pootled on okay all our lives, and then suddenly it’s all going to shit and you just need some help. So don’t feel bad if, if that’s you. ’cause that’s what happened to us and I’m, I’m much, I feel much better now, although I must say as I go deeper into menopause, I think I’m having to like, make even more allowances to myself and just, just be kind to yourself, right?

[00:49:01] Sarah: I would also add in, and we haven’t talked about this, we’ve both got children with ADHD and the challenges of looking after yourself with ADHD while supporting a child with ADHD, who it may affect in a different way while also going through the menopause is quite a unique experience. And I think that’s where you’re absolutely finding a tribe and feeling like you’re not alone in this, I think is really important. That’s partly around the shame, but partly around the, this is really bloody hard, isn’t it? And feeling a bit like when you’ve got a newborn or you’re pregnant, it’s that, it’s that your equivalent of it, antenatal classes, but for the menopause, that’s what we need, Rachel.

[00:49:42] Rachel: Menopause, antemenopause classes.

[00:49:45] Sarah: Parenting teenagers

[00:49:46] Rachel: Oh my God.

[00:49:47] Sarah: are neurodivergent while you’re neurodivergent going through the menopause. It’s a really snappy title. I think it’s gonna catch on working and working as a doctor.

[00:49:57] Rachel: Doctors, teenagers. ADHD be. Oh my God. That is like, that’s like a, a niche’s dream, isn’t it? Yeah. We’ll make it happen. But if anyone’s in that niche, seriously, hit reply. Let us know. We’ll, we’ll make it happen. We can have our own little support group.

[00:50:11] Sarah: We’ve got 1,000,000,001 different ideas about this guys, and if you’ve got others, let us know. We may not finish all of them, but we’re very open to it.

[00:50:20] Rachel: Right, I think that’s enough for today, Sarah. But thank you so much and yes, goes without saying, you’ll come back and we’ll talk more about this soon. If people wanna get a hold of you, find out more about what you do, how can they find you?

[00:50:29] Sarah: Yeah. I’m drsarahgoulding.com and I’m @DrSarahGoulding on Instagram and LinkedIn.

[00:50:37]

[00:50:39] Nazia: The most common topic which comes up all the time is the question, do I have ADHD or not? And I think there are a few, uh, things which have been attached to ADHD, but I think ADHD in campuses more, much more than what actually is up in the media. And, um, the most important thing is, you know, whether you have ADHD or not, the most important thing is to get a diagnosis. Think about it, get a diagnosis, and then you can change it. Um, it changes How you approach people and how people approach you.

[00:51:10] Nazia: So it’s, um, this is something which is discussed quite often on the group, and I think it’s very important to talk about it and, um, if you are in doubt, get a diagnosis.

[00:51:20] Rachel: I think one thing for, for women, and so I guess guess particularly for the guys in the PMGUK group is that, you know, estrogen plays a big part in ADHD. In fact, my co consultants said that if your brain becomes estrogen deficient, your brain actually looks much more ADHD. And I think that’s the reason why a lot of us, around the time of the menopause are getting, getting diagnosed with it. But then you can see it it all the way through our background.

[00:51:42] Rachel: And I, I would say that even if you don’t have clinical ADHD, I think a lot of doctors display some traits of ADHD. ‘Cause like neurodivergence, it’s a, it’s a bell-shaped curve and at some point there’s a diagnostic cutoff isn’t there? And some, some point there isn’t. And what I like about the strategies for ADHD, I just think they help everybody actually. Even neuron normative or whatever we call people who aren’t neurodivergent, you know, I think it helps them too.

[00:52:06] Nazia: Yeah. No, absolutely.

[00:52:08] Rachel: And so please do feel free to share it with your colleagues, with anybody who you think might have ADHD, you think it, some of the strategies might help. Or also people that are having to work and deal with people with ADHD because some understanding from the people we work with and from our friends and family really goes a long way.

[00:52:24] Rachel: So Naz, thank you so much for the opportunity to share this and we’ll be back soon with another bonus episode for PNGUK.

[00:52:30]

[00:52:32] Rachel: Thanks for listening. Don’t forget, you can get extra bonus episodes and audio courses along with unlimited access to our library of videos and CPD workbooks by joining FrogXtra and FrogXtra Gold, our memberships to help busy professionals like you beat burnout and work happier. Find out more at youarenotafrog.com/members.