My ADHD journey

Introduction

Hello everyone, I’d like to introduce myself, my name is Dr Sarah Clubb, and I’m the new lead for Equality diversity and inclusion (EDI) in our region.

I’m a GP in Sheffield and mum to two children who both have ADHD and autism. I have previously worked as both a partner and salaried doctor. I was myself diagnosed with ADHD two years ago.

What is EDI, and why is it important?

The RCGP states that its vision is: “To be an inclusive organisation where diversity is respected and encouraged.” The aim is to ensure everyone has the opportunity to reach their full potential and also help, educate and guide colleagues on issues that arise, both as doctors and as employers.

As EDI leads, we hope to identify areas of significant ignorance, misunderstanding or inequality in the profession and help to inform and educate. Basically, to learn how we can be aware of diversity and the challenges it poses and then move to remove barriers that stop people thriving.

EDI is such a huge and diverse area. I hope to be able to liaise with other EDI leads and share in their knowledge and insights. With this we can hopefully find ways to practically improve and support our colleagues in primary care.

An unexpected diagnosis

In September 2019, after returning from a holiday, I was greeted by a task that made my heart sink - to complete a coroner’s report. These events led me to receive my diagnosis of ADHD (attention deficit hyperactivity disorder).

For me, work had always been a place where I felt happy, valued, and safe. I was good at my job, I was in control and felt competent, unlike many aspects of my home life. I was working my way through the process of the coroner’s case and dealing with the MPS, when I started to become ill, slowly losing my ability to cope with risk taking. I sought help from Practitioner Health, and thanks to their amazing support, I was diagnosed with depression, anxiety, and ADHD.

I had always known that I was on the “busy side of normal", talkative at times, distractable and hopeless at sticking to any hobby. But I naively didn't believe that doctors or professionals could have ADHD and still be successful. I had never heard of the term “masking” before ('masking' refers to the behaviours neurodiverse people use to fit into a neurotypical world) I also did not realise that there were differences in which girls and women often present ADHD symptoms as opposed to the more clinically observed presentation in boys and men.

The diagnosis was a shock; the emotions and grief that followed it were extremely tough to digest. I began to question everything - even my personality. I thought I was a bubbly and polite person, but was it all just part of me masking my disability? I felt frustrated each time I noticed how drastically I had been moulding and adapting myself, masking so that I might fit in and function like everyone else.

A new working landscape

When I returned to work after 6 months as a salaried GP at the same practice, the COVID-19 Pandemic lock down was enforced, and the way in which we communicated with our patients and conducted our consultations changed drastically. The transition from face to face, to telephone consultations and the constant changing clinical guidance was an additional stress. I was trying to keep my clinical knowledge up to date in a fast paced, ever-changing pandemic, when I was already struggling with risk taking.

Following the conclusion of the coroner’s report, and although I was found to have provided appropriate care to the patient, the whole process and unjustified criticism along the way from the coroner’s office and the MPS reduced my ability to accept risk and live with risk. This led to work no longer being my safe and happy place. Remote consultations took away a level of protection and physical examination, and so my heightened anxiety around possibly missing something continued to increase by the day.

When I look back at my story, I wish I could have helped my past self. My intense reaction to criticism or error, I can now see that this was what is known as RSD (Rejection Sensitivity Dysphoria) which is an extreme emotional and sometimes physical reaction to criticism or rejection real or perceived. RSD can often feel like an almost physical pain and the mental torment that comes along with it can feel unbearable. You convince yourself that you are not good enough for your job, family, or your friends. The strong feelings of injustice and unfairness from being put through the coroner's situation came from my strong will to play fairly, and follow the rules set in place, which I believed would protect me. I realised that these strong beliefs regarding the importance of following rules are part of how I have learnt to understand the neurotypical world. When these rules were changed, I floundered. I can now understand my reactions but still struggle with these feelings to this day.

Working as a neurodiverse GP

As a neurodiverse doctor, I had heavily relied on all my senses, my intuition and had always been a visual learner. I now know that my memory is also heavily reliant on physical and tangible evidence. Following telephone consultations, I would picture the patient whilst writing up the notes which seemed to help my executive functioning issues. However, trying to relay this information into my patients' records, without being able to read the patient sat in the chair in front of me and physically see how ill they looked, or even the basics of having to remember to ask which side of the body their pain was located, only increased the anxiety of making a mistake. There seemed to be only one positive at the time to not having the patient sat in front of you, which was that I could quickly use resource tools to look up symptoms to assist with diagnosis.

As I learn more about this condition, I can see why medicine and general practice attracts neurodiverse people; general practice is a fast-moving vocation, with abundantly varied and stimulating days which keeps you engaged.

Being able to move around the building, or out on visits with a permanent a base/office meant I felt safe (and didn’t lose too much stuff). I could use reminders on the walls, wall planners and tasks on the computer. I can’t count the number of notebooks I have lost, or post-it notes and scrap pieces of paper. I always had a lunch break away from my room, along with some fresh air and usually someone to chat to which helped me relax and reset for afternoon surgery.

Unfortunately, at this time I do not yet feel I am able to return to clinical practice, but I do feel passionately that with more understanding of neurodiversity in the workplace, more support and more work done to diagnose people earlier, general practice could be a wonderful place to thrive as a neurodiverse doctor.

RCGP forum

You may wish to visit the neurodiversity group on the RCGP members' forum.