From the Guidelines
You can be a successful emergency medicine physician with ADHD and executive functioning challenges, as the fast-paced and varied environment of emergency medicine can be well-suited to individuals who struggle with sustained attention on repetitive tasks. Many physicians with ADHD thrive in emergency medicine, leveraging their strengths in crisis management, creative problem-solving, and hyperfocus during critical situations 1. To manage your symptoms, consider a multimodal approach, including medication options like stimulants (e.g., Adderall 10-30mg daily, Concerta 18-54mg daily, or Vyvanse 30-70mg daily) or non-stimulants (e.g., Strattera 40-100mg daily or Wellbutrin 150-300mg daily), as well as cognitive behavioral therapy specifically targeting executive function skills 1.
Some key strategies to implement in the workplace include:
- Using checklists and templates for documentation to help with organization and attention to detail
- Setting smartphone reminders and using noise-canceling headphones during charting to minimize distractions
- Establishing routines for high-risk moments like patient handoffs and medication ordering to reduce errors
- Utilizing electronic systems with built-in safety checks to compensate for executive function challenges
- Disclosing your ADHD to trusted colleagues to receive support and accountability
It's essential to find personalized strategies that work for your specific challenges while leveraging your ADHD-associated strengths. By doing so, you can excel in emergency medicine and provide high-quality patient care, as emphasized by the code of ethics for emergency physicians, which prioritizes patient welfare, respect, and fairness 1.
From the Research
Executive Functioning in Emergency Medicine Physicians with ADHD
- The ability to succeed as an emergency medicine physician with moderately severe executive functioning deficits and ADHD can be influenced by various factors, including the effectiveness of treatments such as methylphenidate and atomoxetine 2, 3, 4, 5, 6.
- Studies have shown that both methylphenidate and atomoxetine can improve executive functions in individuals with ADHD, although the magnitude of improvement may vary depending on the specific domain of executive function and the individual's response to treatment 2, 4, 5.
- For example, a study found that atomoxetine showed significant improvement in spatial working memory, spatial short-term memory, sustained attention, and spatial planning, while methylphenidate showed significant improvement in spatial working memory 4.
- Another study found that osmotic-release oral system methylphenidate (OROS-MPH) was associated with a greater magnitude of improvement in response selection/inhibition compared to atomoxetine 5.
- Long-term treatment with either methylphenidate or atomoxetine has been shown to improve executive functions in children with ADHD, although no beneficial effect on delay aversion was found 6.
Treatment Options and Outcomes
- The choice of treatment between methylphenidate and atomoxetine may depend on the individual's specific needs and response to treatment, as well as the potential side effects and interactions with other medications 2, 3, 4, 5, 6.
- It is essential to work with a healthcare provider to determine the most effective treatment plan and to monitor progress and adjust the treatment as needed.
- With proper treatment and support, individuals with ADHD and executive functioning deficits can develop strategies to manage their symptoms and succeed in their careers, including as emergency medicine physicians.