Beyond ADHD A Physicians Perspective Ep 22 Dr. Mitra Ayazifar (Ophthalmologist, Oculoplastic Surgeon, Owner of Capital Eye Medical Group)

Dr. Mitra Ayazifar: I should. And what I do, are two different things..

Dr. Diana Mercado-Marmarosh: Hi, welcome to Beyond ADHD, A Physician's Perspective podcast. I am your host, Dr. Diana Mercado-Marmarosh. I'm a family medicine doc, with ADHD, practicing in a rural setting in Texas. I am a mother to two very energetic toddlers who are three and four years of age.

 

And in the past year, I have undergone radical transformation after discovering  ADHD coaching, and life-coaching. For the past decade, my typical day consisted of having 300 charts backlog, a graveyard of unfinished projects, and a lack of time awareness. I didn't realize that I was not filling my own cup. I was running on fumes, the last year I figured out the secret; learn to stay in your lane. So now my mission is to help others develop systems that tap into their zone of genius. So they too can reclaim their personal lives back like I have.

Hello? Hello. I am so excited today to have one of my good physician friends here with me today. We're just going to be having a conversation that is probably a conversation that you might be thinking yourself. Whenever you get a little bit scattered mind or you feel like you get squirreled, you might be wondering if you have ADHD yourself.

You know, sometimes we're pulled in so many different directions. So me and Dr. Mitra Ayazifar are going to be talking today about what kind of questions you should ask. How can somebody gets screened for ADHD, and then is there anything wrong with us? Like, are we being perfectionist or are we being procrastinators or like, what's going on?

So we're just going to have a conversation and see where this takes us. But I want to introduce her. She's a very, very special guest and I'm so honored to have her here with me today. Dr. Mitra Ayazifar ,she is an MD of course, and she's an ophthalmologist in a solo, private practice in California. She is the owner and the CEO of Capital Eye Medical Group with two locations in grass valley and also one in Roseville.

And she partners. Patients to develop their best potential vision so they can live fully and enjoy their hobbies for many years to come. And we are so excited that she's also an ovarian cancer survivor. So, so much to talk about today. And I am so excited. She's here and she's willing to be all in to ask the certain questions, go for it.

Dr. Mitra Ayazifar: Thank you so much, Dr. Mercado for having me on here. I'm so excited to kind of express, I guess, some of the questions that go through my mind on a daily basis. And I'm sure I have so many colleagues and probably so many patients that, you know, wonder. Is it just that I'm disorganized? Is it that I need more organization systems?

Is it just that I have too many things on my to-do list? Or is it just that I don't want to do the things that I procrastinate on, so it always makes me wonder, Hey, is there a particular, you know, is there like a scale? Having ADHD, are there different variations or is it just that, you know what? I procrastinate and that's plain and simple, I guess I need answers to those questions.

Dr. Diana Mercado-Marmarosh: Awesome. Yeah, those are very good questions and you're right. People that sometimes have no awareness, whether this is just like, you know, too many things, it makes you wonder. But let me ask you one question before we jump into that. Do you feel like you have so much potential, but like you never fully reached that potential?

Have you ever felt that way or do you feel like no, I'm pretty content where am at.

Dr. Mitra Ayazifar: You know, obviously I felt that way before I joined, you know, Dr. Una's EntreMD business school, because I always felt like I wanna, you know, I want to provide more for my patients. I want to do more, more than just check their eyes more than just, you know, uh, check on their visual complaints. There's so much more that goes into it. And I think part of it just came from being on the other side and being a patient myself and wondering, wow, you know, there's so much out there that not necessarily every single physician, like, no, but we need to be our own advocate. And I try to be an advocate for my patients too.

Having joined the school. I think now I have so many things that I want to. You know, I love my practice. Thankfully. I love doing what I do. And I feel like, gosh, you know, like these experiences that I have, I want to somehow share it with, with patients or people. What else can I be doing? So that's, that's how I feel. I feel like now I have a path where I have the network and the support to kind of do the things I want to do.

Dr. Diana Mercado-Marmarosh: Yeah. And the reason I asked you that question is because a lot of my patients, because I'm a family medicine doctor, and when I do diagnose it, when they come in, you know, we do the screening questionnaire for anxiety and for depression.

And then I also give them the screening questionnaire for ADHD, which we're going to go through right now with you, just so we can see where we're at. But one of the things that they always tell me is that. They feel like they have a graveyard of unfinished projects that they have like 10,000 ideas and they feel like they can't do them all at once because they're so excited.

They want to do them all at once. And so they feel like they're never a hundred percent like realized or they had so much more potential. And like you said, maybe it, is that something that is so good that you pointed out that sometimes you might have ADHD and you're just not aware that you do because you unconsciously have set up your own systems or have placed yourself in an environment that allows you to thrive.

So for example, you might've married. Somebody who is very OCD and you didn't know. Right. And so they're kind of compensating for you, or maybe you be in a work environment where they don't mind that you're a little bit late. They don't care as long as you get your work done. And they're not like, why aren't you here at 8 51, you were supposed to start at nine.

You should have been 10 minutes early to be on time. And you know, you roll in at nine 30 and they would already fired you because you rolled it in at nine 30 and. Oh nine because you know, 9, 9, 59 it's still 9, you know? And so I don't know if you have felt any of this. Did you ever feel like you weren't a hundred percent realize where you want it to be.

Dr. Mitra Ayazifar: I think, you know, now that you're mentioning that this is probably why I respond, well, maybe I do better when I have a coach. So I feel like definitely, you know, having started the EBS has helped a lot. Also with like the health coaching. I feel like, okay, I know what I'm supposed to eat. I know what the philosophy is behind, you know, intermittent fasting and all of that.

But somehow that accountability seems to put me in a situation where I'm much more successful with it, you know, with the mindful marathon, shout out to Michelle, Quirk, you know, joining her program. I feel like, okay, if I told myself I'm going to train for a 5k. I'm not sure that I would, you know, stay on task, but then having these weekly, almost like homework helps me keep up with it and actually be excited about doing that.

So I wonder if everybody's like that or is that. Portion of ADHD that, you know, makes me do better with that. Just accountability in general. The only thing I have to say, you know, I'm my own boss at the moment. So she's really mean. And the only thing, the only thing I see is like on my, my desk, especially at one of my locations, goodness, you know that these papers are piling up and it's like, I've already taken care of the patient.

I've done the patient care, I've done the surgeries and it's all the other stuff that I need to do that that's not medical necessarily that I just don't like to do. Yes, I do.

It's painful. I barely get on my, I'd rather get on my, you know, on my phone and, you know, listen to a podcast or something else rather than do that. Oh my god. Yes. Yeah, yeah, yeah.

Dr. Diana Mercado-Marmarosh: And the thing is that even though it's boring and painful, you are probably going to delay it till the last minute. When somebody tells you I need this, otherwise X, Y, and Z concept. Because, and that's the thing with ADHD, and I know I haven't asked you the questionnaire, but the thing with ADHD is that it's almost a missed namer on the diagnosis because you hyper-focus on things that are of interest to you. Oh my God. Do we hyper focus? Like sometimes we think we're going to spend 20 minutes doing XYC two hours later. Are you done? And you're like, oh, what? Like you were so in the zone. So to say, and it could be very complex thing.

So like you just concentrated in a surgery and then, like you said, this other thing that seems like should take you literally five minutes to complete a form, they take you an hour because it's painful, like you just said. And so it's the executive function tasks that are boring, or when we decide to do it, like at the end of the day, when you already made 10,000 decisions throughout the day, and you're like, Ooh, I can't wait to do this task that is boring and painful, but I already did what I needed to already took care of the patient.

They have their meds. I'm done. Right. And, I always joke around and I say, how come nobody was videotaping this? Like, this was an amazing encounter. Like why don't like can't just somebody submit my video from them, like, and pay me like we did amazing. They just compliment me. Why do I still have to sit down and write it?

It's the thing where you leave your heart in the room and you realize how long you were in the room and then the time blindness of it. And then you go because you're a little bit late and then more late and more late, it adds up. And then you don't have time to do this boring thing that is the chart. Or the callback or some paper that has for FMLA or whatever.

Right. And then some of these things, unfortunately, are not paid for like the FMLA paperwork or something else that you're having to do. So it's like an additional task that you don't want to do. And so I don't know if any of that resonated with you, but let me ask you the questionnaire and see what you think.

Okay. All right. So to make it simple, we'll just say, we'll do like a 1, 2, 3, 1 being does not apply to me, three being like, yes, for sure. This is totally me. Okay. And then a two is like, yeah, I could see that, but it's, it's definitely not a no. Okay. So 1, 2, 3, but if we were doing the questionnaire, it's like five of them.

So I get, I don't know if you could remember five, but it's usually harder to remember. Never rarely, sometimes, often, very often. So that's why I'm just giving you either as a, never to sometimes, or the very often. Okay. That's what I'm going to have. Answer it think about it, like never sometimes or very often.

Okay. So the first question is how often do you have trouble wrapping up final details of a project? Once the challenging parts have been done? Let's say you already got like 80% of it done, but then you still have to wrap it up the final details. Like how troubling is that for you.

Dr. Mitra Ayazifar: Sometimes.

Dr. Diana Mercado-Marmarosh: Okay. How often do you have difficulty getting things in order when you have to do a task that requires organization?

Dr. Mitra Ayazifar: I guess. So right now I'm only focusing on my patients. Right. So without the systems that I have set in place where I double and triple check, you know, like the lens number and all of that, I would say it would be, I guess, sometimes still number two.

Dr. Diana Mercado-Marmarosh: How often do you have problems remembering appointments or obligations?

Dr. Mitra Ayazifar: Often, unless I have put it in my calendar and the alarm goes off.

Dr. Diana Mercado-Marmarosh: When you have a task that requires a lot of thought. How often do you avoid or delay even getting started?

Dr. Mitra Ayazifar: Often.

Dr. Diana Mercado-Marmarosh: How often do you feel like you're fidgeting or squirming with your hands or your feet? When you have to sit for a long.

Dr. Mitra Ayazifar: I would say a one.

Dr. Diana Mercado-Marmarosh: And how often do you feel you're overly active or you're compelled to do things like you were driven by a motor kind of like impulsive, like you just have to get to that right now.

Dr. Mitra Ayazifar: I would say not compostable. Never.

Dr. Diana Mercado-Marmarosh: Okay. So those were the first six. So if you had scored five of those had been up sometimes, or very often you would have scored a positive.

Right now you scored 1, 2, 3, 4. So you're a little bit shy of saying that you have ADHD right now. Let's do the bottom part and see what it shows. How often do you make careless mistakes? When you have to work on a boring or difficult project.

Dr. Mitra Ayazifar: Never. Because I just avoid them.

Dr. Diana Mercado-Marmarosh: I would say often that okay. Was they never because avoiding. Okay. Number eight.

Dr. Mitra Ayazifar: I don't even get to that point.

Dr. Diana Mercado-Marmarosh: How often do you have difficulty keeping your attention when you're doing boring or repetitive work?

Dr. Mitra Ayazifar: I would say a three because it's so boring, you know, it takes me longer.

Dr. Diana Mercado-Marmarosh: Yeah. How often do you have difficulty concentrating on what people are telling you, even when they're speaking directly at you?

Dr. Mitra Ayazifar: I would say never that's you know, that's the best part of, I feel like that's the best part of my job when I'm in the room and I'm listening, coming up, listening to patient's stories that I take so long in the room, my ma has to come and knock on the door. So I am paying. attention to what they're telling me.

Dr. Diana Mercado-Marmarosh: How often do you have misplaced or have difficulty finding things at home or at work?

Dr. Mitra Ayazifar: At home? I would say, often. It's usually my phone, my keys. Where's my computer.

Dr. Diana Mercado-Marmarosh: How often are you distracted by some activity or some noise that is around you?

Dr. Mitra Ayazifar: I would say sometimes. So that would be a two.

Dr. Diana Mercado-Marmarosh: How often do you leave your seat in meetings or another situation when you're expected to remain seated?

Dr. Mitra Ayazifar: Oh, never at work. I behave.

Dr. Diana Mercado-Marmarosh: How often do you feel restlessor fidgety?

Dr. Mitra Ayazifar: I guess sometimes it depends on the activity. I would say two.

Dr. Diana Mercado-Marmarosh: How often do you have difficulty unwinding and relaxing when you finally have time for yourself?

Dr. Mitra Ayazifar: I would say sometimes, two.

Dr. Diana Mercado-Marmarosh: How often do you find yourself talking too much when you're in a social situation?

Dr. Mitra Ayazifar: Never. I actually am pretty quiet.

Dr. Diana Mercado-Marmarosh: When you're in a conversation. How often do you find yourself finishing the sentences of other people when you're talking to them before they can even finish it themselves?

Dr. Mitra Ayazifar: I would say I actively am aware of that. So I would say never to sometimes I wish there was a one and a half somewhere.

Dr. Diana Mercado-Marmarosh: Okay. How often do you have difficulty waiting your turn in situations when there is turn-taking that is required?

Dr. Mitra Ayazifar: I would say, I would say never. I follow those rules. I mean, I am able to follow those rules.

Dr. Diana Mercado-Marmarosh: How often do you interrupt others? When they are very busy?

Dr. Mitra Ayazifar: Never.

Dr. Diana Mercado-Marmarosh: Okay. So on the bottom, an eight or more would have been considered positive. And on the bottom you scored 1, 2, 3, 4, 5, 5 out of eight. So on the top you scored four out of six and on the bottom you scored a five out of 12, so there's obviously some of the things that are there that could say, you know, that you have some possible ADHD characteristics, right. But this is a screening test. Like if you really wanted to know a little bit more in detail, they do have what is called neuropsych testing. And that's a little bit more eight or nine hour tests where it's almost like a neuro psych test. Right? So they'll give you some things for you to answer some pictures, some things to draw back they'll ask you questions, like math, all kinds of stuff, because they're trying to see how you're functioning.

The thing with ADHD is that especially in females, they don't tend to be diagnosed until later in age. Like usually after the birth of a child or after they go to like college or med school or law school or some type of professional school or. Promote it like to now be like the CEO of this, or like some level leadership thing, or sometimes even when they get to menopause because of the changes in the hormones and the low estrogen, like that can cause stuff to be more obvious.

And then females tend to be more inattentive type than hyperactive. So there might be missed. So it's like that female who was in the back of the room was quiet. Who's not screaming, who's just daydreaming. So they're like the perfect student for the teacher. Right. Because they're like, great. She's just in class.

And she said a little angel. She's not saying anything. I know aware that her mind is in 10,000 other places and not really right here. Right. And that's why I was asking some of those questions as you saw. How often do people tell you, Hey, but you were looking at me, how come you didn't catch none of that.

It seemed like you were like, did you space out? Like what happened, basically? What happened? You know? So that's the thing with that, right? Sometimes it gets, it gets a little fuzzy because they automatically assume, okay, well, she is. She's gotten this far, she graduated from college and sometimes they ask you, did you graduate from college?

And you say, yes. Are you married? And you say, yes. Do you have a job? And you say, yes. They're like, okay, you don't have ADHD. That's the old way. Like, but they don't know how hard it is for you to be carrying all the hats in the air. You might be doing it out of obligation or because you love what you're doing and you don't realize that you're doing it harder than somebody else is doing it.

And I think even in the profession, I feel like there's all these norms that get thrown at us. You know, you're supposed to work like you don't have a family and you're supposed to have a family. Like you don't have a job. I was asked recently by one of the male physicians that joined my group. He asked me, he's like, why is it that I'm one of like many females in this group?

He's like, how come I'm the only male? And he's a psychiatrist. And so I say, I'm not sure. Do you have any insight, am I saying the, the content wrong, you think I might not attracting male? Like you think I'm being exclusive. And he said, you know, I think it's because males tend to delegate tasks a lot easier than females do.

And so he said maybe his wife needs like the males, wife needs to come to your course. Cause I'm pretty sure they're burned out. He said, I'm pretty sure the males have no idea. That they even have ADHD because they're used to be in tardy and somebody else picks up their stuff. He's like, I'm not trying to generalize.

He's like, but as a male and a psychiatrist, he's like, I can tell you that males, you know, usually don't come to see me until they have hit rock bottom because somebody else has. Picked up their slack. Like maybe they got a divorce or maybe they failed board exams or whatever. He's like, otherwise they're not going to come and seek help.

And so it's just interesting how there's so much regarding ADHD that we still don't know. And then you throw in the genders in there and then like what sometimes we feel as females, like, we feel like this mother nurturing thing, we want to take care of everything. And we want to be perfect in all the areas.

Yeah. And so why do you think you procrastinate? Like, do you think it's just like you asked me that question, which we still haven't even acknowledged or discuss whether it is for procrastination or whether it's really just a form of, you know, of you just doing all the things. And sometimes we do need rests, but what makes you think that you procrastinate?

Dr. Mitra Ayazifar: You know, I actually was puzzled about this because we were, I mean, in a group and you might be too where we were going to read book about Brian, Tracy, with something about frogs. I forget it right now.

Dr. Diana Mercado-Marmarosh: Eat that frog!

Dr. Mitra Ayazifar: Eat that frog. Okay. So I downloaded it on my audible. I knew I'm like, okay, I'm in this group or I'm going to be listening to this on my commute because you know, when I go to my one location, I have 45 minutes each way. This is the perfect time to listen to this. Can I tell you it's been several months and I haven't finished it. I mean, I'm procrastinating on listening to a book on procrastination. I don't know what to say about that. I'm like, okay, I need to gain some insight. About what Brian, Tracy is saying about this.

And I haven't finished a book. I don't think it's because there are so many other things. I mean, there are so many other things that I want to do

Dr. Diana Mercado-Marmarosh: So tell me what what's going on. Like, are you putting it in, are you putting play, forgetting about it? Like what, what do you think is going on?

Dr. Mitra Ayazifar: I think I know it's there, obviously, because, you know, I even came over with the Tik Tok laughing about it, but I don't, there are other things obviously that I like to listen to also, but I know it's there. It's like it's it's right here. Saying, you know, Mitra, you haven't listened to me. This is no, you wanted to find out, you know, how to get around procrastination.

That's why I'm thinking. Well, maybe it's not just pure procrastination. Maybe it's ADHD. I need to figure it out. It's in my phone.

Dr. Diana Mercado-Marmarosh: Did you find it boring?

Dr. Mitra Ayazifar: Maybe, maybe I almost felt like, oh, I really need to sit down and take notes with this. And so if I was walking the dogs or if I was driving, that was probably not the best time for me to, I guess, take advantage of it.

But then when I do sit down, there's so many other things I, I need to do. Like that's not at the top of my list and yet I should figure it out. You know, I should. And what I do are two different.

Dr. Diana Mercado-Marmarosh: I give you a quick tip there any time we say I should do X, Y, and Z. We're never going to do it. No, it's it's like a innate wire thing somewhere, somebody told us we were supposed to do it a certain way. That's why you're saying I should be doing XYZ, but inner gut is telling you no. Fucking way. I'm not doing that. Like, it's just telling you, like, it's creating some type of visceral response, no matter what you're not going to, because it doesn't feel aligned with you.

It's not a value of you, at least not right. The second. It just doesn't feel right. And so just catch yourself any time you use that word, just get curious and become interested in why did I think that? So there's the thing like that. Yes, you're correct. There are certain books that you need to maybe hear two or three times, or you may have, you need to hear it and come back and you can get the gist, but you really need to sit down and like you said, journal on it or outline what it means or whatever.

And you're not going to catch everything at once, but at least you can go through. If you find it interesting with an open mind and curiosity, but I think some of us, we are like an all or nothing. It's either I'm all paying attention or I'm not paying attention at all. And so we want to get perfect. Like you said, all the notes, and like you said, when you sit down that all of a sudden that's not as important than something else.

In general people with ADHD. And even though we maybe with this screening tests, it's questionable whether you have it or not, but there's a lot of stuff that maybe that I'm saying that's still relate to you and can still be applicable for most of us it's now or not now. And if it's not now, if you don't put it in the calendar of when you're going to pick up that nugget again, it's just not going to happen.

It's just, won't, there's never going to be a perfect time when you're like. Oh, this is the perfect time to learn how to overcome my procrastination. Like never are you going to be like this is it! Right. And so if you, this is an intention of yours to like, at least get curious about it. It doesn't mean you have to apply anything, but if you get curious about it, then you're tapping into a different thing versus if you're walking in with, I should know how to figure this out, then you come in in with like an expectation that it's almost kind of negative. Like I should have already figured it out. Why am I so slow at this? Or why, why am I so dumb? Whatever, insert the line that your brain is probably offering.

That is probably not the best way to approach it. Anytime we throw the word around procrastination, our brain. It doesn't matter who it is. Our brain has equated efficiency or effectiveness to equal, worth or productivity. Right. When we talk about procrastination, we're like, that's a negative feeling or that's a negative thought or that's something I should not be doing.

Somebody, one of my clients pointed out to me the other day. She's like I had the most validating experience with my therapist the other day. She says, it's really beautiful when you're opening up to understanding yourself from a non judgemental way. Although I wasn't, she said I was being judgmental.

Like you just said earlier, when you said my boss is, so mean, we have this inner critic, right. For some reason, things that. They beat you up. Nobody else can tell you anything worse than what you already told yourself. So supposedly that's going to motivate you to like do it, right? Like put the fear in Jesus, in you.

So to say so that you can get it right. But we already know nobody functions their best when they're feeling like that. Right. But if you feel like loyal to your boss, like you're going to do all this other stuff. Right. Because it's aligned with you because it feels right because you're being accountable, like you said, and that's something with ADHD too.

We will do anything and everything for anybody else, not for ourselves, we forget. And so that's why self-care is so important, but you've have figured out the hack, that's showing up with somebody being accountable to somebody that's going to get you to then be like, okay, I can be tethered somewhere.

Like I had to come back to earth. Cause they're asking me questions right. With this being said, like, when you, you decide, okay, I'm going to. so what, what her therapist told her that getting back to that point was with a procrastination. She asked her, you know, she was telling her, I can't believe I did this again.

I have not done my grand rounds. I know I had to prepare this lecture. I knew like three weeks ago I had to prepare this lecture and like it's next week. I have to prepare my next, your legs weak. And haven't started. I like I knew for so much time and she's like, I always do this. I should show shoot.

So she was doing the shoot shoot, shoot. And then that there were solar. Whoa, whoa, whoa, whoa, stop. Stop. Right there. Stop right there. She said, do you work well under pressure? She said, yes. Have you finished your stuff under pressure before she said yes. So then why do you have to do it any other way? If this is a way you do it, then do it again.

Yeah. And she said, everybody says, I should have everything she's like, should, should, should. So she said, I felt validated that I didn't have to do it differently than I was doing, because I she's like really only takes me three hours because I already know what I want to say, but not until I have a deadline, do I have to jump in and do it?

And she's like, and I feel good about the outcome of that.. So she said I did it, I did the three hours, like, like I, she gave me permission to keep doing it and to not feel guilty about it. And she was like, and I felt proud that I was able to be somebody who could complete it. And she said, I felt good for the first time to use my own system.

Even though it looks like procrastination for somebody else, but this is the way I function. And it has never failed me before. Why do I have to beat myself up for listening to the way I function? That was so insightful. Now I'm not saying that to going Kershaw, everybody to leave everything to the last minute, but I'm just saying that sometimes depending on what task it is, especially a task that you have never done before.

You might have to break it up into chunks. Like maybe the first time, you know, you think of the idea, maybe the next time you researched the idea. Maybe the next time you do a dirty draft, maybe the next time you go and insert it, whatever, like you might have to break it down. But some of the stuff that we procrastinate on could be that either they're boring or in our brain, we have decided they're too big of a task to do right this second.

So we rather buffer with some other low hanging fruit.

Dr. Mitra Ayazifar: So I'm curious, like with someone, when do you say to someone that has ADHD and I'm sure you approach this many times where like they have to study for a board exam where it's not, you can't cram that. Like how do, how do you even coach them into doing

something like that?

Yeah. So with that, this is what we have to always explain to people is. Our brains, the ADHD brain is still curious. Like we are always going to be lifetime learners. It doesn't matter, which is good. And it's bad. I mean, it's always good, but it's bad in the sense when, like you just said, you're having to do this board exam, you're just supposed to give back the facts.

Like if they say. What are the three pre-renal, blah, blah, blah, blah, or pause Reno, blah, blah, blah, blah. Like you should be able to spit it out. Or like, if you see an MCV of a hundred, you should automatically be thinking, okay, well, it's going to be macrocytic anemia. I has to always be bottoming, B12 deficiency, or fully like, those should be things that you could put right by.

Dr. Diana Mercado-Marmarosh: People with ADHD, they're going to go read everything about macrocytic anemia, everything about folic acid. Like they're going to get lost in the weeds. They can't see the big picture when they read. They want to read every single letter. Because they're afraid they're going to miss something because they can't figure out that they need to prioritize and they don't get through the whole thing, but they need to learn to do it their own way to study.

They have to learn. Do I have to synthesize this by drawing? Do I have to synthesize this by making a flashcard? Do I have to synthesize this information by. Talking it out with my tutor because my tutor would tell me what is the actual prioritization of that data? Because in our mind, everything is a priority.

You can't figure out which one is the priority, and therefore you can see why some of them go through like questions and they do 10 questions. Three hours. You're like, sweetheart, you're not going to have three hours to do 10 questions, but they really want to learn every single little detail. And so this is where I say, I'm sorry, but the board exam is a memorization exam and you're never going to have 30 seconds.

To examine your patient. So right now, when you see this, you think this, when you see this, you think this, this is gonna be a different type of tests. This is not the type of test that you are going, the way you learn, which is okay, because you learn by further understanding. But you're going to have up-to-date in your exam room when you're seeing your patient, it'll be okay.

You're going to have time to bring them back and do whatever you need to. But for this board exams, they need to really know themselves. And this is where they have no insight what has worked before and what won't work before. This is where they really have to get curious. And it's so important that they use.

Work with like a learning specialist. There are some out there, or even with like an ADHD coach or just any, uh, learning coach, because then you start to figure out how your techniques work only for you. And you don't have to, it's normal for us to compare, like it's human nature for us to compare, but what you make it mean after that is what makes the difference, because if you were comparing and you're like, but they're so fast who cares?

You, how do you learn? How do you do it? Because they're not taking your test, you're taking the test. It's your name on the test? And so it's bringing it back and sometimes again, people want the all or nothing. They want the highest grade. I'm like, who cares? You just want a pass, a pass means MD. And so that's where, where we have to get back to that.

But that's a good question. Yeah. The standardized testings do not reflect how smart and how driven and how motivated somebody with ADHD is because it's just not a fair test because we're not used to spinning things back. We're used to understanding so many different levels and sometimes too detailed for what the test is asking.

Okay. So I think I

have a couple of plants, obviously. I think the book where I say, oh, I should listen to this. I think I've been trying to do it perfectly the first time. Right. So as you said, it's okay to go through it once, listen to it once, whether I'm walking or doing whatever, and then come back to it, listen again.

And then if I need to take. Take notes. And as far as I should, I think I need to get better with planning it. Okay. When am I planning on doing this? You know, and calendar. And just get to it, put a task list, prioritized and, and basically

get it done. Yeah. And even if you decide I'm going to listen to this for 10 minutes, if my ride is 45 minutes, I'm going to listen to it for 10 minutes.

I'm just, or I'm just going to listen it for one chapter. When he sees, he says, he's done with a chop there. Perfect. Then I'm going to listen to something else. Like it doesn't have to be all or nothing. Right. What have you just listened to it for five minutes is better than nothing. And it's just, you just get curious.

And that's the thing too. When I tell people when you're reading something, don't just jump into it. Like, look at the titles, look at the pictures, ask yourself a question from what you're looking at. Like, huh? What are the two types of blah, blah, blah. Like when you're looking at it, if you ask you questions from what you're doing, all the sudden you're reading with intention.

To grab information of the questions you create it from the, the bold words and the big titles, right? Not just diving in for, you don't even know for what. Right. And so now you're reading with intention. And so a lot of people have district Tuk, which I haven't done yet, but some have, whereas. If they like the book the first time around, or if they listened to it.

But they're like, like one of the books that I've been listening to, which is the way of integrity, each chapter has like a journal prompt, which like, again, you're on driving, so I can't be doing it. Right. But then I ordered the book. And then I'm like, oh my God, that's a big book. Thank God. I first listened to the audio because I wouldn't have opened the book otherwise.

Right. But then now, because I can go exactly to the book where I wanted to do, and then you can read the book with intention as, as well. You know what I mean? And so it's just doing it a different way and doing it and not being worried about it. Yeah, that, that definitely

makes sense. So yeah, I think just this perfectionism thing is not helpful at all.

It's like, why does it have to be perfect the first time? And there, there are definitely some of the books where audio books that will take me a lot longer. Like you said, it's like, I will listen to a chapter and it's, it's boring. It's good information, but it may be boring and I can't do it all in one sitting and I don't have to, so I'll come back to it at a different time.

And books like those, like you want to listen. So that's why if you break it up into chapters, like if you decide I'm just going to listen to one chapter, I'm going to just listen for 10 minutes and you're listening with the intention of what can I implement today? Like what little thing can I implement today?

Like eat the frog. He, he talks about doing the biggest task. First because that's like what you're trying to avoid, but, you know, while that's a good idea, not necessarily the right idea for everybody, because that might send them through a rabbit hole and three hours are gone, which might be okay. Right.

But what if for you, it worked better that you decided that you were going to do. Two of the tasks of when to take five minutes and that's going to get you pumped up and then you jump into the tasks. That's the hardest, because you're already going the brain can't tell. So once you start something you want to continue, right.

And so, again, there's not a right way. It's just, how can I implement? And the thing with all these books you take, what fits you, try it. And you let go of. It's just meant to, it stimulate your own brain to come up with your own ideas or try some of lawyers. Right. But these types of books where they're like self care books, they're not just meant to be like passive they're meant for you to try to.

Implement. And we already know, none of us are like, Ooh, I can't wait to change all my life today. You know, most of us are comfortable and even most of us are comfortable in being uncomfortable sometimes because we at least know where we are. And I always joke around. I see the tick there. Let me remove it.

You're like, Nope, Nope. Don't move it. I feel the pain. I know the pain and I'm like, no, I can pull it out. You'll be okay. No, no, leave it alone. You're like, okay, you're going to walk around with a tick on your butt. Yes. Leave it alone. Okay. You know, and so it's just funny how our human brain gets used to different things.

Absolutely. Absolutely. Is there a book about like, that's your favorite. You know, maybe not eat that frog something other than that, as far as like organizational skills or something

that you would suggest, well, I don't know about organizational skills per se right now. I'm still working on them myself, honestly.

But one book that I would suggest that I think you would really love. It's the four hour. Like, that's my goal, like to one day have only work four hours a week. Like how amazing would that be? And again, the way he talks about it, it's fun. He's telling you stories and he's telling you all kinds of stuff.

So it keeps you interactive and it makes you like, almost be like, Huh? That sounds amazing. At one point he goes through the whole thing. He says, you know, there was one time I had three VA's who were working for me all over the world. And it was funny cause I was in a fight with my wife. And instead of fighting with my wife, I send my VA a message to send her an email telling her blah, blah, blah, blah, blah.

And then of course I had to send the other VA a message to buy her flowers because I knew I had lost that fight, but still, you know, So it's so funny how he was like, you know, it's amazing to shoot somebody a quick email and be like, Hey, take care of this. And then you go to sleep and somebody in India or the Philippines or Australia takes care of it for you.

And because they're working, that's their norm or time zone. And so I think that's a book that you should definitely look into. I did listen to eat the frog. I liked some of the stuff, but other stuff, I was like, eh, For our workbook. I think that you would a four hour Workday that you would like that. Okay.

I'm going to

look into it for sure. And one more thing before we wrap this up, I mean, with procrastination and I think this is the thing for everybody. Sometimes it's not procrastination sometimes it's just that we're tired and we're trying to do things at a certain time. That that is just not ideal.

Like we're sometimes like some of us are trying to pajama chart, right? Like, you're trying to do something that requires executive function. Like when you have no time, like no energy, like, it just doesn't make sense. So sometimes some of these tasks, it's not that we're trying to procrastinate. It's just we're we feel like we're ignoring it, but we're at the same time, we're kind of listening to our body that this is not ideal.

Like, yeah. Jump on there. And it's going to be three hours for you to do, like what a, probably taking you 20. The next day after you had slept. Right. And again, I think we go back to this thing that society keeps shoving your procrastinator procrastinator. Well, what if I am like that? What if it means I'm an ideal restaurant?

You know, I like to rest, right. And so you just gotta figure out how are you using it and don't be using it to like, keep telling yourself there you're only worth the. Doing producing money for somebody else, you know, or for yourself?

No, that's, those are very valid points. It's almost like, oh, well, if I have the diagnosis of

ADHD leading that, that, that makes

it okay.

That I'm, you know, procrastinating. I don't know what I was looking for, but I know these are definitely questions that probably other people have also. And. I, you know, obviously for my patient care and everything, there are certain things that I have like 10,000 checkpoints, just because I want to make sure and double check and triple check everything about them.

But this is more like the things I need to take care of.

And here's the thing that it just, because today, maybe the way you answered the questionnaire, it doesn't seem like you have ADHD. It doesn't mean that that was correct, because what happens is people with ADHD, they might tomorrow my ask you, and you might have a totally different answer.

This is funny, but it's not funny because people with ADHD. One day, my answer, based on what they're thinking and another day based on what they're feeling, sometimes they don't match. And so the people that don't have ADHD, you ask them the question. It doesn't matter what day you ask them, or what year you ask them.

They'll give you the exact same answer. People with ADHD. I'm telling you one day to the other, they changed. And then you can see why everybody around you is so confused. They're like, but yesterday. I said, and I was like, yeah, that was yesterday. What about it? You know,

You know, and so, so you could see how you're not meaning to be difficult, but they say, they call you difficult, but you're not trying to. And you're just like, yeah, that was what I was feeling yesterday. But today I'm thinking this and you're like, they're not the same. No, because yesterday I was mad and today I'm super excited.

And today, and today I'm thinking that this is doable, but yesterday was an impossible. And they're just like, oh my God. And so, so I'm just telling you this, because what I have seen is that, that at work, because again, our level of responsibility that we might be functioning, because you answered a lot of question based on how you were doing work.

But if you answer the question based on work and home, it might show something else because. You might've already spent or your executive energy at work and you come home and you're like hot mess. Like you almost feel disconnected. And so that we, something else to like look into, because like you said, you might have all these checks lists and you have developed your systems unaware that you have developed systems, but it could be because you were so careful.

Not on purpose, of course, because this is something not that we do. It's just that again, we jumped from one thing to another, to another, uh, and we have a time blindness and everything comes at us and we get overwhelmed and sometimes irritated because we can't prioritize because everything seems so important right.

At that moment. And so what happens is then you have those checklists. So therefore you don't think there's a problem there for ADHD, but if you were to take away those systems, damn hot mess here. See what I'm saying, they could have been somewhere along the way you might've gotten burned and you're like, oh no, we're going to way over turn it all the other way.

And so now you're way compensated by checking 3, 4, 5 times where somebody else never checks more than once. Like they just totally trust themselves. Not that I'm saying that you don't trust yourself. I'm just saying in general people overcompensate, sometimes for that.

Dr. Mitra Ayazifar: Yeah, no, I totally understand.

Dr. Diana Mercado-Marmarosh: Yeah.

So now I just give you more things for you to go home and think about, and just be curious and just observe don't judge, just observe and don't judge, right. Just be like, huh? Like when, when do I function? And what am I not wanting to do? And just get curious with it and be like, where is it a hot mess?

Because you know, in my, in my course, it sounds funny, but I actually have a declutter coach. And like, you would be surprised like that my, my physicians are like, yeah, keep that part. Don't don't let go of that part. Like, you wouldn't think that. You know, people like paper clutter, or like systems with like, I don't know why we have 10,000 lids that don't match, you know, and, and socks that don't match.

And you're just like, where did they go? I know it was like the stocks become lids. I dunno. The

Dr. Mitra Ayazifar: clutter coach did that. That would be very interesting. Yeah.

Dr. Diana Mercado-Marmarosh: Hey, I'll refer you. She's amazing. So tell me, where can people come and find you? Cause it sounds like you're doing amazing things over there taking care of people's eyes.

And, and I always think that they should go see a physician, especially our diabetic patients. Right.

Dr. Mitra Ayazifar: Right. Um, so I am, um, my website, you can find me at www cap. I med.com, C a P E Y E M

Dr. Diana Mercado-Marmarosh: E d.com.

Dr. Mitra Ayazifar: Um, I will share my link tree, which has my tick-tock has my Instagram and my Facebook, but basically my practice is in Northern California.

And it's called capital I'm medical group. I am my boss. That's why I said she's mean. And

Dr. Diana Mercado-Marmarosh: so I get to say that she's working on she's working on getting better and I'll give you another trick real quick with that. And I picked up this trick at an emotional intelligence course. I didn't even know they had those courses, but they do basically.

Any time you catch yourself being mean to yourself or a thought that just pops up, that you don't even realize that it's not the truth, but it's, it's kind of hurtful picture your, your S your niece who's three years old, or your daughter who's three years old saying that thought to you. Or that somebody's told that thought to them, like, let's say if the thought is like, you're too, you're too loud or you're too, you're too fat or you're too slow.

Whatever thought all of us have a thought that keeps popping up in whatever we're doing. Picture a three-year-old being told that somebody, you, you carry that your daughter like that, they just told you that you're just. Or you're just low or whatever. Right. And she's coming to you asking you for advice.

Like what would you tell her? You're probably going to give her some advice that you're going to, the mama bear is going to come out, right. You're not going to hit her being talked to, and it doesn't have to be even your daughter. It could be anybody that you were being seen wrong. Right. And so it's so weird how we.

We'll have so much more compassion for somebody else, but ourselves. And so when you do that, all of a sudden, even your three-year-old take, take your own three three-year-old picture of yourself and, and, and defend that person really. Because at the end of the day, again, You can get more bees with honey than you can with vinegar.

That's true. That's for sure.

Dr. Mitra Ayazifar: Thank you so much. I appreciate your time. Thank you so much for interviewing me.

Dr. Diana Mercado-Marmarosh: Thank you for asking all these questions, because I really think there's a lots of people out there wondering this thing. So these are perfect questions because like I said, unfortunately, and this is why we're having this conversation.

Unfortunately. Females are not given that opportunity to be screened for ADHD if they are smarter, older, educated. Right. Because they just assumed that no, that's just a shallow thing, blah, blah, blah, blah, blah. Right. And so they will spend so many years with a diagnosis of anxiety or depression. And never get to the right thing until somebody else picks it up.

Right. And so if you find yourself, like you said, Lucy, and all the keys spending, having to spend extra money on late fees or, you know, being impulsive sometimes and buying all the things or, you know, just. Watch out for that. Cause it might be something else.

Dr. Mitra Ayazifar: Thank you very much. Now I'm going to be definitely checking in with myself more often.

Dr. Diana Mercado-Marmarosh: All right. Well, thank you so much. Have a blessed day. Thanks. You too.

As omeone who understands that time is our most valuable asset. I am so honored that you have shared your time with me. Please click the subscribe button and join my Facebook group. Beyond ADHD, a physician's perspective so that you never missed an opportunity to create time at will do share this podcast with your friends.

I can learn to live life and stay in their own lane.

 

About Dr. Mitra Ayazifar

Dr. Ayazifar is an Ophthalmologist practicing in CA and has been practicing for over 25 years. Her goal is to make a positive difference in the health of her patients in need. She believes that vision care goes far beyond a simple eye examination.

 

Website: capeyemed.com/

Instagram: Instagram.com/mitramd3/

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