Beyond ADHD A Physicians Perspective: Dr. Tonya Caylor

Dr. Tonya Caylor: Let them be wrong about you. That was a powerful statement that the first time I heard it was like, Oh wow, okay. Because it just, it gave me freedom to let go of the control because I think we get socialized in medicine to really. Perform and we want good grades. We want the a plus with extra credit when the gold Star.

And and that performance based approach really highlights we are caring what other people are thinking, and so it's not that we don't care. It's not like we wanna have a terrible reputation, but it's like giving up control and trusting that if you show up as your best self, your reputation is gonna be fine.

Hello. 

Dr. Diana Mercado-Marmarosh: Hello. Welcome to Beyond adhd, a Physician's Perspective. I am Dr. Deanna Mecado Mage. I'm a family medicine physician practicing in rural. I used to be hindered by my adhd, but I now see it as a gift that helps me show up as a person. I was always meant to be both in my work and in my personal life in the past.

Two years, I've come to realize that unlearning some of my beliefs and some of my habits, I'm excited to.

Hello. Hello. I am so excited today. I have a very special. And you won't believe it. She is in Alaska today. So it was fun getting our time zones to line up. And her name is Dr. Tanya Taylor, and she's a family medicine physician. And I have the pleasure and privilege of meeting her actually last year.

And it was a very cool. It was the Physician's Coaching Summit and we hit it off the very first night over our doors and some wine talking about how Covid has really led us all to come to an awakening that mental health is there and that we would probably all sub functioning, but now we've realized that.

We've put ourselves through unnecessary suffering, and she's actually on a mission to help educate residents and physicians and all the healthcare industry to be able to realize that, they have choices and they can make choices. And so I am so thrilled to have her here today, and she's gonna give us lots of good tips and share with us her journey.

So would you like to give us a little bit more information about you? If I missed. Yeah. Thank you 

Dr. Tonya Caylor: so much for having me here, by the way. And I we really did. So I'm Tanya Taylor, family physician, academic physician coach up in Alaska, although I coach remotely throughout the lower 48. That's what, that's the term that we use out here.

And it was a great conversation because you and I, when we first met, realized that we had similar purposes and and you also had a very keen interest on. Academics, trainees who were struggling with ADHD and time blindness and those sort of things. And my passion has always been the residency level, academics and seeing that there were ways that you would be able to help that same population and with your expertise.

And it's an area that I love to coach in. And so it was a great conversation. I and we started like brainstorming. How could the people who follow and listen to me and the residents that I work with gain for those who have a d type tendencies or just time blindness or just want a little bit of a calm in the chaos.

And then me being able to talk to the followers that you have about. Ways to identify areas of unnecessary suffering and really begin to not only, survive, but flourish in their chosen careers. Yeah, that's how we got here. So thank you for having me. Yeah. 

Dr. Diana Mercado-Marmarosh: So I'm so excited about this particular topic because I, I think that we don't realize that we are just future of habit, right?

And sometimes, We think we have the most efficient systems. . Yeah. But we realize that some of those systems actually might need to be upgraded because some of the underlying beliefs, or they're old software, they need to be updated. And we don't realize that, some of the, because we haven't questioned some of those things like that we ourselves, Adding to the suffering that we were sharing with everybody else.

And we don't realize that, we have choices. So today I think I wanna hear your experience. What have you seen in helping residents is there anything that stands out to you? That, maybe to them is not obvious, but to you, because now you have this expertise and you're able to see it from a detached lens and you're not in it with them per se.

You have the ability to hold space and help them see that maybe some of those things that they're doing are, are not really true, and their brain is telling them that. Yeah, I think that's, 

Dr. Tonya Caylor: I kinda, you hit the nail on the head there with that description because not just residents but faculty and all attendings and whether they struggle with a d type tendencies or not.

We do have these habits and we have these ingrained thought patterns. That don't service well. So one of the largest areas of taking back like decreasing unnecessary suffering is actually our mindset. And I know there's probably, I think. Somebody has looked at the stressors in medicine and about 80% are systems issues.

And thankfully there are people now who are actively trying to improve the systems. But that 20% that we can control, a large percentage of that is a mindset and it can give you great relief just by that. So there's a few things there. One is identifying. I think just starting with the basics of when you find yourself frustrated, stepping back and looking at what are the actual facts, like not the story you have about the facts, but what are the actual facts?

Because we have these ingrained thought patterns that go and jump right onto different assumptions or put together stories that add to our previous stories that may or may. Tell the whole picture. And so just separating out facts and that I like to say it's a fact if you remove the adjectives, you remove any assumptions, you remove any loaded words, you remove any judgments.

Now, there's nothing wrong with those things, but for the sake of getting some clarity, when you take those things out and that is what you know, that by itself. Realize that you usually have a story and those stories about those, that circumstance, that set of facts is usually what leads you to the unpleasant emotions.

Now, this isn't about toxic positivity. You're not gonna look at a pediatric abuse case and somehow will yourself to, find the silver lining. This is just about. When you look at what you're thinking, how's it serving you? I think that is like an powerful thing and it takes some time.

And this is why you and I love coaching is because it sounds like an easy concept, but there's so many nuances that our brains really are attached to the stories we tell. And so that's where coaching really comes in handy to help you see what you're creating in your experience by. Not taking the time.

Once you have those automatic thoughts pop up to really looking at what you. That, 

Dr. Diana Mercado-Marmarosh: That's so important. One of the modules that I coach in my group is self coaching and self care, and I purposely put both of them in the same class because, They both seem very foreign to us. . 

Dr. Tonya Caylor: Yes.

Dr. Diana Mercado-Marmarosh: And like we have no problem, like self-sacrificing for our patients, for our family, for whatever. Even for the neighbor or for the people we haven't even met. Like we're Okay. Like busy, whatever we had going on. And it's so interesting that I walk them on how to do self coaching. And they're in awe when I tell them, Okay, only circle the.

They're like, There's no facts there. I'm like, I know. Isn't that thought ? 

Dr. Tonya Caylor: It's so true. . 

Dr. Diana Mercado-Marmarosh: And then we go through what they think are a fact, like I'm too slow or I'm always late. Or nobody loves me whatever your brain has told you like thousand times, right? , and you never question it.

And then I'm like, Okay, in comparison to whom? , , all 12 people in the court of law would have to say yes. Yeah. You were like 1, 2, 2 minutes late or whatever. And so it's interesting. Like what our brain offers because it's trying to protect us always. It's always trying to make sure that we don't look like a fool or whatever.

Like it's always trying to protect us. But sages us too, because it's no dramatic . Exactly. 

Dr. Tonya Caylor: No, and I think it's really true, right? So when you think I had too many patients today, and that seems very real and you could probably argue that. Half an hour, but just getting like concrete, like what are the facts?

Okay. I had 14 patients in a half day, okay? There are a lot of physicians who would say, Wow, that is a lot. And there are a few physicians out there be like, Oh, that's all on a day's work, right? A fact is one that everybody would agree with. And so yes, 14 patients, we could argue that. But when you think there are too many patients on my schedule, what, When you check in with yourself, what emotion does that bring up?

And once you realize what that emotion is, what do you do out of that emotion that actually helps you see those 14 patients? Because most of what you. Is not serving you well when it's coming from that emotion. And and so when you say, Okay, I have 14 patients and a half day, what might somebody else think about that?

Or what is a different perspective? And even, it doesn't even have to be something positive. It can be like I'm gonna do the best I can. Just that is going to like decrease that amplified limbic system where you're amygdalas all ramped up and help you to settle in and get started in a way that serves you in those 14 patients best.

Yeah. So yeah, I think that's one. And I love that you you started in on my, one of my second points. And I, this is kind. Like maybe some unnecessary suffering, but I like to think of it as like how we protect and rebuild our energy and rebuilding our energy goes along with what you were talking about as self-care and When I give a, I have this talk that I give to physicians about time management efficiency, and I have a slide in that talks about prioritizing your downtime.

Number one, everybody's first reaction is what? Downtime. And then the second is what is that even doing here in a time management efficiency talk? And so it gives me the opportunity to, number one, tell them there is going to never be down. If you do not prioritize it, it needs to go on your schedule first.

It doesn't, it's not the thing that falls off at the end of the day if you don't get through the other check boxes. And so by learning, and that's very uncomfortable when you first start doing it, but learning to do that and you are you're refreshed and be by being refreshed, you're gonna be more effective, more efficient, and more present.

With what you're doing. And so in the end it is incredible efficiency and time management step. So I love that you brought that up. Yeah. 

Dr. Diana Mercado-Marmarosh: Before we started hitting record, we were having a conversation and you asked me, How do you do everything? How are you? The secret. It's not a secret cause I tell everybody to do it.

But you just said you have to prioritize yourself. I had to decide that Thursdays I was gonna have a day off. Thursday was CEO day. I was gonna meet with the CEO all day. That's me. come to CEO all my life. Like I get to decide who I talked to. And it took me a while to realize that planning.

Really was important. And I don't mean planning where you have to put everything every 15 minutes. I don't mean that. I mean like the big things that you really don't want to miss. Like you don't wanna miss a doctor's appointment, you don't wanna miss your kid's recital. You don't wanna miss like what time you have to be at the airport, right?

Like the things that you really don't wanna miss, you wanna put and. I know usually when I say schedule your fun first, they look at me like I'm crazy. What you just said, right? What? Self care, what time For myself. But the thing is if you don't prioritize it, nobody's gonna be like, Oh my God, Dr.

You look so tired. Let's get you a day. Like, how many of us have Like probably needing to be in the emergency room ourselves. And we're still like over there trying to see patients. And it's so important that you realize you're human first and that as a human check with yourself.

What would any normal human be like? Would they like. Not call in because their kid is sick, or would they call in because their kid is sick? And we like guilt ourselves. We're like, No, but we're super human. And that's where I think people don't realize that. I'm not asking you to be super human, I'm just asking you to be human and that's okay.

Dr. Tonya Caylor: Yeah. I, as I'm listening to you just reflecting that I think this generation of medical trainees are a bit ahead of us where we were at that stage, right? Because most of them are now recognizing the fact that's not the life they wanna create, where they just go. And they want to intentionally build in.

This balance for lack of a better word, I like the word harmony, but they wanna have that built in and yet they're running up. The rub is that the medical culture is slow to change, and that's not just the attitudes of those of us who've gone before them, but it's also the systems that need to be in.

To allow that to happen. And again, that goes back to systems. And I am not a systems person. I'm a individual. I love working with individuals or small groups, but I do believe there's a lot of room and I really am hopeful that this generation of trainees will be able to take on that mantle of crafting the culture of medicine in a way.

They're still loving their job and giving to their patients, and they're doing in a way that doesn't mean they have to neglect everything outside of work. And so yeah, so I love that. Another thought I was, the other thing I like to really talk about in a manner of protect, protecting your energy so you can really enjoy and flourish.

Choosing service over people pleasing because I, there are a lot of altruism comes through in medical trainees and it's a beautiful thing, and then there's that piece of it that crosses over a line and it stops coming from a place of service that, that internal motivation. Like that's renewing, right?

It just, it's energizing when you're working from that place if it's what is driving you. But when you cross over to that, people pleasing, that is when you're doing it. And because you want them to be happy, you want to make sure they're not disappointed and you stop doing it from that service. That is draining.

It drains your energy. It leads to a lot of resentment, and so tapping back into. What your bandwidth is, what is coming from a place of authentic service? And what is you trying to co control other people's emotions and what other people think about you? Because you know what, that's what goes on in their mind is their business, right?

And you showing up as your best self, it doesn't mean that you have to be selfish and could care less about people and callous. But you're gonna be your best self when you're working out of that authentic service piece instead of that people pleasing piece. 

Dr. Diana Mercado-Marmarosh: Yeah. That's so important that you just said that because I think that was one of my aha moments that finally freed me up to really be me and embrace me because I'm not sure if you're aware or not, but people with adhd.

We, we don't take rejection well sometimes we have this thing that is called rejection sensitivity in phobia. And while of course nobody likes to be rejected, We'll just put it like that. But for us, it's almost like they're burning us. It's like we take it to the extreme and it lingers and it, because we all, I don't know, we all already self sabotage with some of the thoughts that we have, but this takes it to the 10,000 level.

And so we, I figured out from an early age, That if I was just not too loud, if I was just not too crazy, if I just got good grades like then I think I was people breathing because that's what told me that was gonna get me ahead. And I didn't realize that I was not just that and of course I did always want to be a leader and provide service, but I noticed that I was very, what's the word, Adaptable.

And so I could. But at some point you adapt so much that you're masking and you use sight of yourself. And like you said you cross a line that you didn't realize you're crossing. All of a sudden you're triple . All of a sudden I'm like, okay I know I asked for time not to pump. Like I can't be pumping in the patient's room.

Like, why do you have And so it cause us a line because you don't wanna say no, but at the same time, You still need to eat. You still need to be okay. And this is one of the things that we don't realize that like you just said If you go and give all your 140 at work and then come home, you drink, like you don't have that extra energy.

Why are we going to work to take care of her families, right? Like financially emotionally, all that, right? But then we come home and you're like at negative like 200, and then you're irritable and moody with them, right? And you don't realize. Them over there, you were people weasy. But then over here at home, you're not even people.

Weasy, you don't even care anymore cause you're so tired. And then it's it's so funny because I remember they would describe things to my husband and my husband be like talking to her about the same person. She's not that nice at home sometimes. And it's funny how you then have to realize, Okay, I'm gonna come and serve because this feels.

But I'm not here to self-sacrifice because if I self-sacrifice, then it is not gonna work out because you're only gonna get me at 20% instead of getting me at 90%, right? Because I said yes to something that really didn't want to, but I said yes because I felt like you asked me to and so we don't realize.

That sometimes we do have to say no, because I know that nobody wants us to be perceived as, Oh my God, the difficult one. But sometimes it's not worth the energy to try to convince anybody of any of anything. If you know you and you know your why, like it's okay. Let them be wrong about you.

You, you know why you're doing it. . And then like you said, you show up as yourself. And the moment that I learned that I wasn't responsible for my husband's happiness or my patient's happiness, but all I could do was control my own happiness. I was like, Oh, light bulb. I don't have to go and do things for others.

If it happens, great, I would love to provide joy for you, but it's not my responsibility, like it's 

Dr. Tonya Caylor: so free. Yeah, it's definitely freeing to realize that I like what you said let them be wrong about you. That was a powerful statement that the first time I heard it was like, Oh, wow, okay.

Because it just, it gave me freedom to let go of the control because I think we get socialized in medicine to really. Perform and we want good grades. We want the a plus with extra credit when the gold Star. And and that performance based approach really highlights we are caring what other people are thinking. And so it's not that we don't care. It's not like we wanna have a terrible reputation, but it's like giving up control and trusting that if you show up as your best self, your reputation is gonna be fine. And if somebody disagrees, they can be wrong about you.

So empowering. 

Dr. Diana Mercado-Marmarosh: Yeah. Yeah. And I remember that when I had that shift, it was such a lightning thing because it's always one or two patients that are Coughing and ruckus, right? And you're trying to please one or two patients that are like draining the energy out of you. And I'm like, all the other 80 or 90 people that I saw this week didn't say a thing.

They actually said, Thank you. So why am I worried about those two, three people ? And so our brain, and this is something I always tell people, like I purposely ask them, To begin the class and end the class with their takeaways but their wins for the week. And you'd be surprised how hard it is for them to practice that skill because they think it was just luck that made it happen.

Dr. Tonya Caylor: like you, it's too true. I didn't have that 

Dr. Diana Mercado-Marmarosh: meditation and that's why I closed my notes. No that's not why you closed your notes. You close your notes cuz you're now following a system. Let's talk about your system . 

Dr. Tonya Caylor: It's so true. Like dismissing the positives is such a common great, and it's really interesting cause I do the same as a lot of times I'll challenge the physicians I'm working with to what is going well, or, Hey, that was a win.

Did you celebrate it? Or, What do you love most about this? And they'll say and they'll think really hard and they'll gimme something. And then there's. They do this, but they blah, . Cause we have that built in negativity bias that is just common to humans, right? That really ramps up when we're under a lot of challenging situations and can become a habit back to that, bring it full circle back to that habit of how we think through things.

And so I love that you and I approach that similarly in trying to point their brains in a direction that's gonna serve them even better. 

Dr. Diana Mercado-Marmarosh: Yeah. Yeah, I think we all eventually reached those awareness because we didn't even realize we were causing self harm to each other because we I remember the first time I heard somebody say, If you are not practicing self care, you're in self neglect.

And I was like, Whoa, . That was wrong statement and chill there. But then I thought about it and I. 

Dr. Tonya Caylor: Yeah, actually right, 

Dr. Diana Mercado-Marmarosh: like if I'm not prioritizing myself, like I'm choosing to think that it's okay for me not to like, see myself as somebody who needs certain things and desire certain things.

And most of us, like when we've done surveys like. We just wanna know that we mattered and that, we're accepted. But I think that it begins with you. If you think you matter and you think you're accepted, then like everything else follows. Yeah. That's so good. Perfect. Yeah. So tell me, I'm pretty sure you're gonna have everybody wondering where could we find this big for my residents this amazing, Where can they find.

Dr. Tonya Caylor: Thank you so yes, Anybody, If you know anyone that is, works at a family medicine residency cuz I partner with residency programs and individuals within there to work with both faculty and residents. They can find me at Joy and family medicine.com. I'm also on Facebook at Joanne Family Medicine Coaching and on LinkedIn as Tanya Taylor.

And yeah, so refer any of those to me that might want to have an external coach create a safe space to be able to have these kind of conversations and unpack both individually in a group. I would love to talk with them and see how we could partner together. Yeah. So thank you again, 

Dr. Diana Mercado-Marmarosh: Diana. Yeah.

Yeah. And we were talking offline before we started that it, it's so important to show up and ask questions because when we don't show up and ask questions it can lead us into a way where we end up in legal trouble sometimes. We're not doing chart, we're not doing something right.

And. It's so important to set up like environments such as what you have for residents to be able to come and talk freely without feeling like they're gonna be put in the spotlight and they're gonna be bluster and they're gonna be told that they're the bad resident or something. Right?

Because many times it could be that they're doing the best that they can, they just don't have the correct systems in place for them, right? And Please reach out to her and don't let it be a thing. Okay, . All right, great. I always ask everybody what they see themselves doing for fun in the next three to five years.

Where do you see, you're in Alaska now. I don't know. Are you gonna come to the States or are you just gonna go all over Europe or what are you gonna be up to? 

Dr. Tonya Caylor: Yeah. I have a few ideas. I think one is, I'm just gonna say that I really enjoy the coaching job. So that will still be that's in my ideal three to five year future.

Also traveling with my husband. We love to travel and I have two little grands. They are three and five and within that timeframe, probably being closer to them so I can spend more time as they're growing up. Thanks for asking. I'm super 

Dr. Diana Mercado-Marmarosh: excited about all of that. As some of the physicians that are hearing my podcast have ADHD and sometimes have wondering attention.

So if they zoom out and now they're back and they're ready to hear the takeaway message, what would it be for today? I think 

Dr. Tonya Caylor: the takeaway today is that they likely have a lot more control of how their brain works than they've been led to believe, and by doing some mindset work, as unsexy as that sounds, it really can give you the power to enjoy the day to day, despite the circumstances.

Dr. Diana Mercado-Marmarosh: Yes. So there you have it. She gave you the key really. Think about your thoughts and then set up a community that helps you to unwind some of those thoughts and you know it doesn't matter. Use all the resources. Go talk to a therapist. Go talk to a psychiatrist. Go talk to a coach. Go join a dance class.

Go paint. Go do something for you that's gonna improve your self care, and that is going to help you get you to where you're going. Thank you for spending your time with me. I really believe that time is your most valuable asset. Please subscribe to the podcast, share with your colleagues, and don't forget to check out my website at ADHD Live Coach dot.

Where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.