John Kruse, neuroscientist, psychiatrist, and author of the book, “Recognizing Adult ADHD: What Donald Trump Can Teach Us About Attention Deficit Hyperactivity Disorder”, shares what it’s like to truly hear your patients and look beyond the data. From his years of supporting ADHD patients, he’s discovered what it’s like when you connect with those around you and find the time to care.
Thank you so much for your time! I know you are a very busy person. Can you tell us a story about what early experiences brought you to choosing a career in the medical profession?
My father served on bomber planes in Europe during WWII, and shortly after returning stateside at the end of the war, he contracted a measles-like illness and became totally blind. Although he recovered some vision, significant impairment continued through the rest of his life. In grade school my older brother permanently lost hearing in one ear after a brief cold. I felt that the doctors shrugged off both losses with an “it is what it is” approach. My own response was that such profound changes had to result from some discoverable biological processes, and that knowing what caused these problems might illuminate a path back to recovering function. Medicine seemed the ideal route to discover more about how bodies work and to do more to help their healing. (My assumption now is that both my father and my brother suffered from post-viral leukencephalopathies.)
Can you share the most interesting story that happened to you in your career as a doctor?
Early in my career, I diagnosed a man in his thirties with ADHD, and with medication and psychotherapy helped him in his journey over the next two years as he finally finished college. He was then hired for a much more lucrative and interesting job than he had previously ever been able to attain. However, he also began abusing methamphetamine he bought on the street, a habit he kept hidden from me. He became delusional and paranoid, thought his mother was a murderess, and flew to his home state to confront her. Because he made threatening calls to her from across state lines, he was put into a federal jail. This was when I learned that my voicemail capacity was twenty calls, because for a week he would fill it up several times a day, ranting at me for stopping his prescription before he had flown back east. The experience crystalized for me how our treatments can transform lives profoundly, for better, or for worse, and sometimes both for the same individual.
Can you share a story about the funniest mistake you made when you were first starting out on your career? What lesson did you learn from that?
In the first year of medical school, as an introduction clinical medicine, we were assigned to a medical ward for an hour a week. I was scheduled for an ob-gyn clinic. The senior resident instructed us to introduce ourselves to the patients as medical students. As we approached the first patient, a rather unkempt woman in her fifties, with long uncombed, gray hair, she flung her hospital gown open, and ignoring the female senior resident hovering at my side, addressed me as the doctor and asked for my opinion on the labial cyst she was suffering from. I was flabbergasted and mortified, as a virginal, closeted, gay man whose first and only glimpse of female anatomy had been twenty-one years earlier, from the inside out, and upside down. Seeing that I was flustered, the resident belatedly stepped up and introduced herself as the doctor, only to have the patient dismiss her as “I don’t want no candy-striper.” (an outdated term for hospital volunteer). The episode powerfully revealed the white male privilege I was being granted, however unwarranted.
To #DareToCare means to survive and thrive in today’s medical world. How do you take care of yourself? What’s the routine you must do to thrive every day?
I teach my ADHD patients the importance of scheduling daily activities, in order to be mindful and focused while doing each one, and to reassure yourself that you know that you will complete the essential tasks for each day. I tell them to start by slotting in times for sleeping, eating, physical activity, and meditation/recuperation before placing any work or school activities on the calendar. If work itself doesn’t include social interactions, I would include scheduling some time connecting with other humans as an important part of each day. I think that this is good advice for anybody, with ADHD or not, myself included.
I write a series of letters to my God-daughter in my latest book. In that same vein, what are 5 things you would tell your younger self?
5 pieces of advice to my younger self: 1) Cultivate caring and intelligent mentors. 2) Cherish friendships. 3) Smile more. It’s free and makes yourself and the world feel better. 4) Accept yourself for who you are, even if you are concerned that the world isn’t ready for that version of you. Either they will catch up with you or their opinion doesn’t matter. 5) Just because you are patient and diligent don’t believe that you have unlimited time to achieve goals.
How can medical professionals reclaim heart-based healing amid pandemic, political, and other pressures?
I would start with my approach to social media / “news”, by advising everyone (doctors and patients) to regard this information as a medication – you need to get the proper amount for you or you might overdose. Stay attuned so you have some awareness of the world, but if it paralyzes or irritates or overwhelms you, you’ve consumed too big a dose. Secondly, most of what is in the news, important as it is, will not affect what you eat for dinner or who you go to bed with that night. Thirdly, it virtually never matters whether you find out about a current event as it happens, or a few, or several hours later. Shut off the flow of extraneous information.
I think heart-based healing centers around listening and regarding patients as people, not as collections of symptoms, not as boxes to be checked off on a screen.
Is there a particular book that you read, or podcast you listened to that really helped you in your work as a healthcare professional? Can you explain?
The classic movie, The Wizard of Oz, reminds me to consider that we have to address both the Tinman (feelings, heart) and the Scarecrow (thoughts, brain); that people need to be brave (Cowardly Lion) to reveal so much of themselves to us in the doctor-patient exchange; and that (like Dorothy and Toto), most of us want to be surrounded by approving and accepting friends and family.
Because of the role you play, you are a person of great influence in the healthcare community. If you could inspire other doctors and nurses to bring change to affect the most amount of good to the most amount of people, what would that be? Said another way, what difference do you see needs to be made for our collective future?
To be effective healers, we need to hear, not just see our patients. With modern computer algorithms for sorting data, we obsess on the presence or absence of a checklist of physical signs. We lose not only the meaning that these appearances, sensations, and experiences have for our patients, but often, by not hearing our patients, we can’t even asses the reliability of our data. We record thousands of “yes/no” data points but much of this data is worthless. As the computer programmers say, garbage in, garbage out.
In the first year of medical school, Dr. George Engel, one of the fathers of “biopsychosocial medicine” taught us to pay attention to both the content and the process of a patient’s description of changes in their bowel habits. If you don’t know whether you are interacting with a “back handed flusher” (he pantomimed someone glancing skyward as they reached behind themselves to pull the lever disposing of the toilet’s contents) or a “fecal microscopist” (he scooped his hands together and brought them inches from his face and peered intently into this makeshift bowl), you simply don’t know how to interpret the reply that the individual hadn’t noticed much difference in their stools. The back handed flusher may well have missed significant changes, but the fecal microscopist will be able to provide excruciating details. If you don’t know which you are dealing with, you don’t know what their response really means.
How can people connect with you?