Dr. Diana Mercado-Marmarosh joins the podcast and discusses how she was able to overcome charting challenges and unfinished projects by understanding her ADHD and pivoting to use it as superpower to help herself and others.
During this episode you will learn about;
[0:00] Intro, Charting Mastery ad
[3:01] Tell us a little about your journey to medicine.
[6:16] Boundaries, limits
[11:33] Charting and challenges
[18:57] Hidden curriculum in medical school
[22:42] See the patient as a person, not the disease on the chart
[28:11] Life goes on for everybody who keeps living.
[33:16] Redundancy in charting when the computer knows
[37:38] Tell your staff what you’re trying to accomplish.
[42:03] Be willing to speak up and say “no”.
[46:40] What to do if you feel like you’re not fulfilling your role.
- “Because the thing that I loved the most, which was to take care of others was the thing that was basically maybe going to cost with my life. And I did not sign up for that.” – Dr. Diana Mercado-Marmarosh
- “And so, I came to realize that ADHD, I could see it as something that was disabling to me, or something that could be used as a superpower.” – Dr. Diana Mercado-Marmarosh
- “It’s just each of our own individual experiences or personality, they all get to be brought together if we let them. And then that’s our unique expression of how we can care for our patients and provide value to others around us.” – Dr. Ryan Stegink
Does charting in medicine seem overwhelming at times? The tens or hundreds of charts that you still have to finish and sign…it’s exhausting right?
Charting Mastery™ is a 6-week- long group coaching program, led by Dr. Ryan Stegink, where physicians like you, will get equipped with the skills and approach to finish charting at work and get home sooner for what matters most to you.
The first cohort launches in early November 2022. You can get on the waitlist and be one of the first to hear when you can become a founding member by going to…
There will be CME available through reflections on the material, powered by CMEfy.
To learn more about Dr. Diana Mercado-Marmarosh, go to – https://www.adhd-lifecoach.com/
Above are the episode show notes and below is the transcript via www.otter.ai.com. Some episode transcripts have been edited more than others, but they are up in the meantime to help those who would rather read and for searchability on the web. Extensive editing has not been prioritized as I seek to both produce regular content and maintain my own wellness. See the website disclaimer if you have questions, since this is all for your education and entertainment only. Enjoy!
Dr. Ryan Stegink 0:00
Does charting in medicine seem overwhelming the queue of messages, labs, patient calls, that never seems to get smaller the pile of pre authorizations awaiting your input, the 10s or hundreds of charts that you still have to finish and sign. It’s exhausting, right. And still, all you want is to be able to go home with your work done, to be able to spend time with family, hang out with friends, practice self care. I want to invite you to join me for a six week long coaching program chartingmastery where you will get equipped with the skills and approach that you need to get home sooner and leave that work at work. To check out more info, and to join the waitlist, head over to charting mastery.net You will be among the first to hear when the doors open so that you can join me on this journey. There will be opportunities to reflect and earn CME after the different sessions as well. And now on to today’s show. Welcome to the MedEdWell podcast. Empowering physicians to get work done at work, then be able to reflect and choose what is important for both their life and medical practice. I’m your host, Dr. Ryan Stegink general pediatrician and life coach for physicians. Hello, everyone, and welcome to another episode of the MedEdWell podcast where physicians come to be encouraged and equipped to take the next step in their own wellness journey. Thank you so much for subscribing, and sharing these episodes and for engaging with these concepts. Today I am honored to have as a guest, Dr. Diana Mercado-Marmarosh. Dr. Mercado-Marmarosh is a family medicine physician, clinic Medical Director and Chief Medical Officer. She is also the founder of overachieved life coaching. Prior to discovering coaching, Diana typically had 200 charts open and a graveyard of unfinished projects. But that has changed. And now she’s on a mission to help physicians and medical students create systems that are simple to implement with ADHD, supporting their zone of genius and reclaiming five to 10 hours per week of their personal life. Her clients learn to leave work at work. She is happily married with two preschool aged children, and enjoys travel, painting, Zumba, yoga, Nidra, meditation, and exploring different cultures. Thanks for Deanna, welcome to the show.
Dr. Diana Mercado-Marmarosh 3:01
Thank you so much for having me. It’s a pleasure to be here.
Dr. Ryan Stegink 3:04
Thanks so much. Tell me a little bit more about yourself and your journey to medicine.
Dr. Diana Mercado-Marmarosh 3:09
Well, I didn’t really think I was gonna go into medicine. That’s a funny story, actually. I actually got a scholarship to study international business. So a part of me wanted to travel the world. And I figured that business was the way to do it. So you could travel the world and see and get paid to do it. But when I was in high school, I actually joined a program that was called upper bound math and science. And I was going for the math part of it because I figured maybe this will teach me a county or they will teach me some type of business. But of course, it was really just geared towards science part of it mainly because like we we got exposed to surgeries and like family medicine and like very cool things that I would have not had the opportunity to do from where I was at in in South Texas because I didn’t know anybody who was a physician. So I wouldn’t have had that type of exposure had I not gone to that program. And that program was actually two summers, and it was in Oklahoma, and I’m in Texas and in South Texas. That’s where I I grew up in Mexico till I was 10. But then I was in South Texas and even though it was Texas, it still felt like little Mexico because everybody spoke Spanish there. So it didn’t really make a difference. And everybody around me look kinda like me. So when I went to this program, it was like my first encounter with like, diversity. And in my mind, I knew we were all the same, like that’s what I thought. But it was beautiful to actually start to see it and have friendships. developed friendships through that. So, in my mind, I still kept thinking I was in denial, even though I went back to high school and took all the science classes and all that, like I was in denial that I was going to do science. So I get to college, and I didn’t even last a semester in business. And then I was like, this is boring. And I went to science, decided I was going to be a physician. And but I guess now life has its turn. So maybe I didn’t know a little bit of that, about that. Now I’m hoping to still merge my love of traveling and doing business and even now doing retreat somewhere in engaging that. So it’s, it just shows you that you don’t know where your journey is gonna take you.
Dr. Ryan Stegink 5:45
That’s so great. Thanks for sharing your story, it just each of our own individual experiences or personality, they all get to be brought together if we if we let them. And then that’s our unique expression of how we can care for our patients and provide value to others around us. Yeah. So for you balancing all these things? How did you kind of deal with jumping from one thing to another? How has that been for you kind of being able to focus on each of those different areas? Yeah.
Dr. Diana Mercado-Marmarosh 6:16
So I, like I said, I always wanted to travel, but I never really thought I was going to be doing the fitness part of it. Because in my mind, I felt like that was too many details. And I wanted to just go in somewhere, see my patients not advertise anything. And then like get a paycheck somewhere and like not worry about how the money came in, or what happened and not worry about, Does this one have insurance, it doesn’t have insurance, like I just wanted to do the doctor part. And then endemic hits, and all of a sudden, like, you could not, you could not take that break, like everybody else was taking a break because out of necessity. You were expected to show up and all kinds of stuff, like was brought to the surface. For me, I was like, why I signed an oath to do no harm, I didn’t sign an oath to put my family at harm, and all kinds of feelings like we’re being brought up. And I was being forced to like process that I was having to do, you know,
Dr. Diana Mercado-Marmarosh 7:30
a will to say, who my two and one year old are gonna go to. And I was so mad about that. And I, I felt like I was hopeless. And I felt so like crushed. Because the thing that I loved the most, which was to take care of others was the thing that was basically maybe going to cost with my life. And I did not sign up for that. And so I started to think like is it really worth it for me to be charging 20 or 30 hours outside of work on something that I’m kind of testing in this morning until I and I started to realize that maybe didn’t have to be that way. But I still didn’t even know that I was living in burnout. Like in my mind, I felt like as a female physician with little kiddos like, you were just expected to do all those things. Like you were just supposed to do everything for others without setting boundaries, because you were taught like, do everything for your patient, like your patient always comes first. But when I was forced to be like, Okay, your family or you or your patient, like that’s when I started to like question like, Okay, what if I really did only have 24 hours to live? Like, how would I live my life? Like, what would I really do? Like what type of patients would I really want to talk to? Like, I want to talk to those that tell me off. And so like I started to like, just question and wonder and start to dream again. Like what if they could be something different? Like what if I could practice medicine in my own terms? What if, what if I didn’t just have to do everything that the insurance tells me to do? Like, all this prior authorizations, all this like time sucking activities that don’t necessarily give you a return for your time, right? And I think and believe me, I was a hot mess. I was a really hot mess. I was charging 20 to 30 hours outside of work. I was always feeling like I had all these wonderful projects I would start but I wouldn’t complete. I felt like I I kept asking myself why what’s wrong with me? I’m a physician. Why can’t I just adult like why can’t I just have a house or why can’t I just didn’t that but I didn’t realize that I was neglecting my diagnosis of ADHD. I got diagnosed as a first year medical student with ADHD. And when I became an attending, like, they were like, you’re an attending, like, you need to go see your psychiatrist, like, don’t just keep coming to the student clinic, like you’re no longer a student, go go see a psychiatrist. And so I was like, Okay, fine. And so I was at Baylor. And I was like, Okay, well, I mean, I think any random psychiatrists should be able to understand ADHD and professionals, why didn’t do my due diligence, and I just showed up with somebody and that person didn’t even give me like two minutes of his time. And he was like, you’re a physician, you should know better. You all grow ADHD. And I didn’t question it. Because I was like, Well, I’m just general dog. I’m not. I’m not a specialist. So he must be right. And like, I felt embarrassed and ashamed. And like, I just left and like, for 10 years, I neglected my diagnosis. I just told myself, boy, it would be okay, like, I got this bar, at least I passed on my board exams, I should be grateful that I’m even here. And so I told me, so I’m just gonna keep working harder and harder, like I can’t, I can work hard, like, I know that. It’ll pay off. And it was like a love hate relationship. Because I, it was a privilege to be able to take care of my patients. But it was, like, I hated the administrative part of it, where I had to write all these notes, because I was like, nobody was paying attention. I just did an amazing job of they’re like, somebody should have recorded that. Why does Delta write a note? And in my mind, would tell me things like, You’re too slow. Or you’re not writing it right? Or, you know, and of course, like, who’s to say you’re slower, or you’re not writing it? Right? Like, I’ve had to learn later discover that some of the thoughts that we have, like, they’re just there, and doesn’t mean they’re true, but if we never question them, like, you keep buying into that same thing, like it wasn’t until one of my coaches was like, Okay, so, which, which English class? Did you flunk? Or what Spanish class? Did you plan for? What what what did you flunk? That was a writing class? And I was like, Well, none. And then why is your brain telling you you don’t know how to write it? And I was like, oh, yeah, I guess I didn’t think about it that way. And so I say all this because there’s so many times that we don’t realize that we have preservation, we are living, we’re just, we just have habits. And we do routines that we don’t even question. And we think that well, they got us here, right? But we don’t realize they’re gonna get us there. And, and that’s why all of a sudden, I knew something had to change. I just didn’t know what and then I heard about coaching on one of the podcasts, and I joined Sonny Smith’s empower women physician group, this was in October of 2020. And I didn’t go in there thinking I’m gonna start a business. I just went in there because she said there were some CME credits. And she said that it was gonna help you, like be a better leader or something like that. So I was like, okay, I can do that, you know. And so while I was in there, I saw like, how normalizing it was to start having conversation of what it meant to like, have feelings, not keep masking stuff, realizing that we’ve all gone to, through challenges, and that you’re not your challenge, like, and so I came to realize that ADHD, I could see it as something that was disabling to me, or something that could be used as a superpower. Because with ADHD, it’s a spectrum. And it’s either, you’re told,
Dr. Diana Mercado-Marmarosh 13:49
You’re too much. Or you’re told, Oh, that great job, you’re being such a great leader, like you spoke up, you said whatever, right. And so it could be like, good and bad, but at the same time, like, I didn’t make it mean anything if I missed up something, because I just knew it might take me a couple of trials until I got it right. And that’s what I wanted to do. And so it could be seen also as a persistent, right or insistent, or whatever you want to look at it. Stubborn, whatever. But the point is that the more that I was in that program, I realized that maybe coaching was a way for, for me to help myself and maybe to help other people who might have similar experiences as myself that maybe they weren’t even talking about. And so I decided to share my story in February of 21. And that was in a podcast that was called the choice yet because ADHD II for smart as women. And it was the first time that I talked about my story because prior to that, I think I had told five people that I had ADHD because to me, it was a very shameful thing. And when I did that, all of a sudden, all these people from all around the world medical students, physicians all around the world, Australia, Canada, Brazil, like they started emailing me and telling me, Wow, I really related to your story. Like I could have said everything. Like, I thought I was the only one. And, and that like, that just moved me so much to be able to tell like somebody somewhere who’s listening to a podcast, like you don’t even know who it could like impact. And it was through that, that I was like, Okay, I don’t see anybody saying that they’re specifically helping this type of high achieving people. Why not me? Like, they don’t have to tell me a lot of stuff. I already know. I’ve been coached all. So by the time I decided to start to understand my diet, my diagnosis, and not to make it mean anything like I was like, Well, I don’t shame anybody for having diabetes, or high blood pressure, cholesterol. And they have to have information in order to do something about it. Like, why don’t you get information about it, so you can do something about it. So I came to understand that ADHD started and ended with me, like, I could use it as a way to empower myself. Or I could use it as a way to cripple myself, like, it could go either way. And so I knew I didn’t have any time awareness, I know how to start using external cues. And so with, you know, some using timers, somebody comes and knocks on my door and says, Hey, Dr. McCulloh, do you need anything? And then I say, Yes, I need a TD app, or I need a UA or I need the labs printed, please? Or do you have a sample of blah, blah, blah. And so it almost became them part of like the routine. And so I knew that when it came knock, I should be wrapping it up, I should have entered orders, I should have done something. And of course, I know that. It is what it is. Some patients take a little longer, some take Don’t you know, but it gave me a starting point, a way to then set up a different routine instead of being three hours late,
Dr. Diana Mercado-Marmarosh 17:23
you know, to be
Dr. Diana Mercado-Marmarosh17:24
maybe an hour and a half or an hour late, right. And so it just started to to change. And believe me, I had to learn that it was going to take whatever it was going to take, and I wasn’t going to make it mean anything. And then when I would walk in instead of saying sorry for being late, I started to say thank you for your patience. It’s so great to see you today. And of course, it changed for me, because then I feel already bad to start a relationship with that patient, saying I’m sorry, like you’re always almost like an inferior even though like they don’t know you haven’t eaten or you haven’t done XY and Z and you’re still, you know, like, and so I have to learn all these boundaries there to say, yes, I would love to see you, but not an hour later than your scheduled appointment. So like, yeah, come back next time. Right. So you just had to learn to realize that you were the most important patient in the room, not that you were angry when you knew that. And you were aware that? How am I doing? Did I eat? Did I eat? Did I do a five minute meditation? Did I what? Like when you started checking in with you, then everything else changed because then I didn’t. I wasn’t sub functioning. I was fully functioning. And and I didn’t even realize I was sub functioning because I had been the norm forever. And again, it was that love hate relationship like you love your patients so much that you keep showing up. But then you pay for it later.
Dr. Ryan Stegink 18:57
Yeah. Well, thanks so much for sharing your story again. And I think it’s really helpful just to see how some of these things being brought to your awareness through coaching, and just others speaking into your life. That allowed you to say it’s like, okay, what, what story? Am I telling myself? What, what am I feeding myself that it’s been so ingrained? That I believe it? And I think sometimes we just have to push back against some of those things that maybe explicitly taught or implicitly taught that hidden curriculum in Medicine says, oh, it’s like, well, this is the ideal situation. And this is the perfect thing. And this is how much time we’re giving you. But every patient is different. And I want to be fully present with each of them. And so I really liked what you said. It’s like, Thanks for your patience. I’m so happy to see you today and be able to help you with whatever you have to bring to your session. Yeah,
Dr. Diana Mercado-Marmarosh 19:59
you Yeah, because now you’re starting from a place of like, gratitude that they’re there instead of a place from, like, shame that I’m making. Right? It’s such a different energy in the room. And of course, I mean, it’s not like, everybody’s always gonna be like, grateful that you took so long, right? But once they see that you’re there and you are fully present, like, they didn’t mean, it changes like, and of course, you always have some that you’re just like, well bless you on your way out, right? But it is what it is. And you have to learn yourself. And it’s how you present to everybody is different. And that’s the beauty of it. Because I love to joke around with my patients that and when they come and they haven’t come in a while, and they’re like this and this, and then I’m like, Oh, my God, I’m like, you’re broke, and I will what’s quite odd, you see, like WD 40, and everything. Yeah, so I think it’s just important for you to realize that you’re human, and that you get to show up as human, you know.
Dr. Ryan Stegink 21:07
So I’m just finding out what makes makes that rapport connection, like work for you, if it’s your same jokes that you use. It’s like, things that you know, that maybe you write in their sticky note in the chart. For me, it’s like, I have patients in my clinic from all over the world. And I speak Spanish, not fluently, but well enough that I’m able to do my visits in Spanish, but even other languages. I know, a little bit of Yoruba, Swahili, Somali, like other greetings, saving, even just saying, even just knowing a few greetings, it just so their face lights up, because you tried. And then they can laugh and be like, you actually know how to say, thank you, goodbye. How’s your baby, your baby’s fine. And it’s just so helpful for bringing that back. As you’re trying to keep moving forward. It doesn’t have to take so long during the day, but it just helps keep that human connection. Like you’re saying,
Dr. Diana Mercado-Marmarosh 22:12
yeah, like, I tried to make an effort, as I’m coming in. Like I say, Oh, my God, it’s September, it’s December is gonna be here already. Or where did the Summer Go? Or what did you do this summer? What are venture digitaler? Like, I tried to ask them something. Because then that just it’s like, you’re talking to a friend like it just eases into it. And then I’d say, Well, you know, I was looking at your labs, right? Before I walked in, I see that you’ve done so great, even though you’re a one sister nine, like you were 13 last time. So that’s really good. And so I think it’s just about realizing that everybody, I think everybody’s always trying their best. But of course, some of us have a little bit more challenges and others. And so instead of asking them, like what’s wrong with you, you learn to ask like what’s going on? Because then you can have more insight that it’s not that they want to take their math, they couldn’t afford their mat or something. Right. And so I think it’s just like you said, making the effort to see them as the person, not the disease on the chart, right like that, that makes such a difference. And I think that’s probably one of the reasons why I still have a job. Because, I mean, when I had all those notes open, like, you know that you’re the admin, it’s like, worst nightmare, right? When they’re like, We need to get paid for this things, right? I mean, they would always get done, but because the report you build with the patients, and they keep saying like, Oh, most amazing doctor, I’ll wait three months, six months, whatever, right? It, it just that just precedes you, you know. And I remember like, when I right now, I’m working like two hours south of Houston. But I have for the longest time for the two or three years later, like people driving down two hours to come see me. I’m like, You have a lot of doctors in Houston, what are you doing talking to a little town life. But it’s just, it just shows you that you know, it’s so important to have that connection.
Dr. Ryan Stegink 24:22
So as you think about that connection, and yet those administrative burdens and where you were, what specific steps did you take first to help you get caught up and to be that proactive? Intentional? To get to where you are now?
Dr. Diana Mercado-Marmarosh 24:39
Yeah, so I think my brain kept offering me the thought. You don’t have enough time. Like, you don’t have enough time for you. You don’t have a talk for family. You don’t have enough time for whatever. And I had to ask myself like, what are the things But I only I can do like that would make a difference, right like, and I actually had to start thinking that way. And even though I kept telling myself, I don’t have enough time, like, I knew that the investment investment in myself would make me find the time. So when I invested in in ew P, which I never even knew what coaching was, I signed up for this program, and I didn’t even know what coaching was. But it just sounded like I was gonna get some leadership thing, right. And then I was like, Huh, I wonder what it would be like, if life coaching is cool. I wonder what if I invest in ADHD coaching, like, that’s even more specific. And I didn’t even know that existed, like, I would have tried it since medical school had I know that was there. And so all of a sudden, like, when I didn’t even have enough time, I’m like signing up for private one on one ADHD coaching, group coaching and like, trying to do live, all while still having a full job and being clinical director, and then I got promoted to Chief Medical Officer. So I think it was going back to like, what’s my priority? Like, what’s gonna matter? Like, a week? And a year? Like, what do I have to let go of, so that I can do the things that only I can do? Or the things I really want to do? Not that I have to do? And I think that was like the shift? Because and believe me, at the beginning, it was hard, because even though I was paying like three or $400, for this private one on one session with my coach, I missed the first two. Because even though I was blocked in, in paper, right, like I was blocked, they would have booked it before. So like, I was still in that mindset that, well, the patient comes first, right? And I remember one day, I got home, and I was so pissed at my husband, I cannot believe them that it did the job. This is a second time I missed this. And I already told them like, this is what I’m doing trying to get back. And he looked at me and he’s like, did they put a gun to your head? I was like, Well, no. And he’s like, so why is their time more worthy than yours? I didn’t say that. He’s like, by directions did, he’s like, You could have said, your double booked it, you tell them that I have an appointment, I have a meeting I have whatever. From this time to that time, the patient is welcome to wait. Or the administrator can go and explain why. And you do your thing. Like if you already paid somebody or whatever. And so from then I was like, my time is more important. Like my, if I’m right there, right. Like, you know, if I am 100% present, then they get better me. So I think it was those two situations in that conversation. That again, got me to see that. Yeah, I mean, work would go on if something happened to me on the way home or something, right? They will replace me.
Dr. Diana Mercado-Marmarosh 28:21
I don’t want to think that way. But it’s true, like life goes on for everybody who keeps living. And so I’m like, What am I gonna be happy? When am I gonna choose me? Or my family? You know, if all I’m doing is charting, like I knew something had to change. So first thing I knew I couldn’t be writing chapters. That’s what I wanted to write. Like, I wanted to be writing chapters of books. It was just supposed to be a page in the book, right? But in my mind, like, I wanted to pretend I was a specialist, I was gonna send this person to write it. And so I was like, No, my job is to really, I started doing bullet notes. And I just started to use my assessment and plan to narrow my HPI. And I started to get to like, what would I want to know, in 1530 seconds before I walked into the next doctor’s appointment like or to my colleagues reading, like before they walked into the room, and I started to consider them as they were just love notes. For the patients. It was just what happened right now. I don’t have to write the whole book. I just have to have to write what’s going on today. Right? And so I think my mind shifted from perfect notes to like, Done is better than not done and done right now. It’s gonna be more accurate than later. And right now it’s gonna take me three to five minutes and later it’s gonna take me 10 to 20. And so, I just started to little by little start using timer Start using music start using different things. And realizing that whenever I was getting tired it was because I probably hadn’t taken a break or I hadn’t eaten, or I had not set a boundary somewhere that got me into trouble. Like I allowed people to keep texting me or pulling me out of the room or doing different things that were distracting because, you know, I also cover the hospital. And then at that time, I was covering the nursing home, and then I was doing the clinic. And so for somebody who doesn’t have ADHD, an interruption like that could only take you maybe two minutes to for you to get back on track with somebody with ADHD might be 15 minutes. It’s not that you’re trying to do too low. It’s just you didn’t set you’re like, you need to tell people give me give me a second, let me finish my thought. And then you answer because then that that’s gone. And then good luck, right? And so that’s why sometimes it takes us forever to reply to a text message. We saw it, but then we were distracted with something else. And then like a week later, you’re like, Oh, my God, I didn’t even reply by it. And so it’s, you start to realize where some of your blind spots might be that you don’t even know what blind spots, and then you just start to find systems or safety nets to help you to do that. So what I think what was most valuable for me was figuring out how to systematize things so that not, I wasn’t responsible for everything in my in basket, figuring out, oh, let me order labs one week before, and then have the patients come. So have the labs done, come see me and then we talk about your lab. So then I don’t have to be going through all the labs, like they’re coming so I can talk to them about it. And if they miss the lab, like my nurse would call them and be like, hey, you need to reschedule. So like having a system, and then figuring out, okay, I’m not just gonna do it for me, because I’m the Medical Director, we’re having a meeting, we’re doing it all this way. So that way, it doesn’t matter if there’s covering me or covering you. This is how we’re doing it, or like med refills, like don’t bother me, give them 30 days. And then if it’s a controlled substance, they have to come see me every three months. Like that’s it. And not not just for me, for everybody. We’re all doing a contract. We’re all like, making it to where how can I make it simple for me, but not just for me for everybody so that the nurses are like, Well, what about this? Well, it’s well done, instructors, you know, we’re all doing it the same way. Don’t get confused. We’re on the same page. I think when people realize the reason we were doing that was to decrease our burnout in our administrative stuff. Did that the other people want to do it? Probably not right? Because that’s more work on their plate. But when they realize that they all get to go home earlier, then it worked out, you know, you just have to find a way to have others step up and become team players. Because decisions are not secretaries, even though it that’s why it feels like at the end of the day, sometimes
Dr. Ryan Stegink 33:16
I find myself have some time to help give some insight into how the EMR like works and how to customize some things. And yeah, whenever there’s an opportunity to say, who who should be doing this? Or how do we get the computer that already knows some of these data points, to be able to file them so that reports can be run, I don’t need to check every single box. I shouldn’t be doing that. And if we’re going to add something, can we take something else away? Because yeah, like you said, it needs to be the right person at the right time, doing the right thing. And even, it’s just bringing some of those things to awareness. So for me, our clinic had some remodeling construction. And that kind of shook things up. And it was finally the impetus for me to go even more room to room. And so I now finish, probably 90 95% of the time can finish my note in the room. But I make sure I sign the orders, especially since I’m a pediatrician, and I’ll get the vaccines all queued up, say when I want them to come back. And if I want them to come back for vaccines, I’ll often put that in my note so they don’t have to call me or secure chat me in the EMR to say what do you want for them? I already looked at it and I dealt with it. And then I go to the next room because previously I would go back to the work room and login and finish my note there. But then I’d end up talking because I’m social even though I’m an introvert and I’m easily lose some of my train of thought it it just took extra time the steps but when the construction was there and I had to go way around I just sat with that discomfort, that feeling and allowed it so that then I could choose to say no, I’m going to finish this, and even just telling the patient, I’m finishing up my note and talk to the kids in middle school and say, Does anyone like more homework? Neither does Dr. Ryan. So that’s really helpful, just what you did for yourself. But then with your leadership role, being able to do that for the clinic, I think that’s really, really inspiring. Yeah,
Dr. Diana Mercado-Marmarosh 35:33
I think that when you when you show up and you, and I mean, it took, it took a little bit to get over myself, right, because I had this like, shame about ADHD. But then when I started getting coaching, I was like, Okay, kids, not that they’re kids. But that’s how I felt. I was like, Okay, kids, mom has a confession, I have ADHD. So please help me help you. Do this as a team. And, and so I think it was really good that I did that. Because then no longer was I feeling this like pressure that I was putting on myself. And it actually it started the discussion. And you’d be surprised how many more people I been able to diagnose. And, and now it’s like, Okay, Dr. Mike Gallo is the diabetes experts, large ADHD, dash, like anxiety and depression Queen over there. Because, like, we don’t have an endocrinologist. And so that was, that was just my expertise not or I just loved it. Because I could see that point. I could explain things to people that, yeah, like beans and rice, actually are still carbs. They’re like, why? And I was like, I know corn too. They’re like, wow. And so you tell them, you know, and then when you start to see that they make changes, it changes. But to your point, like, when you set up your system, like when you know what you’re doing, and then you start to automatize it that even though it feels very painful at the beginning, when you’re starting something new or different. Feels weird, because our brain wants to go back to the old thing that might have been painful, but you knew the level of pain, like this is just a muscle repetition. And then eventually that becomes your new norm. And and then when you don’t do it that way. You’re like, how come I was like, it feels off it and so I think like for me, like I tell them, I literally tell them help me help you. Like if the patient is telling you they have urinary frequency get the UAE before I walk in, like have it ready for me. Okay, they’re here for a wellness, like, look it up? Which vaccines do they need? Like, here’s the list, give it to them, like start the timer before I walk in, they already had it. Now if they want to have a discussion about HPV, or I’ll have the discussion, but how are we ready, because they’re gonna get it, you know, like nine out of 10, I’m able to talk him into it. And so I think just knowing and then like training your staff like telling them, okay, Dr. America, my address one or two things with you, she’s not going to address 15? Like, what are your top two? Right? And so it takes the whole team to tell them, of course, you want to talk to Dr. McDowell for two hours, she wants to talk to you too, but you have to split it up. Like you can’t split it up, you know? And so I think if you tell them to help you, then they can help you otherwise.
Dr. Diana Mercado-Marmarosh 38:37
If they don’t, then like you’re though you’re trying to be the quarterback
Dr. Diana Mercado-Marmarosh 38:43
and The Waterboy at the same time, and it’s hard.
Dr. Ryan Stegink 38:47
Yeah. Well, it just is empowering to them. And it’s an opportunity to train and invest in them. And I encourage them to say it’s like, why are you ordering this? It’s like That’s not typical. And it’s like, well, they’re traveling and they need their meningitis vaccine before their sixth grade shots, or whatever the case may be. Or then sometimes they’ll be like, did you really mean to order that? And it’s like, oh, no, I did not thank you for doing that. And so it’s it’s that team approach because I think it’s for so long. I thought it’s like, oh, I have to do this or I have to call and maybe that slightly abnormal result can be called in the next hour or two. It’s not going to be an emergency.
Dr. Diana Mercado-Marmarosh 39:30
It’s also like realizing that if you tell them what you’re trying to accomplish, like it can be so much helpful. Like you know, sometimes your your whole activity is like getting out so that you can go to your kids game or or to a dentist appointment you’re going to miss or to a conference that you’re trying to fly out to like they still tell me document that’s been a little bit unreasonable. You’re telling me you have to drive to Austin, and you have to be there at three to get on that boat, but you want to leave at noon, they’re like, I think you need to cancel the morning. And so sometimes, like, just sharing with them what you’re going through, I mean, not all the details, but at least what you’re trying to accomplish, then they can find ways and help you to like, there’ll be like, oh, yeah, she cannot meet with you. Like if a drug rep is trying to talk to me at lunch, they’re like, no, no, she has a meeting or whatever. So. So they can also be like, they can carve out your time and give you that sanctuary of five minutes for you to eat without somebody else taking away your time, right.
Dr. Ryan Stegink 40:36
Or if you realize that your medical assistant is doing vaccines and bloodwork for two or three siblings, they’re just recruiting one of their colleagues and saying, Hey, can you read my next patient? And so I think some of it’s just that proactivity and taking the time to really slow down and consider what the processes are. And then you can say, which little steps do we want to do? Because we’ve all done hard things. We’ve all done new things that seemed really awkward at first, I remember doing my second year physical exam training and seeing the standardized patient and I was like, How do I put this all together? And then it’s like, now you just go take a history and physical and it’s a lot more automatic. So I think just realizing that it’s a process and taking those first steps.
Dr. Diana Mercado-Marmarosh 41:25
Yeah. And then, and then once you are doing whatever you’re doing, like even asking yourself, what went well today? Like a lot of us don’t take that time, right? Because we just like app, whatever. And we think that what went well, the reason you close your nose is because you had three no shows. But no, it wasn’t that like maybe that helped a little, but it was probably your mindset, or it was something that you did along the way. And realizing what are you doing well, or what threw you off? What was the distraction. And we don’t take that moment in time, some time to reflect because we’re so busy trying to like keep going. But it’s in that pause that then you were like, okay, yes, I really did do this or, or no, that doesn’t work, and maybe be being willing to like speak up and say, You know what, like, I’m not the best. At the end of the day, let’s put like three accused back to back at the last four slots, or a phone call, like three last phone calls, right? So that it doesn’t matter when I call them at whatever time I call them. Like, it’s okay, they’re not in person here, like bringing down my neck or whatever, right? Like realizing if you’re somebody who’s like, can’t, doesn’t like to wake up early, like maybe start to clinic a little later tend to tend to for whatever, like you get to decide how right and not make it mean anything. Yeah, so my my clinic is so cool, like, in the sense that we are open seven to seven. But you as a provider get to decide like you can come in from seven to seven and work three shifts and call it full time and you’re done. Or you could come in like seven to five, for shifts, or or eight to three, whatever you you get to decide. However, as long as you see what you need to see, you’re okay. And so that provides some flexibility for the moms or the dads who have to pick up kids from daycare and different things like that. And when you are thinking of the wellness of the people, then they stay right because it’s a family you’re pitching in, versus like being non non flexible. And, and then we also have a Saturday clinic, which is cool, because then we rotate one physician or one nurse practitioner on a Saturday. And that that means during the week, you have one extra day off for you to do whatever when you’re recovering that Saturday. So it’s just being willing to think outside the box to be creative to ask, How can I show up the best for my patient? But before I show up for them, how did I show up for me first?
Dr. Ryan Stegink 44:01
Yeah, well in just making some of those, those asks of like, this is what I need for my family in this season. But find ways to say how can we make this a win win, to speak leadership’s language of saying I was previously split at two clinics as I was for the first probably four and a half years. And then it’s like, how can we make this work? It’s like well, actually the clinic I want to be at I have a lower no show rate. I have more completed visits, and I’d be happier. So and then I have more continuity. So it ended up being a win win. It just took some time to get those moving pieces together.
Dr. Diana Mercado-Marmarosh 44:41
Yeah, it’s you becoming aware of those right? Like if you don’t even know that. Those key things, it’s hard for you to advocate for yourself because you even know we’re really good at this other place where you really want it to be.
Dr. Ryan Stegink 44:56
So if you had one piece of advice for someone who’s just coming out of training to say how, how should they think about their processes or even just to have whether they might need to get evaluated for ADHD? How did how would you advise someone early in their career? Yeah, so
Dr. Diana Mercado-Marmarosh 45:14
one takeaway point, whether you’re just starting your career as a resident, or whether you’ve already been doing this for 20 years, and you were still hitting your head against the wall, is give yourself three to five minutes before you walk into the other patient room. Your aim is to close your note. But if you are not able to, because some patients are a little bit more complex than others, still give yourself those solid three to five minutes to do your assessment and plan. Because usually, the assessment and plan is the meat is the meat. And I don’t know how your EMR is but in mind, and I don’t do it right there. And then I have to spend another three to five minutes just trying to figure out where I ordered where I, the vitals were, it’s like five clicks to try to figure out what I did that day. But if you give yourself the assessment and plan, then it’s easy to for you even closer, right there. And then at the end of the day, or the next day to go back and be like, Oh, I can put this in my HPI, I can put that in my assessment and my physical exam and the new you’re done. Like it literally takes you one or two minutes to complete there after, instead of 10. And so that makes a big difference. That would be one one advice in terms of the ADHD, or anxiety or depression or anything else that you might want to get evaluated. Realize that you know or energy levels or frustration or irritability might have to do because there is something where you are not really fulfilling your role. Like maybe you’re not being efficient, maybe you’re not exercising, you’re not sleeping, you’re not doing anything else. But you could also have hypothyroidism or something else going on. So it’s important for you to realize that some sometimes emotional dysregulation might be that you’re just very irritable at the end of the day. And you might think that that’s normal. But it’s not really normal. If all of a sudden people are looking at you like why why did they react this way? To you? It’s so obvious or might not be? For me, it wasn’t obvious that it was my inability to prioritize because everything coming at me felt like it was an emergency. And I didn’t realize that. No, it really is not an emergency like her wanting me to put like an order for IV fluids is not an emergency is not going to trump me getting out of my room. So that then I can go back into that room. And then they have five other questions for me. So I had to like realize that. Is there something there that is slowing me down? Is it me? Or is it that I’m getting distracted? Or what? So what I’m saying is, with ADHD, sometimes we’re impulsive. Sometimes we interrupt people, because we’re trying not to forget what they’re telling us. Sometimes we look really moody. And so I say all this because you might be labeling that physician as lazy or, or late or disruptive or whatever. But it might be that they’re really trying to hardest. It’s just that they don’t they’re not aware that that they don’t know that they don’t know, because maybe nobody’s told them that they could have ADHD or they could have autism, or they could have something else. But because probably their love for that field is fueling them to finish and do whatever. So so just approach it from the perspective. Hey, you could approach you’re like, Hey, I see that, you know, you seem like you might have been struggling or you were upset yesterday. Is there something going on? You don’t have to tell them you have ADHD or anything, right? But you could just say, Hey, I see that something might be going on. Can I help you in any way? You know, sometimes just normalizing it and talking to them, like, can can seek the awareness like I would have never known I had ADHD? Hadn’t my roommate told me? Yeah, I see you studying like 80 to 100 hours, and I don’t see your retaining information. You read that three times already? What’s going on? So has she not told me that? I would have thought well, I don’t know if maybe English is my second language. Like I have to read it three times. I don’t know all this medical vocabulary, right? But it took somebody else observing that. So I think well, now I can look back and be like, oh, yeah, my family, my family. But I at that point, I couldn’t because that was just my norm. So I think what’s important is that if you feel like maybe Eat, you’re working a little bit harder
Dr. Diana Mercado-Marmarosh 50:03
than your colleagues. And it’s not to compare and despair. But, you know, you will know, if you’re like, how come everybody’s at home and I’m still here, like, you have that time blindness, and you don’t even know you have it, like, just just look into it. And I can send you a link if you like. It’s a perfect it’s a journal on how to identify ADHD and physicians. And it’s a really well written article that has these conversations on how to help identify it.
Dr. Ryan Stegink 50:35
Right? I can include that in the show notes. If someone wants to learn more about you how to work with you, where could they find you online?
Dr. Diana Mercado-Marmarosh 50:43
Yes, come to my website. It’s ADHD, dash life. coach.com. Or you can find me on Tik Tok or Instagram, beyond ADHD, a physician’s perspective. And if you do go to my website, like every month, I have a free webinar where you can come and like learn, like in basket tips or charting tips or boundary tips. But you know, what is important is that you just invest in yourself, whether it’s with me or the Ryan, or with anybody out there, who’s teaching you how to improve your work life, because you are your most important investment. And I mean, how much money do we spend trying to get to med school? And then how much money do we invest in our houses and our purses and our things, right? And those, they depreciate, but what you put in your brain, the quality in all the hours. So think about that think that you are worth this investment, because I know usually we all prioritize ourselves. But when you do, oh my god, it’s amazing. The ripple effect that happens also you get the better mom, their wife, better patient, better physician, and you’re not even trying you’re just more better you and not because you needed to be but just because all of a sudden you start to align with what you really want it to be you start dreaming again.
Dr. Ryan Stegink 52:09
So great. Thank you so much, Dr. Mercola, for joining me on the MedEdWell podcast and sharing such amazing insights.
Dr. Diana Mercado-Marmarosh 52:18
Thank you so much for having this platform inspiring everybody.
Dr. Ryan Stegink 52:23
For all of you listening, I want you to consider how you can apply what you’ve learned from Dr. Mercola, and today’s discussion. And then please share this podcast with another doctor in your life and subscribe to the podcast. You can help change the culture of medicine and promote wellness for your patients, your colleagues and yourself. Thank you so much for all that you do, and have a great day. And now for our important disclaimer. Dr. Ryan Stegman is a practicing general pediatrician at the MedEdWell podcast is not reflected, I believe. Additionally, the MedEdWell podcast is for educational and entertainment purposes should not be considered advice regarding legal, medical, or any other specific in such a case, you should seek consultation with a certified professional in that particular area. Again, thanks for joining us on the MedEdWell podcast. Have a great day