Dr. Diana Mercado-Marmarosh: Come join me May 1st through the sixth so that you can rest rediscover your strengths, reconnect with yourself and those physicians like you who are ready to leave work at work. And re-energize. This is the invitation for you to make 2023 your year. Join me in Costa Rica in this really amazing, non-judgmental, intimate decision community.

I am gonna show you how to rest and how to recharge. Let's transform your brain. So that you can start to dream the life that you always wanted this year in 2023. I can't wait to learn all about what kind of year you're gonna have after this conference. Take care. Hello. Welcome to Beyond ADHD, a Physician's Perspective.

I am Dr. Deanna Mecado Mar. I'm a family medicine physician practicing in rural Texas. 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 a personal life. In the past two years, I've come to realize that unlearning some of my beliefs and some of my habits, We're just as important as learning the new set of skills.

Hello.

Dr. Brittany Panico: Welcome everybody. I am Dr. Panco. Dr. Brittany Panco. I'm a rheumatologist in the Phoenix, Arizona area, and I'm here today with Dr. Marcado. She's a family medicine physician in Texas, and we are here to talk about time management techniques and how this can be important for people with all kinds of health conditions, particularly.

Autoimmune conditions. Dr. Mercado is a specialist with a d h, ADHD and is a life coach specifically for physicians, primarily, but adults with A D H D, and she has. A coaching program that helps people reclaim their time. She has developed systems that help people live life with time management techniques and time awareness, and I'm really excited to talk to her today about how this can overlap with virtually any chronic condition, particularly patients who struggle with things like fatigue and just being aware of how, we can create time and how we can get.

The things that we have to do with ease and less stress. So welcome Dr.

Dr. Diana Mercado-Marmarosh: Mercado. Thank you so much for having me, Dr. Panko. Yeah, like three years ago, I would've never thought, Hey, I'm giving this lecture, or I'm giving this talk, or we're having this conversation because I. Was somebody who always was drowning with a graveyard of unfinished projects and I just could not find enough time.

I couldn't even put myself on the calendar because I felt like there was so much to do that I was always negative in time. And . So anyways, the pandemic did a good number at getting us to focus on what is really critical here, because no longer did you have maybe the community that you were unaware that you had at your fingertips because, as a physician you're being cautious how many extra interactions you're having cuz you didn't wanna be in asymptomatic carrier of a disease that you could get somebody sick.

And . Yeah. So that got me to start to think, how can I do this in a creative way that doesn't feel like a drag ? And how can I do it in a way where it feels like I have some control? And I think with chronic diseases like autoimmune or even like chronic diseases like diabetes or high blood pressure, or even a D H D to where.

So much we feel sometimes it's out of our control and right. And it can make us feel like, what's the point? What's the point when I can plan to unru in the face, but it's not gonna happen. And so I think this is where then I started to realize that we are all in our own journey and that we shouldn't be looking at what our neighbors doing to measure ourselves like that.

We should look. where my zone is, like where I am at, and have that awareness that our executive function or our emotional regulation tools are gonna bury from day to day. And being aware enough to recognize. , how am I today? Am I at my 80%? Am I at my 120% or am I at my 20%? And nothing is good or bad if you're under 20 or you're in your 80.

It's just being aware enough to then create the systems to support you in that energy state. The thing is with our brain can't tell. , if we. If we feel like something's gonna be hard or easy, but it normally is conditioned to think that everything's hard, , . It's just conditioned to think that way because it's trying to keep us safe.

It doesn't want you to be in any pain. Like I haven't met anybody who wakes up and says, oh, today I can't wait to Inflict so much pain on myself that I'm just gonna be paralyzed and not do anything that I said I told myself I would do. And so I bring that up because sometimes we're not aware that some of the things that we're doing might be like a trauma response to a situation.

. And so we all hear five flight, but we sometimes don't hear a freeze or faw, which is like people pleasing. And so today, , when I wanna talk to you about how to create time with ease, it's gonna be I can tell you all the things, but really you have to look into yourself cuz you hold the answers and see, okay, yeah, I work best when this or this or this.

And you have to. Pick out what you like and then be willing to try something different that maybe you weren't aware of. So for example, people pleasing and saying, no are the fastest way. Setting boundaries are the fastest ways to create time, because if you are passionate about something, and then for example, you want to dance Zumba or you want to read a book, all of a sudden, like you had a block time to do that and somebody asked you to do something else and it wasn't really what you wanted to do, but you said yes.

Now you're not realizing that saying yes to that thing is saying no to yourself or say, and so that's what I mean when I say create time with ease, because if you are. Thinking not from a selfish way, but from a way of how do I refuel my cup so that I can be at that 80% if I need to be at that 80% instead of being at the 20% and not being aware that you have the 20%, that's the fastest wage for you to be able to have more energy.

And like I said, I know that there's sometimes things are outta control. Maybe the Zumba instructor canceled on you and you already had it on your calendar, right? So deciding on purpose, okay, what is my plan B for self-care? Maybe my plan B is just reading a book like, or maybe it is calling a friend or maybe it is.

to have tea by yourself and relaxing, like realizing that you still have that block time for you is how you continue to feel your cup. And when you do that, all of a sudden you're like in a place of abundance. And if you do decide you want to do something, you're not feeling like you're having to or an obligation to.

can be very energy draining and time draining because you're there and you're like thinking, why did I do this again? And like, all that reminiscent, right? All that energy Yeah. And emotional tasks that drain us. And so it, it's so important to realize that to create time, you can plan things but have a loose planning to it to where you're not so rigid and then you're then disappointed.

Life happened, but where at least if life happens, you still have some flexibility or some fluidity to it instead of like just being stuck. Does that resonate with you? It does. I

Dr. Brittany Panico: love it because oftentimes we'll book so many things in our day or tell ourselves we have to do all of these things, and then we're just rushing on and on to.

And I find that way with work, especially when we have a certain number of tasks to complete in the day, and if we get behind or something takes a little bit longer than we planned in our brain, that's just so much energy being consumed to think about rushing onto the next thing. So I like how you talk about building an a little bit of a buffer because that allows our brain recover.

from the event that we did or the thing that we had planned. Because for people who tend to be more introverted, that running or that motion even in your brain is so energy consuming and leaves people really feeling exhausted. So I really like how you explained

Dr. Diana Mercado-Marmarosh: that. Yeah. In another way to think about it.

Is we all wake up with a certain amount of decision making capacity. Executive function. Okay. So if hopefully you slept six or seven hours, we can say we wake up with a hundred percent battery of decision making capacity. And as we go through our day, the more decisions that we make, Like it depletes it a little, depletes it a little, depletes it a little.

So if you are not checking in with yourself before you know it, like we're overwhelmed, we're anxious, we're angry, because maybe we haven't like you just said, slow down enough to acknowledge did I finish this task? Did I switch to another task or and we're not and when? Switch from task to task, and people say, oh I'm multitasking.

It really is not helpful. There's studies out there that show that if you just stuck to one task from completion to end, like you could get through like what? It would take you in a whole year when you're multitasking. You could get through everything in nine months, you would have three months to yourself of doing nothing , and you just kept one task at a time and I know it's like human nature or sometimes it's just the environment that we're in, that.

Pushes us there. Ki if you are a physician and you're in a busy practice and somebody ask you this and somebody ask you that and la da, or then the phone dings or we are constantly being pulled in many directions, but when you again, are intentional and saying, okay. Give me a second.

When somebody comes and disrupts you and you finish your thought and then you pay attention to them, it, it might feel weird, but you needed that nugget for you to complete that thought in order to then fully give them your attention. Because otherwise it might take you 10 or 20 minutes just to try to get back to that task that you were doing.

And that's where we feel. We're losing time and we might not even be doing the task, but you're pissed off that they interrupted you. Again, that emotional like tax that drains your executive function, right? The

Dr. Brittany Panico: ruminating Yeah.

Dr. Diana Mercado-Marmarosh: It gets to . Yeah. And on purpose, like having set break points for yourself and saying, okay, after seeing 10 patients or after like at 11 o'clock, like I usually start to feel drained.

Like at 11 o'clock I'm gonna go to the restroom. I'm gonna take three minutes to do my tapping meditation, or three minutes to just take a deep breath , and then come back and get me a glass of water and then keep going. I know it sounds weird, but. Few minutes of you being purposeful, you are actually creating time because you are allowing your nervous system to decrease that cortisol level, that adrenaline rush that go into Okay, right here, right now, this is what I'm doing.

Right here, right now, . And so it allows you to increase your norepinephrine and oxytocin and it slows down the pace a little bit, enough for you to catch up with yourself and then keep going. And the more that you do this on purpose, the more that you start to see. . Yeah, I have a sense of time.

And somebody with a d h d, we, we have time blindness and so sometimes we have to use we have to use timers to get, to be our external source of time awareness. And so not making it mean anything, if you need a. Like if that means your husband comes and taps at you, or your nurse comes and asks you or your child, if you tell your child, Hey, after you finish watching that cartoon, come check on me and see how I'm doing and being aware to use others to help you to manage the time is the fastest way. The kids are like the most amazing at being like present in the experience, right? They have that curiosity and that sense of awe and everything. And we might pass and see the same thing and we might not think anything because we didn't even see it, right?

And it's just remembering that to create time with ease, you have to start with what you really want. Because if you don't even have an intention at the beginning of the day, believe me, somebody else will put all of their intentions in your calendar. Exactly. And it's not yours. And if you waited to earn it, You're never gonna earn it because we're so hard on ourselves.

So what I say is have a dopamine menu. Meaning what are the things that are gonna boost up your energy, your excitement, or just your peace, right? Because we're maybe something we're just trying to neutralize when we're like on overdrive. We're just trying to get to like neutral ground. And if you on purpose can pull out the things that you like, whether it's looking at your.

The vacation you're gonna go to, looking at pictures at the beach or looking at the mountain, you're gonna go on a hike or looking at a, the picture where you went with your best friend, like somewhere like that, like reminds you of the Hawaii, because otherwise if we wait until we completed all the.

We're gonna be doing some tasks just to be busy and not, they're not, those tasks might not even matter five years from now, 10 years from now. Versus if you said, okay, today my intention is to get to my kid's soccer game, so maybe you don't close the recharge, but you gave yourself five minutes before you jumped onto the next patient to do the assessment and plan.

And so it doesn't seem like you're saving yourself time, but you really are because most of. We can have a really easy time putting in the, what happened in the top, in the pro, in the physical exam, because we already did the hard thinking, which was the assessment and plan, right? . But if we waited, Then we're looking using long-term memory and instead of taking you five minutes, it might take you 20.

And so that's what I mean by creating time by being aware, then you realize what the intentions are. If the intentions are just close all your notes today, then you might go approaching that scenario in a different way. But all. Like when you have a chronic disease, you might be thinking that doesn't apply to me, but it does.

You might have certain medicines that you have to take throughout the day. . . So if you pair it with something you need to do anyways, like that's gonna help you because instead of, that's what they call habit Stacky. So let's say that. , you need to take a medicine for breakfast and then, or before breakfast, and then you need to take a medicine like that lunch.

And then maybe you need to take something at at dinner. What are you gonna do in the morning? I hope you're brushing your teeth. So maybe right before you brush your teeth, you take that pill and then you have it stacked, right? . So hoping you're eating lunch. So maybe at lunch, right before you have lunch, you take that medicine.

And so again, You could set a reminder or you could have it stack in at the beginning. It might feel weird and you might need reminders. Could be your spot, like I'm saying. As the goal is for you to automize things and just like we automize that medicine that you need, you have to automize that time for your mental health, like I'm talking about with meditation or with exercise and it, and don't think that we need to go like exercise, and do a marathon.

Like I'm talking like. Park a little further, right? , you go see your doctor or when you go to the grocery store , instead of spending the five minutes looking for the closest parking space, , like park a little further where they're not gonna hit your car. And you can actually get some exercise in there.

And again, that gives you a sense of you being in control of what sometimes feels not controllable, whether you're gonna have, Be really short of breath or be really, sometimes it feels like we don't have control, but you do what you can that day and that's okay. You don't have to always be pushing yourself.

We're not robots like , the cars need gas, the phones need to get recharged so we .

Dr. Brittany Panico: Yeah, definitely. And I like to, that you mentioned, touching base, checking in with yourself about drinking water and making sure that you're eating. Because a lot of us will be will try to do so many things today that we forget to drink in between, right?

If you feel like you don't have time to go to the bathroom, you're not gonna force yourself to drink. But like you mentioned, going to the bathroom can incorporate a few extra steps. It's healthy for you to drink your water, and you can do another kind of habit in that time. Like sometimes I'll tell patients, do a couple squats when you're washing your hands, or add some form of something in there that does benefit you and recharges your brain and just gives you that mental, clearance where you can just clear away the space for a minute or, close your eyes and take a few deep breaths.

Something like that. I like that you incorporate that habit stacking technique in, cause I talk about that a lot too.

Dr. Diana Mercado-Marmarosh: And when we're doing some of those habit stackings, it sometimes when you do something you like anyways with something you don't like, like that saves you so much time because it decreases the initiation that it, the task would've taken.

the dread. , exactly. Like for me, I hate doing the dishes. Like it's just, I'm not like, Ooh, sign me up. But I don't like how messy it looks afterwards. Or the drag when you've ignored it like a couple of days and so has your husband and everybody else. On purpose. Like I will put on a podcast or an audio book or turn on Shakira.

Something that like I can't wait to do and I'm like, okay, I'm gonna do that while I'm doing the dishes because then the second thing becomes you don't even feel it because you are not. So focused on that. I hate doing this thing. Which is not really true, but your brain keeps going there.

. And so instead you replace it with I can't wait to do the dishes. I'm about to listen to Shakira or whatever. Maybe we're never gonna a hundred percent do the thought swap, and that's gonna be okay, but at least it makes it a little bit. Doable or bonus if you can get somebody else to come do the dishes for you,

Exactly. Lemme get that out, .

Dr. Brittany Panico: Yes, for sure. Thank you. That was really amazing and I think we can all, learn something from you. So where can we find

Dr. Diana Mercado-Marmarosh: you? Sure. So you're welcome to come to my website. It's adhd live coach.com. I do have a 12 week program for physicians or any healthcare professionals who are looking to set up systems to support their son of genius so they can leave work at work and reclaim their freedom of time.

You don't have to have a D H D to work with me. You just have to feel like whatever systems you currently have are just not like the best and you're ready to find some better ones. And, sometimes we gotta thank those systems cuz they got us here, right? But Maybe they're not the best and we can prevent burnout or we can prevent feeling that stuckness, and do it in a different way. I used to think I just had to work harder to get stuff done. And now I'm thinking I just have to work smarter to get things done. Exactly. And most of us are very smart, and so we have to be willing. To just do it a little bit differently cuz you might just surprise yourself that rearranging a couple of things can make a big difference.

And so yeah, my goal is never to fix you because there's nothing to fix. It's just the system around you that needs a few tweaks. And I know some of us are like, I don't even have time for that, but, You are your best investment, and whether it's for your health, your mental health, your physical health, your spiritual health, you need to make sure you take that time because again, somebody else will put it on your calendar.

And it's not this, it's not you on the top of the priority.

Dr. Brittany Panico: Yes. And then you have a podcast too,

Dr. Diana Mercado-Marmarosh: right? Yes. So come to my podcast. It's called the Y A D H D A Physician's Perspective. If you have a story to tell me about your A D H D, or you have a family member that you support with their A D H D, or if you just have some tricks that you wanna share that has helped you with your chronic conditions, come and tell us, because we will take all the tricks

Dr. Brittany Panico: That's awesome. Thank you so much. I'm so glad we had this conversation.

Dr. Diana Mercado-Marmarosh: Thank you. It was a pleasure. 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 ahdlifecoach.com where you can find out about my upcoming coaching group classes, as well as free master classes and other exciting events that are happening.