A New Diagnosis

Nancy, an internal medicine physician, half-listens to her 60-year-old patient explain his disparate symptoms -- a little achy in the hips, some irregularity. She makes a mental note to refill his prescriptions, make sure he is showing up for testing on his Coumadin therapy, and worries that she is missing some sign of serious illness.

Meanwhile, two other patients wait in exam rooms, the nurse has a question about a refill request, and Nancy's kids are in the waiting room wondering if she is going to cop out again on her promise to drive them to soccer practice.

No wonder Nancy feels alienated, has trouble focusing, is quick to snap at her staff, and has started drinking a second glass of wine in the evenings.

This fearful, distracted state increasingly characterizes physicians and high-ranking business executives -- so much so that Edward "Ned" Halloway, a psychiatrist and specialist in learning disabilities, coined a new diagnosis for it: attention deficit trait (ADT).

As Halloway explains in the January 2005 issue of Harvard Business Review (visit www.hbr.com to order a back issue), ADT is similar to its "cousin," attention-deficit/hyperactivity disorder (ADHD). However, while ADHD is a neurological disorder, ADT is purely the result of the multi-tasking, data-filled complexity of contemporary life.

"ADT is an artifact of modern life," Halloway explains. "As our minds fill with noise ... the brain gradually loses its capacity to attend fully and thoroughly to anything."

Halloway describes businesspeople living in such fear and anxiety over work pressures that their brains function largely in survival mode, pushing activity from the sophisticated frontal lobes needed to handle the task to the primordial lower brain.

"The deep regions interpret the messages of overload they receive from the frontal lobes in the same way they interpret everything: primitively," he says. "They furiously fire signals of fear, anxiety, impatience, irritability, anger, or panic. These alarm signals shanghai the attention of the frontal lobes, forcing them to forfeit much of their power. ... In a futile attempt to do more than is possible, the brain paradoxically reduces its ability to think clearly." The result is inflexible thought rife with mistakes.

Go ahead. Self-diagnose. Does this cycle sound familiar? What about your colleagues --  is there a Dr. Nancy at your office?

I realize you don't really need a diagnosis for modern life. If we actually tried to treat everyone suffering overload with ADT, we'd soon have an overwhelming new field.

Still, it's worth noting that with all the interruptions and data physicians juggle, it would not be surprising to see cases of ADT breaking out in medical offices from Key West to Juneau.

And what an opportunity for the pharmaceutical industry: imagine a drug that could alleviate the "symptoms" of work in the 21st century. ADT could be diagnosed at least as often as ADHD. Better, it could be marketed to physicians and consumers with a single campaign, since stressed physicians would be a prime target market themselves. Now that's a blockbuster. But when nearly everyone has a malady, is it still a malady?

In any case, since there is no biological cause for ADT, no pharmaceutical solution is likely.

But my point isn't that we should diagnose and treat this "disorder"; it's that we should recognize there are physical consequences to simply adding more stress and more work to get the job done. Physicians are trained to believe that working harder and longer is a solution. That's one reason primary care physician productivity rose 11 percent between 2000 and 2001, and another 5 percent the next year.

Our brains can only handle so much stress before they become inefficient. The brain locks up and mistakes happen. At some point, being more productive becomes, well, counter-productive. Next time you find yourself spinning, ask if doing less would let you do more. 

You know how to work hard. But do you know how to work smart?

How do you and your coworkers deal with stress? E-mail me at pmoore@physicianspractice.com, or chat with colleagues at http://groups.msn.com/PhysiciansPracticeRabbleRousers.

This article originally appeared in the March 2005 issue of Physicians Practice.