I was halfway through my first year of OB-GYN residency when I learned that my brain had been working against me my entire life. By then, I had passed licensing exams, matched into a surgical specialty, and learned how to function convincingly while exhausted. What I had not learned, and what medicine never taught me, was how to recognize when “high functioning” was actually quiet suffering. And that distinction matters, because medicine is built to reward endurance, not sustainability.

My experience is not unusual. Medicine routinely attracts people with traits associated with attention-deficit/hyperactivity disorder (i.e., intensity, hyperfocus, rapid problem-solving, emotional attunement) while simultaneously structuring training in ways that penalize cognitive difference. When attention, impulse control, or emotional regulation do not conform to narrow expectations, these differences are often mislabeled as professionalism issues rather than recognized as manifestations of neurodiversity. The result is a system that benefits from these traits in moments of crisis, then stigmatizes them in moments of learning.

Like many physicians diagnosed with ADHD in adulthood, I was an early overachiever. “Gifted and Talented,” as they called it. Straight A’s. Advanced classes. The kind of hyperfocus that could carry me through exams and projects at the last minute. Teachers described me as bright, intense, and “a lot.” I learned early that being right, being excellent, could compensate for being different.

The medical school struggle

Medical school changed that equation.

The sheer volume of material, long stretches of unstructured time, and relentless reading did not play to my strengths. I struggled to stay awake while studying. I struggled to stay awake while reading. Around that time, I was diagnosed with depression and started medication and therapy. Not long after, the episodes of overwhelming sleepiness worsened. I could not tell whether it was the depression itself, a side effect of the medications, or simply the cumulative weight of medical training. I only knew that staying awake had become a daily challenge.

More than once, I caught myself nodding off behind the wheel on my short drive to an offsite rotation. Out of fear of causing an accident, I was briefly prescribed modafinil, despite not meeting criteria for narcolepsy, because staying awake felt like a matter of safety, not productivity.

Some aspects of my mood improved with treatment, but the core struggles remained: difficulty sustaining focus, disorganization, impulsivity, and a bone-deep exhaustion that never seemed to lift. I matched into OB-GYN residency and graduated medical school in the middle third of my class. For the first time in my life, I had not exceeded expectations. I carried that quietly, unsure whether it reflected a transient struggle or something more fundamental I had yet to understand. It was not until years later, after a comprehensive ADHD evaluation and appropriate treatment, that I understood how much of that exhaustion had been my brain fighting to stay engaged.

Residency amplified everything

Twenty-four-hour shifts were brutal. I could push through the chaos of rapid task switching, constant stimulation, and endless urgency, but afterward I would crash, sleeping for 18 hours straight. In the moment, I functioned well, but in the margins, things began to fray. As fatigue accumulated, small details slipped through my fingers. Notes left half-written. Orders forgotten. Tasks started with good intentions, then abandoned when something more urgent intervened.

What troubled me most, though, was not the exhaustion or even the mistakes. It was how those moments were interpreted and how quickly intent was confused with attitude. The same intensity that served me well in emergencies read differently in quieter settings, and the gap between how hard I was trying and how I appeared to others began to widen.

I interrupt. I always have.

In teaching settings, I would finish attendings’ sentences, ask questions before instructions were complete, challenge reasoning mid-explanation. To me, this felt like engagement: my brain sprinting ahead, trying to keep pace. To others, it looked like disrespect. Dismissiveness. Being “unteachable.”

No one ever sat me down and said, “You may have ADHD.” Instead, I received familiar feedback: slow down, listen more, be less defensive, do not talk back. I tried. I read self-help books and went to therapy and then tried again. But effort alone does not rewire executive function, no matter how motivated you are.

The diagnosis

I feared that these traits, or “personality issues,” as I privately called them, would derail my chances of pursuing a surgical subspecialty. So I did something I had avoided for years: I asked for a formal evaluation.

Not a screening questionnaire. Not a casual suggestion. A full neuropsychological assessment.

It took nearly six hours over two days. I wanted proof. Something objective. Something that could tell me whether this was real or if I was just making excuses for my shortcomings.

The diagnosis did not come as a shock. It came as a relief.

Suddenly, my life made sense. The talking too fast. The interrupting. The ability to thrive in emergencies but struggle with routine. The way I could hyperfocus in the operating room, where distractions are minimized and roles are clear, yet drift during surgical timeouts for straightforward cases, unless I was deeply responsible for the patient.

It explained why I was excellent in high-stress situations requiring rapid, accurate decisions, and why I connected so easily with patients. My ability to empathize, read emotional nuance, and sit with women in labor or with cancer had always been one of my greatest strengths. ADHD did not diminish that. If anything, it sharpened it.

Starting stimulant medication was transformative. For the first time, I could read an article without falling asleep. I could sit through conversations without constantly trying to fight the physical urge to interrupt. I felt like a clearer, steadier version of myself. I was not a different person, just one with fewer obstacles.

The diagnosis did not fix everything. I still struggle with emotional regulation, especially when receiving feedback. I still feel things deeply. But I finally understood that the “faults” I had been trying to eradicate were not moral failures. They were neurobiological differences.

A system hostile to difference

Here is the uncomfortable truth: Modern medical training selects for ADHD traits and then punishes them.

We reward hyperfocus, stamina, crisis performance, pattern recognition, and emotional intensity. We value physicians who can juggle complexity, pivot quickly, and remain calm under pressure. Many of us with ADHD excel at exactly these things.

But the system itself is hostile to executive function by demanding long hours, poor sleep, administrative overload, rigid hierarchies, and feedback delivered without context. We ask trainees to function like machines while ignoring differences in how human brains operate.

The result? Physicians who internalize shame. Who mask relentlessly. Who believe they are broken rather than unsupported.

I share my story not to ask for special treatment, but to argue for better understanding. If you are a medical student, resident, or fellow who sees themselves in this narrative, here is what I wish someone had told me earlier:

• Struggling does not negate your competence. If you can perform well in the OR, connect with patients, and manage acute situations but feel undone by documentation, organization, or sustained reading, that discrepancy is information, not a verdict.
• Late diagnosis is common and valid. Many high-achieving physicians compensate brilliantly until the system overwhelms their coping strategies. ADHD does not disappear because you succeeded earlier.
• Medication is not a shortcut or crutch, it is a tool. For me, treatment did not create ability but rather removed friction. The version of me on medication is the same physician, just with fewer barriers between intention and execution.
• Feedback can hurt more when you care deeply. Rejection sensitivity and emotional intensity are real. Learning to pause before reacting is a skill, not a character flaw, and it improves with support.

I am not writing this to argue that medicine should lower its standards. I am writing to argue that we misunderstand what competence looks like when it comes from a brain that works differently. When neurodivergence is framed as a professionalism problem rather than a cognitive difference, we risk losing physicians who are deeply capable, deeply committed, and quietly exhausted by the effort of constant self-correction.

Clear expectations, structured feedback, and psychologically safe learning environments benefit everyone, but they are paramount for trainees with ADHD. A resident who interrupts may be over-engaged, not insubordinate. A fellow who struggles with timely documentation may still be an exceptional clinician.

I am no longer ashamed of how my brain works. I was fortunate to receive a diagnosis that gave language to struggles I had internalized for years. Many trainees never do. They leave medicine believing they were the problem, when in reality the system was never designed with them in mind.

If we want a workforce capable of innovation, empathy, and resilience under pressure, we need training environments that recognize neurodiversity not as a liability to manage, but as a reality to understand. Until then, medicine will continue to select for minds like mine, and then ask us to disappear.

Samantha Leite is a gynecologic oncology fellow.