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ADHD Chatter Podcast

The Doctor With 23 Years ADHD Experience: We Let Women Down! | Dr Martin Brunet

Dr Martin Brunet is a GP with over 23 years of professional experience. He's the author of 'Your Worry Makes Sense'.

Alex PartridgehostDr. Martin Brunetguest

Mar 4, 202559mWatch on YouTube

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CHAPTERS

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Chapter summaries

Undiagnosed ADHD behind anxiety in the GP's room
Alex asks how many anxious patients may have undiagnosed ADHD. Dr Brunet says many more than we think, and explains why GPs miss it, including crowded consultations, the old view that adult ADHD wasn't real, and women being overlooked.
- •Anxiety consultations cover so much, such as physical symptoms and risk checks, that ADHD never comes up
- •When Brunet started in GP, adult ADHD in the UK was not felt to be a thing
- •Some long-standing patients, particularly women, now look obviously like ADHD in hindsight
- •Doctors are doing better but need to do better still
How Brunet's view of ADHD has changed since he qualified
Brunet admits his early prejudices: the naughty boy stereotype, parents wanting a label, and ADHD as something you grow out of. He describes how fast views have shifted and the risk of both under- and over-diagnosis.
- •Girls with ADHD were barely a concept and adult ADHD was thought to be outgrown
- •He recalls being taught that autism was a childhood form of schizophrenia
- •He asks patients how long an issue has existed to separate ADHD or autism from recent burnout
- •He compares ADHD with the menopause as something both under- and over-diagnosed
- •He rejects the idea that everyone has ADHD, pointing to a large undiagnosed group
The emotional toll of being missed and the problem with ADHD's names
Alex describes how listeners look back over their lives and raises RSD. Brunet says undiagnosed ADHD has damaged women's relationships and work, then critiques terms like disorder, deficit and sensitivity, and encourages people to reframe labels they dislike.
- •Broken relationships are a theme among patients diagnosed later
- •Brunet wants his language to make sense to patients and make them feel right
- •He dislikes 'disorder', 'deficit' and 'sensitivity' as labels
- •He suggests reframing a label you don't like in your own mind
- •Alex notes the damage of 'disordered' labels for very young children
Loud and quiet ADHD, and the well-behaved boys missed
Asked whether there are two types of ADHD, Brunet says it is a range. He adds that well-behaved boys are also diagnosed late, using the example of GPs diagnosed late in life.
- •ADHD sits on a range of focus and hyperactivity
- •Well-behaved boys at school were missed
- •Late-diagnosed doctors may arrive an hour late after hyperfocusing on a home visit
- •They functioned well but would have done better knowing earlier
How Brunet describes ADHD today
Brunet avoids 'deficit' and 'disorder' and describes ADHD as a brain wired for interest over importance. He discusses spiky profiles and the strengths and challenges that come with ADHD.
- •The brain is wired differently in everyone and can change
- •Wired for interest over importance
- •'Spiky personality' captures highs and lows but the word feels prickly
- •Strengths include spontaneity and adaptability to change
- •The same traits bring challenges like forgetting deadlines
Spotting undiagnosed ADHD as a GP
Brunet says he has become better at spotting ADHD, using listening, intuition and asking how long challenges have existed. He values long-term continuity with patients, who are never discharged, for seeing underlying patterns.
- •GPs started from a low base 20 years ago
- •Finding it hard to keep up with a conversation can prompt thoughts of ADHD
- •Some men with alcohol, drug or legal problems may have ADHD behind it
- •Years of 15-minute appointments help build a picture of someone
Prejudice, labels and the medication worry
Alex raises lingering prejudice around ADHD. Brunet says parents and schools often resist labels, fearing medication or children being held back. He notes adults can choose whether to pursue a diagnosis, citing Bill Gates.
- •Parents worry about labels and about children taking drugs
- •Diagnosing a four-year-old differs from diagnosing an adult
- •Some people avoid GPs for depression or anxiety fearing only medication
- •Medication is an informed choice and not the whole picture
- •Some adults decide they know themselves well enough without a formal diagnosis
Burnout, overwhelm and the stress cliff
After a sponsor break, Alex asks about the consequences of unmanaged stress. Brunet links mind and body, then explains burnout as the overwhelm that follows long surviving rather than thriving, and why strong people and those with ADHD or autism are vulnerable.
- •Mind and body cannot be separated, and anxiety has physical effects
- •Burnout is not a medical term but describes feeling overwhelmed
- •Strong people who pedal harder miss the warning signs
- •Performance can look unchanged while you are only surviving, then you fall off a cliff
- •People with ADHD overload their plates and masking drains people with autism
Social battery, burnout and night-time anxiety
Alex asks whether a drained social battery is a form of burnout. Brunet says it depends on bounce-back, compares it to being fed up versus depressed, and then discusses middle-of-the-night anxiety and sleep with ADHD.
- •If a good rest restores you, it is not burnout
- •A constantly full diary with no recharging is where he would use the word burnout
- •Being fed up bounces back, while depression loses the bounce
- •Waking at night and using the time to stimulate yourself keeps you awake
- •A bedtime book should be interesting enough to pick up but not too gripping
Anxiety versus genuine limits, and avoidance
Brunet distinguishes avoiding events because of anxiety, which practice can improve, from avoiding things that are inherently unpleasant such as sensory overload. He uses his roller coaster nausea as an example.
- •Avoidance is the worst thing you can do with anxiety
- •Inherently unpleasant things won't improve with practice
- •Roller coaster nausea versus fear of a panic attack at a theme park
- •Adapt genuine problems, e.g. headphones or ordering shopping online
RSD, loneliness and learning to tolerate rejection
Alex describes the tug of war between fear of RSD triggers and fear of loneliness. Brunet says rejection sensitivity can become self-fulfilling and suggests gathering varied experiences and accepting managed risk.
- •Alex weighs risk of rejection against being lonely on the sofa
- •Saying no to everything means no invitations, which feels like rejection
- •Seek experiences where people were glad to see you
- •All of life is managed risk, and isolation carries its own risks
- •Use fear of loneliness to help overcome fear of rejection, and repeated exposure shows a trigger is an anomaly
ADHD medication: when and how to think about it
Alex asks at what point medication is considered. Brunet explains that GPs don't initiate it, that understanding comes first, that it works quickly and can be stopped easily, and that it shouldn't be expected to do everything.
- •GPs can't initiate ADHD medication, which is started in secondary care
- •Learn about your own brain before and alongside medication
- •Patients mostly report better focus, and the effect is immediate
- •Some describe it as like putting on glasses
- •Labels can free you or restrict you if used as an excuse
Where the medical community should be in five years
Brunet wishes for more joined-up mental health care, better NHS provision for ADHD diagnosis and support, and more GP time. He notes ADHD is important but not urgent, so it tends to get pushed out.
- •Mental health care is fragmented across separate assessments for ASD, ADHD, OCD and alcohol
- •He would like one coordinating clinician
- •NHS provision is not coping and work is passed to GPs without funding
- •GPs need more time, not just training
- •Important but not urgent issues get pushed out of consultations
The ADHD item: glass balls and juggling balls
Brunet brings a glass ball and explains that he felt anxious catching a creative colleague's ideas until he saw them as juggling balls. He applies this to patients who throw out many symptoms and to understanding what matters to patient and doctor.
- •He doesn't have ADHD but works with people who do
- •Ideas thrown up are juggling balls, not glass, so you needn't catch them all
- •Work out what matters to the patient and to the doctor, then decide together
- •The glass ball accidentally breaks during the demonstration
Agony aunt: medication side effects, and the closing letter
In the Washing Machine of Woes, Brunet answers a question about side effects after ten years on ADHD medication, suggesting talking to the prescriber and possibly trialling without it. The episode closes with the previous guest's three rules and a reflection on perspective and letting go.
- •Every medication can have side effects, and ADHD drugs' are mostly short-term ones
- •Trial and error, such as stopping and re-challenging, can show whether it is a true side effect, after talking to the prescriber
- •Some people take medication only on days they need focus
- •The previous guest's rules include 'Nothing is as important as you think'
- •Brunet links this to letting go to avoid burnout and seeing problems in perspective

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