| are-we-treating-adhd-or-the-conditions-of-modern-life | Are We Treating ADHD - Or the Conditions of Modern Life? | Latest_News | Shared_Content/News/Latest_News/2026/are-we-treating-adhd-or-the-conditions-of-modern-life | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2026/may-june/Heartbeat-Website-Image-Urriola-645x425px.png" class="pull-right" alt="WSMA Reports Heartbeat logo featuring Alina Urriola, MD, MPH" /></div>
<h5>Apr. 28, 2026</h5>
<h2>Are We Treating ADHD—Or the Conditions of Modern Life?</h2>
<p>
By Alina Urriola, MD, MPH
</p>
<p>
My patient, "Lisa," spent a decade as a highly competent, reliable intensive care nurse, thriving in a setting characterized by clear roles, immediate feedback, and focused, high-stakes decision-making. When she was promoted into an administrative role requiring project management, shifting priorities, and prolonged self-directed task organization, her performance declined. She began to doubt herself and was placed on a performance improvement plan. She met criteria for attention-deficit/hyperactivity disorder, and stimulant treatment significantly improved her ability to stay on task and restored her confidence.
</p>
<p>
Diagnoses of ADHD in adults have increased substantially over the past decade. As a practicing physician, I prescribe stimulant medications regularly and—as in Lisa's case—I have seen their capacity to significantly improve patients' functioning and quality of life.
</p>
<p>
At the same time, their expanding use invites a broader professional question: What does it mean, at a societal level, when growing numbers of adults require long-term stimulant therapy to meet everyday expectations of work and productivity?
</p>
<p>
The dominant clinical narrative frames ADHD primarily as a highly hereditary neurodevelopmental disorder rooted in individual neurobiology. While this model is valid for many patients, it is incomplete. Stimulant medications improve attention, task initiation, and persistence not only in individuals diagnosed with ADHD, but in most humans. Their effectiveness alone does not establish a disease-specific deficiency. Rather, it highlights how pharmacologic agents can enhance performance in environments that demand sustained focus, rapid task-switching, and constant cognitive engagement.
</p>
<p>
Those demands have intensified. Modern professional life increasingly requires prolonged attention to abstract tasks, continuous digital availability, greater cognitive load, reduced external structure, and heightened performance pressure. For many adults, attentional strain reflects not individual failure, but the limits of human cognition under persistent load.
</p>
<p>
Adult ADHD diagnosis hinges on functional impairment, yet impairment is inherently contextual, as illustrated in Lisa's case. As expectations escalate, more individuals will meet diagnostic thresholds. This does not invalidate their distress, nor does it negate ADHD as a legitimate neurodevelopmental condition. However, it does suggest that medicine is increasingly being asked to address a mismatch between human attentional capacity and the structures in which we work and live.
</p>
<p>
The ethical concern is not whether stimulant medications should be prescribed—they often should. Rather, it lies in the broader implications of their widespread, long-term use. When pharmacologic treatment becomes the primary means by which individuals adapt to increasingly demanding systems, medicine risks unintentionally relocating structural problems into individual biology.
</p>
<p>
This is not a new tension for our profession. Medicine has long been called upon to optimize bodies for systems: hypnotics for shift work, antidepressants for burnout, beta blockers for performance anxiety. Each intervention may be clinically appropriate. Taken together, an important public health implication emerges. If large segments of the adult population require medication to function at baseline levels of productivity, that pattern suggests systemic strain rather than widespread personal pathology.
</p>
<p>
Acknowledging this tension does not mean withholding care. Patients live in the world as it is, not as it ought to be. Compassionate practice meets patients where they are and offers tools that reduce suffering and improve functioning. But ethical care also requires honesty—recognizing that benefit does not necessarily imply defect, and that treatment does not automatically validate the conditions that make it necessary.
</p>
<p>
As physicians, we are trained to think both clinically and systemically. Caring for individual patients should not preclude reflection on the broader forces shaping their health. On the contrary, maintaining that dual awareness may be essential to practicing medicine that is not only effective, but humane.
</p>
<p>
<em>Alina Urriola, MD, MPH, is a family physician at Vera Whole Health and a volunteer physician at Lahai Health, both in Seattle.</em>
</p>
<p>
<em>This article was featured in the May/June 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/28/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |
| campaigning-for-medicine | Campaigning for Medicine | Latest_News | Shared_Content/News/Latest_News/2026/campaigning-for-medicine | <div class="col-md-12">
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<h5>Apr. 28, 2026</h5>
<h2>Campaigning for Medicine</h2>
<p><em>
At a time when science is under assault and health care faces federal cuts, physician participation in the political process is more important than ever.
</em></p>
<p>
By John Gallagher
</p>
<h5>
<em>Members only; sign-in required.</em>
</h5>
<br />
<p>
The midterm elections are just months away, and just as it has in past years, health care is likely to be a hot topic. Changes to Medicaid and insurance coverage made by Congress last year with the passage of H.R. 1 have already become an issue in federal campaigns nationwide. Meanwhile, at the local level, candidates will have to grapple with how Washington will implement those changes and mitigate some of the negative impact that they may have on patients, to say nothing of the state budget.
</p>
<p>
"There is still so much left to untangle," Alex Wehinger, associate director of legislative and political affairs at the WSMA, says of the new law. Some of the issues relate to federal distribution of funds, but others are structural, including imposition of a work requirement for some Medicaid recipients. The result will put the Legislature in a tough spot. "The impacts will be felt heavily in the state. Combined with the existing pressures on the state budget, it will create a perfect storm for a really challenging dynamic," Wehinger says.
</p>
<p>
Yet despite the stakes involved, to some extent physicians remain underrepresented in the conversation despite the expertise that they can bring to it. There are 20 physicians in Congress, including Rep. Kim Schrier of Washington, who is co-chair of the Congressional Doctors Caucus. There are currently no physicians in the Washington State Legislature.
</p>
<p>
In terms of political activity, physicians are often outstripped by other groups. Some political action committees, or PACs, the entities that allow nonprofits to support candidates, are much more flush with money to influence the conversation.
</p>
<p>
"Whenever there's an issue that comes up, there are many other groups that aren't physicians that are going to jump in and push really hard on the other side," says Elizabeth Peterson, MD, a pediatric plastic surgeon based in Spokane. Dr. Peterson has served on the board of the Washington Medical Political Action Committee, or WAMPAC, the nonpartisan political campaign arm of the WSMA, which was established to help identify and support candidates for political office in the state whose priorities align with the house of medicine. "Physician groups have always lagged behind attorney and nursing union groups, who therefore have more to say on those issues."
</p>
<p>
WAMPAC is governed by a board of 12 physicians, one from each of the state's congressional districts and two at large. The board makes decisions about engagement in campaigns and helps direct WAMPAC's campaign work. The PAC also has a Diamond Club for physicians interested in getting more involved politically. At elevated contributions, the club provides insider updates about the political landscape, as well as invitations to events with candidates and elected officials.
</p>
<h3>A high-stakes midterm</h3>
<p>
The full picture for the current election cycle for Washington state offices is only emerging now. "At the state level, more than two-thirds of the Legislature will be up for election," says Wehinger, who also serves as the director of WAMPAC. "We know that some folks are retiring or running for other offices. There's no shortage of offices that will be on the ballot. It's just the 'who' that is to be determined." (The deadline for candidate filings in the state is May.)
</p>
<p>
However, the general outline of the election cycle is clear. Midterm elections generally have a lower turnout, although there is some indication from recent special elections around the country that this year may be an exception. The party holding the presidency tends to lose seats. Districts that swing between Republican and Democratic candidates are increasingly rare. "A moderate Democrat versus a progressive Democrat is more our version of a swing district these days," says Wehinger.
</p>
<p>
Health care promises to be a major campaign issue. "Every election has significant influence over the political landscape, and that impacts health care in the state," says Wehinger. In particular, the state is still sorting out the
impact of H.R. 1 passed by Republicans last year. The Congressional Budget Office has stated the law will reduce federal spending on health care by over $1 trillion and increase the country's uninsured by 10 million.
</p>
<p>
Clearly, a lot is riding on the election. But as much as the focus is on the ballot box, just as much work—if not more—happens outside of the election. It's not simply a matter of waiting for the results to roll in. Meeting with candidates
to help them understand the issues and then working with legislators on measures important to patients and physicians may not be as visible, but both are critical parts of the process.
</p>
<p>
"People who don't have a background in health care and health care policy are going to make decisions," says Wehinger. "The 360-degree view of advocacy is that it doesn't start on day one of the legislative session. It's about getting to meet these people and share WSMA's issues and priorities so that we have an established relationship when those candidates turn into legislators."
</p>
<p>
Compared to the federal level, state legislators and candidates simply do not have the necessary depth of expertise on staff. "State legislators don't have the requisite expertise to inform their decision-making," says Dr. Peterson. "They don't have the staff to resource it."
</p>
<p>
Nathan Schlicher, MD, JD, a senior vice president at TeamHealth, has a unique perspective on the electoral process: not only is he an emergency department physician at St. Joseph Medical Center, a part of Virginia Mason Franciscan Health, he is also a former member of the Washington State Senate. "Most people who serve at the state level are doing it for the right reasons," he says. Still, serving in the Legislature was "eye opening."
</p>
<p>
"Think about the breadth, scope, and depth of government," he says. "You only have 147 elected people across two chambers, and there are only one or two people who are experts in each caucus or each body that other members rely upon."
</p>
<h3>State impact on day-to-day practice</h3>
<p>
Certainly, the federal government has a huge impact on what happens in every state. That's especially true at a time when health care and evidence-based medicine are under assault at the federal level. "I see the federal government
cutting back on Medicaid and Medicare reimbursements or subsidies, which is very harmful to people," says Nicholas Rajacich, MD, an orthopedic surgeon at MultiCare Mary Bridge Children's Hospital and former chair of WAMPAC's board of directors. "The attacks on science are almost too hard to believe."
</p>
<p>
Yet in many ways physicians are more likely to feel the decisions made at the state level than at the federal level. "The important work at the federal level impacts insurance, Medicare, Medicaid, and vaccines," says Dr. Schlicher. "The day-to-day things that impact delivery of care are going to be done at the state level." Indeed, from a practice perspective, state regulations have far greater impact on physicians. "At the state level, the laws are really what regulate licensure and scope of practice," says Dr. Peterson.
</p>
<p>
By contrast, the sheer volume of interest groups in Washington, D.C., makes it much harder to be heard. Moreover, representatives in particular are trapped in a perennial fundraising loop, which affects their stance on issues.
</p>
<p>
"Votes get determined not just from how much they hear from citizens but how much they hear from lobbyist groups," says Dr. Peterson, who has also served on the board of the American Medical Association's political action committee, AMPAC. "Legislators weigh all the opinions and determine how it will affect their potential vote in the primary and general elections. It's purely pragmatic."
</p>
<p>
State legislators aren't under nearly the same amount of pressure. As a result, "we can be far more effective advocating for things at the state level than at the federal level," says Dr. Rajacich.
</p>
<p>
In addition, says Dr. Schlicher, health care isn't under the same intense spotlight at the state level as it is at the federal level. "The lack of attention on it allows for a little more collegiality than you see at the federal level," he says. "There aren't as many people trying to make the 5 o'clock news with a one-line zinger."
</p>
<p>
Campaign contributions from entities like WAMPAC help physicians get to the table and be heard. "We're not talking about huge contributions, but just enough to let the person know that there is a large group of physicians who have concerns about patient issues and are willing to support the campaign to get their attention," says Dr. Peterson.
</p>
<p>
While some may worry about the influence money has on politics, for better or worse the reality is that campaign contributions are a language that politicians understand. "The political process is messy," admits Dr. Rajacich. "But we should participate because we have the ability to influence what happens."
</p>
<p>
"Frankly, it takes money to engage in this game," agrees Katina Rue, DO, long-term care medical director at Avalon Garden Village in Yakima and hospitalist at Othello Community Hospital, as well as past chair of WAMPAC's board of directors. "We have to have the influence we need by donating to campaigns and starting those connections with candidates."
</p>
<p>
The good news, says Dr. Rue, is that candidates are open to the conversation. "As candidates, they want to meet with us," she says. "It's insightful to ask a candidate for their position before they are elected. I think being able to meet with candidates and see whose values align with the values of science and evidence-based practice is very important."
</p>
<p>
Dr. Peterson stresses that WAMPAC's sole focus in building relationships is on health care. "Sometimes you have to overlook an issue you have strong views about because it doesn't align with someone 100%," she says. "It's not the political party or how they voted on a budget bill or even some controversial issue that we would personally oppose, but more about how they will listen to the house of medicine."
</p>
<h3>A never-ending campaign</h3>
<p>
While campaigns are a vehicle for establishing relationships, the work doesn't end there. Continuing to maintain those relationships is important to making sure that physicians' concerns are top of mind with legislators.
"I do feel that having this connection with them through the political arm allows us to continue relationships back home in the district," says Dr. Rue.
</p>
<p>
At a time when so much of medicine is under question, physicians themselves continue to be highly regarded. That means they can make a difference in conversations with legislators. "Those individual relationships are even more important as society doubts more and more institutions," says Dr. Schlicher. "Of all the people who are going to be involved in advocacy, those in the practice of medicine are still the most trusted. It’s ever more important that you are in the conversation and part of the solution-making."
</p>
<p>
Physician participation in political activities sends a clear message to politicians. "Legislative days are very important, because you realize that they have to be responsive to their constituents," says Dr. Peterson. "Involvement is the best way to get to know your legislators and know the issues before them. You have to be involved or the issues that are important to patients will be ignored."
</p>
<p>
Indeed, says Dr. Peterson, physicians overwhelmingly find participation rewarding. "Every time I see a new person get involved and sit down with a legislator to explain something, almost without fail they get good feedback," she says. "They can't go back to an uninvolved state."
</p>
<p>
However, says Dr. Rue, "Legislative day isn't enough. We need to remain at the table. WAMPAC is one mechanism to do that. The more members and donors we have to our PAC, the more clout we will have with candidates and with the legislators after they are elected."
</p>
<p>
WAMPAC provides its political expertise to all WSMA members as a benefit of their membership in the WSMA and to encourage greater awareness and involvement in the PAC. In general and midterm election years, WAMPAC publishes a legislator report card mailed to WSMA members in advance of the elections as part of WSMA's Legislative Report. WAMPAC also provides WSMA members regular election updates and analysis in the Advocacy Report newsletter. For those interested in diving deeper into state politics, the Diamond Club offers opportunities for more direct interaction with campaigns, including physician-hosted fundraisers. Past fundraisers have included Rep. Schrier as well as candidates for governor and insurance commissioner.
</p>
<p>
"I'm a long-time Diamond Club member, and even as I'm getting to the end of my career, it's important to support that work,†says Dr. Rajacich. However, what is important is membership at any level, he says. "I would like to see a large percentage of members of WSMA join WAMPAC. Physicians need us to advocate for what we do and what our patients need."
Engaging with the system may even mean considering running for office. Each year, the AMA holds an AMPAC Candidate Workshop on how to run a successful campaign. The presence of physicians in legislative bodies is important to making sure that physician issues are heard. Dr. Schrier, whom WAMPAC has supported since she first ran in 2018, has been instrumental in representing medicine during her time in Congress and offers insight into why physician representation in government matters. "Doctors are uniquely equipped to be public servants because of the personal relationships and trust we have forged with our patients and the communities we live in," she says.
</p>
<p>
"Doctors work with our patients as members of Congress should work with the constituents they serve—we don't know their politics, but we are there to find common ground to solve the issues they face. At a time of sharp partisanship and a rise in medical disinformation, I believe this has become increasingly important because doctors in Congress are focused on putting politics aside to fight for the greater good."
</p>
<p>
Meantime, the midterms are looming. Dr. Rue says she understands that for many physicians, the landscape looks bleak. "Right now, people are frustrated, scared, and feeling despair," she says. "Contributing to WAMPAC is one small actionable step that people can take. If we can say that the vast majority of our members donate to WAMPAC, it will be powerful for candidates to hear that."
</p>
<p>
<em>John Gallagher is a freelance writer specializing in health care.</em>
</p>
<p>
<em>This article was featured in the May/June 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/28/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |
| doctors-making-a-difference-estell-williams-md | Doctors Making a Difference: Estell Williams, MD | Latest_News | Shared_Content/News/Latest_News/2026/doctors-making-a-difference-estell-williams-md | <div class="col-md-12">
<div class="col-sm-5 pull-right" style="text-align: center;"><img alt="WSMA Reports Doctors Making a Difference: Estell Williams, MD graphic" src="/images/Newsletters/Reports/2026/may-june/DMD-Website-Image-Williams-645x425px.png" class="pull-right" /></div>
<h5>Apr. 28, 2026</h5>
<h2>Doctors Making a Difference: Estell Williams, MD</h2>
<p>
For Estell Williams, MD, supporting the development of the next generation of physicians, particularly those who have historically faced systemic barriers to entry, is at the heart of her work outside of her clinical practice as a surgeon at UW Medical Center. Dr. Williams spoke with WSMA Reports about her deep commitment to promoting health equity through mentorship, advocacy, and early investment in students to help ensure the physician workforce mirrors the population it serves.
</p>
<p>
<strong><em>WSMA Reports:</em> What has driven you to make of advocacy work such a big part of your career?</strong>
</p>
<p>
<em>Dr. Williams:</em> At the core of my advocacy work lives the quote by social justice revolutionary Angela Davis, “I’m no longer accepting the things I cannot change, I’m changing the things I cannot accept.†From the time I was an early undergraduate student I began envisioning the type of career I wanted to have in medicine when I finally became a doctor. That vision always included leading initiatives that had profound impacts on my journey. I was a participant and recipient of intentional investment and mentorship. I participated in programs founded and run by people who lived through the circumstances they were helping young people navigate. I saw what change looks like within my own life and I knew I wanted to have that type of impact on communities.
</p>
<p>
<strong>Q: Can you tell readers a little bit about UW's Doctor's for a Day program and why you think this type of program is so important?</strong>
</p>
<p>
Doctor For a Day is a STEM program that was created to address the shortage of underrepresented students of color in health careers. It was initially started by a University of Washington School of Medicine medical student Joy Thurman-Nguyen during her first year of medical school. Now a family medicine physician at Kaiser Permanente in Seattle, WA, Dr. Thurman-Nguyen grew up in Seattle and faced a lack of exposure to people of color in health careers. In 2014 when she had finally reached medical school, she envisioned bringing a hands-on, educational day of activities to K-12 students of color, featuring role models — volunteer doctors, physical therapists, nurses and dental students — who looked like them.
</p>
<p>
This resonated with me so closely because she and I shared a similar experience and vision for how we can help shape the idea of what is considered possible for so many students. So as an intern in my general surgery training program at the University of Washington I began working with her to lead the program. The University of Washington School of Medicine and particularly Dean Paul Ramsey, MD, offered start-up funding for the program and collaborated with the University of Washington Network for Underrepresented Residents and Fellows to bring resident and fellow volunteers to help mentor students and lead the workshops with the medical students. He funded part of my appointment when I was recruited as faculty to UW to grow the program and expand outreach work in the School of Medicine.
</p>
<p>
The program has grown exponentially captured here in our <a href="https://equity.uwmedicine.org/wp-content/uploads/2025/12/UW-DFAD_19-25.pdf">UW Doctor for a Day Annual Report</a> and is now one of five outreach programs within the center I developed, the Center for Workforce Inclusion and Healthcare System Equity. Medical students, residents, fellows and attending physicians from underrepresented groups served as role models and mentors leading these workshops, interacting with students and sharing their personal stories of obstacles and successes. DFAD The program now serves more than 1,000 students annually in its programming that runs across the K-12 academic school year September through May. Over the years, word of the program spread rapidly within the Seattle and Greater Seattle area. Partnerships were forged with AfricaTown Center for Excellence and Innovation, Federal Way Boys and Girls Club, Healers of Tomorrow, and many more local nonprofit organizations and school districts.
</p>
<p>
Continued engagement of K-12 students through these pathway programs and mentorship improve the connection of an amazing pool of talented disenfranchised students that may not otherwise continue on the path to a career in health care. To truly increase students who are overlooked and often disregarded in health professions we must invest in students early and create an ecosystem that ensures their success.
</p>
<p>
<strong>Q: Promoting health equity in medicine is a big priority for you. What are you focusing on in your roles as the executive director for UW's Center for Workforce Inclusion and Healthcare System Equity and as a member of WSMA's DEIB Committee?</strong>
</p>
<p>
The Center for Workforce Inclusion for Healthcare System Equity was born out of my realization that we needed a comprehensive effort to support the future development of health leaders. There are many assaults happening to our students that are compromising the ability of our professions to adequately recruit, train, and staff clinics and hospitals delivering care. Health equity involves more than what happens at the bedside but begins much earlier. Health equity involves considering that if we, as a society, aren't providing quality education, we limit the pool of qualified students who can apply to college to make it to medical school or physician assistant school or become a nurse practitioner. When we face limits on the amount of loans students can access, we forfeit the ability of more students to access higher education given financial gaps that change their decision about what career they will enter because they need to feed themselves and contribute financially to their families. We sometimes have such tunnel vision on addressing health equity we lack critical analysis of all the barriers that not only our patients face, but our replacements.
</p>
<p>
I am focusing on building systems that evaluate the larger equity issues at play and how we can build models and educate our Legislature to invest in programs that act earlier. If we wait until it's time to recruit for residency, we have already lost hundreds from the pool in unrealized potential of students who could have gone on to not only address our health care workforce shortage in this state, but also could have been profound clinicians taking excellent care of patients and closing health care gaps.
</p>
<p>
<strong>Q: What are you hoping to accomplish in your role as a member of the WSMA Foundation board?</strong>
</p>
<p>
I was initially approached by Dr. Mika Sinanan, a dear colleague, friend, and mentor to join as a WSMA Foundation board member. Initially the ask was to help expand the health equity strategic focus area that the board was embarking on at the time. The WSMA as an organization and the Foundation board were so committed to this work that was the easy part of the role. Now my focus has shifted. As I complete my final term I seek to truly engage with the strength of this organization, working across Washington state’s rural and urban communities to strengthen its connections with the next generation of future health leaders who will take the mantle and build on the strong foundation that has been laid. I hope to utilize the work I am doing with WIHSE to develop intentional collaboration through the Foundation so we are mentoring students and building our bench of talented students who will go on to receive the WSMA scholarship to attend medical school and remain in Washington to serve the people of the state as future leaders and advocates that improve the health of all Washingtonians. It has been an honor to work alongside a dedicated group of physicians who move beyond words and ACT as advocates in everything they do from the time they spend at the bedside with patients to their personal time they VOLUNTEER to organizations like WSMA Foundation board. It is these relationships that give me hope during times of uncertainty that we currently face.
</p>
<p>
<em>This article was featured in the May/June 2026 issue of WSMA Reports, WSMA's print magazine.</em>
</p>
</div> | 4/28/2026 12:00:00 AM | 1/1/0001 12:00:00 AM |