Each week, exclusively for Slate Plus members, Prudie discusses a new letter with a fellow Slate colleague. Have a question for Prudie? Submit it here.

Dear Prudence,

One of my co-workers, “Antonia,” is struggling. We are both physicians and do shift work in a close group setting. I am probably her closest friend in our group of 30 physicians. Antonia has been diagnosed with ADHD but has never taken medication for it. She is a competent, incredibly empathetic, wonderful doctor, but frequently loses her focus: she leaves papers / stethoscopes / laptops scattered all over the hospital, fills the shared office fridge with snacks she intends to eat and never does, etc. She also has a strong tendency to talk down on herself, and it is hard to listen to. She will frequently say things like, “I took too long to do that note, so I don’t deserve to eat lunch today”; or, “I know I’m the most scatterbrained person in this office, so I understand if you guys don’t want to be my friend.”

She was recently promoted to co-lead of our physician group (no one else applied for the job, so it was her or no one) and … it’s been rough. Recently she presented a proposed change in workflow to our group at our monthly meeting. I know this is a process she has had many meetings about with other specialties and has thought through carefully. However, her presentation to our group was confusing, tangential, and really hard to follow. A lot of questions arose, she got flustered, and her answers made even less sense, and it eventually culminated in her apologizing over and over, near-tears, and withdrawing the proposal she had spent so many hours preparing.

I don’t know what to do. I think her untreated ADHD is destroying her work success and her self-esteem. When she has opened up to me privately about her difficulties in the past, I have recommended a therapist I have worked with before who was really helpful for me; she saw him one time, which I am so glad she was open to, but had no follow-up and things haven’t gotten better. I think medication for ADHD would really help Antonia, but even as a physician and her close friend, I don’t know how to talk to her about that, or if I should at all. My worry is that she already has a low self-esteem and that even my most well-intentioned comments may be hurtful and unproductive. Do I just take her to lunch and listen, keep my thoughts about meds to myself, and keep watching this slow-motion crash and burn?

—Physician, Heal Thyself

Jenée Desmond-Harris: Medication for ADHD is totally destigmatized, and openly discussed. I can’t help but think that Antonia is aware of it, aware that people with symptoms like hers take it and benefit, and for some reason has decided not to!

Unless (and this just occurred to me as I was typing, because it’s something that would totally happen to me) it’s the ADHD itself that is making filling the prescription feel overwhelming, so she’s just not doing it even though she isn’t opposed to it at all. Like, maybe she did get a prescription and the pharmacy was out of stock and she gave up because she didn’t have the focus to call all around town. Again, been there.

Lizzie O’Leary: I actually think the latter is absolutely what is slowing her down! She probably knows, and has probably connected the dots, but can’t get the ball rolling. I found it interesting that the LW mentioned that when she went to a therapist, it was helpful, because I think that gives us a little more information. I think Antonia likely needs help creating a structure. Normally, I am a little wary of my tendency to charge in, but I think this a situation where direct talk is okay. In part because the LW is also a doctor. “Hey, Antonia, I feel like I am seeing you struggle with some executive functioning lately, do you want to talk about it?”

Jenée: I’m LOL because you said last week you are always Team Direct Talk, and you are. I do think LW should say something, but I’m Team Tiptoe Around People’s Feelings so I would do something like this:

LW: Hey, you seemed upset after the meeting last week and I just wanted to check and see if you were okay

Antonia: I was so embarrassed! I kept forgetting my words and getting lost! I made a fool of myself.

LW: I don’t think it was as bad as you’re imagining it was [Tiny white lie!] but the fact that you felt so flustered is terrible. You shouldn’t have to go through that. And your proposal was a good one! I wish you hadn’t withdrawn it. You know, please tell me if I’m overstepping or if you don’t want to talk about this, but you opened up before about your difficulties and how you were diagnosed with ADHD. I know the process of getting on medication can be overwhelming, but it could really help calm your mind and let you feel more able to manage at work. If you want, I could be your assistant and look up a doctor, make an appointment, put it on your calendar, call pharmacies, etc.

Good script?? Or too indirect?

Lizzie: See, this is why Team Direct Talk and Team Tiptoe Around People’s Feelings work so well together! This is a better script than I could have come up with on my own. You had a nice base of praise before getting to the action thing. Maybe saying you see someone “struggle with executive functioning” is jerky. Which, fair! I like your script a lot. I also think the LW can give Antonia some space to vent, if she wants. The “being your assistant” part is great.

I will level with you, when I was in my 20s and dealing with depression for the first time, I was blindsided by it. And kind of paralyzed. And I had a colleague who basically said “here are three therapists. Go to a test appointment and see.” And it was amazing. Because otherwise I could not have gotten myself there.

Jenée: I actually can’t stop laughing about “I noticed you struggle with executive functioning” now. You know how there will be those social media posts that say “How do you tell someone to politely f*ck off in a corporate email” and everyone replies with things like “Please see previous email,” and “Your input is noted.” I think “I notice you struggle with executive functioning” would be an amazing passive-aggressive fake polite line to use on someone who was messing up and making your life difficult.

I Left My 2-Year-Old Alone With My Husband for 15 Minutes. The Aftermath Might Haunt My Marriage Forever. Help! My Mother Has Some Strange Ideas About Underwear That Are Causing a Major Mess in My House. This Has to Stop. Help! I Found the Handkerchief My Mother-in-Law Was Using for a Really Offensive Test. This Content is Available for Slate Plus members only When My Son Came Back From Easter at His Dad’s, He Was Counting a Stack of Money. I’m Stunned by How My Ex Let Him Earn It.

Anyway, yes to colleagues being helpful. Sometimes these are the people who see us day in and day out and may sometimes have a better sense for how we’re doing than a friend who gets a drink or watches a movie with us.

Lizzie: Oh god, I have gone and been an inadvertent asshole again! Some people would say this is because I am a Sagittarius. Others would just say I am blunt. But yes, you are right, and I am now laughing weirdly in the newsroom.

Jenée: I didn’t realize you were there in person! Someone’s going to be like “Lizzie, I notice you struggle with regulating your moods.” And you won’t be able to complain, because that’s your style.

Lizzie: I think we can both agree, your script is better. I also think this is a horse to water situation. The LW can do all this, but should be prepared that Antonia may truly not want the help. And then, she will have to just back off and hope that her presence and friendship makes it clear that she can be a resource if Antonia changes her mind.

Jenée: Absolutely.

Lizzie: I hope you give me shit about executive functioning until the end of time.

Jenée: Oh, I absolutely will.