A few years ago, the Maryland Board of Physicians notified me that a pharmacist had expressed concern about me providing care to adult patients, even though my training was in pediatrics. This led the Board to review a sample of my charts, primarily from a small side practice where I was treating patients of all ages with ADHD—a field I have had a deep interest in throughout my career. 

 While the Board did not find that patients were harmed or that my care was unsafe, they did find that my documentation, particularly in this side practice, could have been more complete. I accepted their findings and used this as an opportunity for professional development. I stepped back to complete additional training in psychiatry and integrative psychiatry, which focuses on lifestyle interventions and nutraceuticals, as well as a course in medical documentation. I also worked closely with a psychiatrist for several months to further strengthen my skills with purely psychiatric patients. For the next two years, as part of the resolution, I have a psychiatrist reviewing my charts periodically and available for consultation. Importantly, there are no restrictions on my license, and I am fully able to treat patients. 

 Sanctions from the Maryland Medical Board are not uncommon, but they are typically directed at physicians who are clearly putting patients at risk. While I am always open to improving my practice, my experiences since the Board’s review have reinforced that this was a documentation issue—not a matter of unsafe care. Some of the Board’s recommendations were not entirely practical in the context of a busy pediatric setting, or were not fully aligned with FDA guidelines or common psychiatric community practices, especially regarding stimulant dosing. 

 There is a justified national conversation around the overuse of certain psychiatric medications, particularly stimulants, due to concerns about addiction. I share those concerns and take them seriously. However, I also believe that careful, appropriate use of these medications is critical to properly diagnosing and managing ADHD. What worries me is that situations like mine could have a chilling effect, discouraging clinicians from diagnosing ADHD or using the most effective treatments when appropriate. I am a strong advocate for non-stimulant treatments, and in fact, I believe that more than half of patients with ADHD could do very well on non-stimulants.

 However, stimulants remain an essential tool, not just for treatment but for making a clear diagnosis, as their effects are distinct in patients with ADHD compared to those without. Overall, this experience has allowed me to broaden my expertise and revamp my approach, and I am now more committed than