Overview and Disclaimer

My Practice and Standards

I have developed (and continue to refine) standards for the recommendation of medical cannabis in my own practice, reflecting my quarter century as a Board certified Family Physician providing primary health care. These are my own standards and should not be construed as criteria for any other physician practicing within the scope of his or her training and license.

General requirements

1. The patient should have a current source of primary care -a Primary Care Provider or PCP- whom he or she sees regularly.

2. The patient should be seen regularly for the serious illness or symptoms for which medical cannabis is used, by either the PCP or by  a specialist, chiropractor, or other health practitioner of the patient's choice.

These requirements accomplish two important objectives:

• Affirming that the patient has access to primary care.

• Clarifying my role as a consulting physician, and not the primary care practitioner (a common misunderstanding).

Even if the serious illness or symptom is stable, I advise the patient to see his or her physician yearly, to review and update the history and physical.

I generally describe this requirement to the patient by saying: "I don't want to be the only physician who is aware of your illness or symptom, since I am NOT your primary care practitioner."

My medical cannabis evaluation is a medical-legal consultation, and is not to be confused with the provision of primary care.

Phone screening

Patients calling for a medical cannabis evaluation are screened by phone to make sure they understand my requirements prior to being given an initial appointment, and to eliminate those who clearly do not qualify.

Pre-appointment

A 45-minute appointment is scheduled for new patients, or 30 minutes for annual re-evaluations. The patient is mailed a detailed questionnaire, along with release forms to obtain records that will be required for the visit.

The patient must fill out  the questionnaire in advance of the visit, and must request or bring medical records related to his or her serious illness.

Appointment

The medical cannabis evaluation is conducted in a face-to-face office visit, which includes the collection of relevant history, problem-specific physical exam, and review of the completed questionnaire and outside medical records.

A written summary of the patient's interview and history is completed for the patient's chart.

All of these data are assessed for indications that cannabis may be of benefit for the patient's symptoms or problems.

Pros and cons of medical cannabis use are discussed with the patient, and informed consent documents are reviewed and signed. Patients are advised that they should continue to assess the benefits that they receive from medical cannabis, and should continue its use only if it continues to benefit their symptoms.

Based on all of the above, a decision is reached on whether or not to recommend cannabis to the patient.

Limited approval -for three months or less- may be given in cases where there exists some documentation or physical evidence of a serious illness for which cannabis might be beneficial, but more recent records are required and/or expected to arrive.

Follow-up

Appropriate follow-up appointments are arranged for patients receiving recommendations. Yearly re-evaluation is a minimum.

More frequent follow-up visits may be required in certain circumstances, such as in some psychiatric diagnoses and some mood disorders, especially if the patient is not receiving ongoing psychiatric care. In this instance, I may require the patient to return with a family member or close friend to corroborate that patient does better with cannabis than without it.

Patients are to continue regular follow-up with the PCP and/or specialist for the serious illness or symptom for which the patient uses cannabis medicinally. At yearly renewal re-evaluation visits,  I expect the patient to bring in documentation that his or her primary provider is aware of the serious illness or symptom, and is seeing the patient for re-evaluation at least yearly.

Forms

I have developed the following forms for use in conducting medical cannabis

Evaluations:

• Consent to assume risk for medical marijuana.

• A questionnaire (adapted from the questionnaire developed by the California Cannabis Research Medical Group)

• Recommendation/approval form

If a 12-month recommendation is provided, it is dated to expire on the last day of the month, to allow the patient a one-month window to be re-evaluated in their anniversary month.  Lately I have embossed the original recommendation with my seal, and  added small lettering on certificate that says "original is embossed."  The embossing limits the reproducibility of the original. I began doing this after finding that a patient had altered his original certificate. (An extremely rare occurrence.)

CONTINUE : Full disclosure

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