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Overview and DisclaimerMy 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:
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:
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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