- 19 February 2012
I had a very interesting experience this weekend. I received an email from a physician. The doctor was a surgeon that worked with Crohn's patients and those with chronic pain. He was struggling with their chronic pain and was being asked about medical marijuana. After much thought, he joined the MMMA website and read the posts I had written before I was 'banned' from the site for suggesting that standards of care were good and responding to the request of the legislature for guidance on what constitutes a 'bona fide' dr/pt relationship. He contacted me because I seemed to know what I was talking about and he wanted to learn more about the program. He made arrangements to meet me at my office in Monroe, MI for a clinic on Saturday to see certifications in action.
This physician was in a position of authority in 'Regular' medicine. A chief of staff at his hospital in fact. While he never used marijuana or wrote a certification, he had an open mind and wanted to learn more to solve a 'problem' he saw in his practice, chronic pain and high dose narcotics which were not doing the job of controlling the pain his patients suffered from. He was looking for other options. Since the medical board had recently published guidelines for the certification process, he felt he now had a 'guide' to follow and wanted to see it in action. The guidelines were the tipping factor and what he was waiting for.
With the consent of the patients, the doctor sat in and participated in the certification visits. He asked questions- 'You were on oxycontin three times a day, now you take NO narcotics and that is why you are renewing your card????'. He reviewed the records the patients brought with them, amazed at the history. The age of the patients also surprised him, most were in their late 40's and 50's, not the 18 year olds with the stubbed toes the media portrays them to be. Success story after story came out, he listened intently and asked questions. New patients, renewal patients, each one took away another stereotype. The certification process, unlike the 'signature mill' he was expecting, was professional, though, and based on records and objective findings, not 'affidavits' or other questionable medical practices portrayed in the media and from the AG.
After seeing most of the patients with me, he started the 2 hour drive home. I am sure the drive gave him time to think about certifications and the medical marijuana program. Like me, medical marijuana had been glazed over as a 'political football, an excuse for drug abuse' when he had his medical training. Like me, he had listened to his patients and rethought his position on medical marijuana. Like me, he viewed the guidelines from the medical board as a green light to 'consider' this as a viable option for treatment. He viewed the guidelines as 'protection'- do these and you have done what the board expects you to do and you are safe. It can be a part of your practice.
Will he start writing certifications? Will he allow his hospital staff to write certifications? I don't know, but he was interested, open minded to the possibility, and clearly was impressed with the quality of the patients and the professionalism of the certification process. It is a start to bring certification into the primary care office. But it shows that my postings are directed not only to patients to keep them safe, but to doctors trying to wrap their heads around this new program. That is one of the main reasons I supported the idea of standards, going all the way back to the Redden case in Oct 2010. Before they start writing certifications they want to know that they will not be viewed by the board or their peers as 'traveling circuses' signing certifications as fast as they can collect the cash from the patients and notarize their 'affidavits' or open the mail.
Many of you know a doctor sitting on the fence with certifications. Think about this example of a primary care doctor coming around to the idea of certifications. Can you use some of the elements to encourage your doctor? The guidelines from the board are key factors, doctors want guidelines and protocols, they want safety from professional review (or the safety of knowing they met the standards), and they want help with their difficult pain patients. If they are interested, have them contact me directly, I can discuss the process physician to physician, and invite them to see how it works with me. I will not find the next doctor willing to do certifications, you will, and I'll help you. But it is up to you to start the search. All of you assess your doctors, and look for good potential certification physicians.