One of the greatest problems we have faced certifying patients for the use of medical marijuana has been to properly treat and protect those with no medical records. While other clinics have waived the requirement for records, we feel that approach puts patients at risk if they ever ended up in court trying to justify the certification to a hostile prosecutor and judge. 'How do you know they didn't fill out the pain log the morning of the visit, doctor?' or 'If a patient signed an affidavit saying they were pregnant (and they were male) would you write them prenatal vitamins?'. Often the doctor goes home, unpunished, for selling a signature without the basic medical evidence to justify what he did, but the patient goes to jail. The current buzz word in Lansing is the 'bona fide' dr/pt relationship.
Pain logs, like 'affidavits', are self reported symptoms by a patient. To make them work, the certifying physician must have standing in the medical community- a valid license, DEA registration, no history of discipline with the board, etc. That good standing makes their opinion count at least for something. But both the medical board and the department of community health does not approve of 'fill in the blank' medical histories as the sole basis of a certification.
My initial thought was to overcome this by having the patient bring their pain log to another physician for review and confirmation. But this proved troublesome as the cost of the physician visit could exceed $150. While I still couldn't prove the patient didn't fill out the pain log the morning of the visit (and in the case of 'affidavit' clinics they clearly did), I could point to my own status as a physician in good standing and state that not only did I find it reasonable, so did another doctor. The next evolution was the concept of 'time stamping' the pain log to prove that it had been filled out over time.
The final stage was to bring it all together, a time stamped pain log, with frequent physician interaction with the patient via email, and an actual visit PRIOR to the certification visit with the certifying doctor. I'd hate to miss the tumor causing your back pain because you forgot to think about it when you filled out your 'affidavit'. The result is that I am going to do the pain log for chronic pain patients, bring them in after a few weeks to examine them and perhaps order some testing, and THEN bring them back to certify they. That is a 'No Record' certification that will stand up in court, because I am creating a full record for you, just like any other doctor would. And I am going to do if for a flat fee of $100 over up to 12 weeks (less than $10 a week), plus the cost of any testing you might require. We will offer $25 off the price ($75 total) for the first month to introduce the program.
Perhaps this will not only result in a better quality of certifications, but make them defensible and bring certifications more in line with the rest of mainstream medicine. This will serve to take away some of the criticisms the AG and others have levied against certification. We will start with chronic pain, which requires documentation of symptoms for 10-12 weeks. The difference between this and the 'No Record' clinics is that there is actual substance to this relationship, which will not only stand up in court, but to peer review in the medical profession and the general public.
The bottom line is there is no such thing as a legitimate no record or 'affidavit' clinic- the only purpose of a notarized 'affidavit' is to protect the clinic from legal action while doing nothing to protect the patient. It is merely a paperwork trick to enable these mills to collect money while giving patients a false sense of security because they don't do the actual medical work to establish a diagnosis. You either have the records, or need to generate them to support the diagnosis you are basing your card on. We've always required the records, now we will generate them as well; the result from either process is a certification that you can count on to support you in court.
Here is the link to get started: http://www.drbobmmj.com/index.php?option=com_ckforms&view=ckforms&id=13&Itemid=157
Dr. Bob