Citizens of many states are passing Constitutional Amendments to allow marijuana use for defined “approved medical conditions.” In some states, healthcare providers and dispensaries have not yet universally “stepped up to the plate” to self-regulate and raise the bar to the highest level possible to appropriately evaluate and care for patients who are considering the use of medical marijuana. In 1925, Francis Peabody, M.D. stated: “The secret of the care of the patient is in caring for the patient”. Caring for the patient includes comprehensive initial clinical evaluation as well as ongoing carefully monitored management of the entire patient and any current or newly developing medical problems or issues pertinent to the patient’s care. Preventive and interventional plans should be instituted in a timely manner.
A “rubber stamp” approach to recommending medical marijuana should never be tolerated. It is unfortunate that the healthcare industry has defaulted in self-imposed high or “gold” standards and “policing” of medical marijuana use within their states. Legislative bodies have been forced to regulate the medical marijuana healthcare providers, caregivers, and dispensaries. As medical marijuana use becomes more widespread in other regions, a “gold standard” of care of the patient may be incorporated into proposed amendments rather than “after the fact” legislation. The “gold standard” of care will require proper evaluation and care of the patient. Not everyone who seeks medical marijuana will be deemed an acceptable candidate for a variety of reasons. All patients should be encouraged to do everything possible to ameliorate “approved medical conditions” by leading a healthy lifestyle and controlling co-morbid conditions and diseases.
Initial evaluations and ongoing appropriate management of the patient should be documented in readily retrievable written or electronic medical records. Initial evaluations for medical marijuana use should include a complete history and physical examination, including a comprehensive mental status examination. Ancillary laboratory, radiologic and other testing may be needed to properly assess the patient.
There are many known contraindications to the use of medical marijuana. Safety of medical marijuana use is of great importance. For example, medical marijuana use may precipitate adverse cardiac events, exacerbate underlying mental disorders or cause drug interactions. Patients, their co-morbid conditions, diseases and disorders are dynamic and change may occur after the initial medical evaluation.
A formal treatment plan is needed in all patients that includes routine follow-up and monitoring of the medical marijuana patient ss needed on a regular basis. Renewals of medical marijuana recommendations must not be made until continuing appropriateness of medical marijuana use is determined hopefully with measured outcomes of success being attained with medical marijuana use. Initial recommendations and renewal recommendations should not be taken lightly or done expediently. “Running” candidates for medical marijuana use through evaluation clinics or dispensaries with “rubber stamp” approvals should be strongly discouraged, if not prohibited, by healthcare professionals in every state and not simply prohibited by regulatory agencies. A “gold standard” for care for medical marijuana patients is time consuming and less lucrative than high volumes of candidate patients quickly receiving medical marijuana recommendations but the tradeoff is better patient care and it is why most healthcare providers entered the profession in the first place.
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