Ensuring The Bona-Fide Doctor-Patient

[tricharious]

How often do you consider this and what do you feel needs to be done to protect yourself as a patient?

[GregS]

That you provide a record of continuing treatment for an allowed condition is first and foremost. Clinical notes from prior consultations that establish a diagnosis and a pattern of good faith follow up can only work in your favor. If starting to treat for a condition that has not been treated before, An initial diagnosis must be made, and the State now requires that a physician who signs off on your certification or who notes in your chart that you stand to benefit from the drug follow you in continuing follow up treatment.

 

Bona fide is a term that the government cannot really pin down, but they use it nonetheless. Be careful of doctors who fail to fully document your treatment and/or who choose not to follow you afterward.

[Wild Bill]

My certifying doctor is my orthopaedic specialist so he treats me for my problems with standard therapy as well as certifying my medicinal use of cannabis.

 

My best suggestion is to call your certifying doctor when you get a cold or other ailment and ask them to prescribe something for those conditions. Antihistamines or non-narcotic pain killers for example.

 

Then if needed in court you can show that the doctor actually treats you for varied medical conditions and isn't just signing a cert for money.

 

Assuming your doctor is legit it shouldn't be a problem.

 

Any observations that Dr. Bob might have on this theory would be appreciated.

[Dr. Bob]

There are certain practices that are trouble.

 

1.  No records required.

2.  Renewals 'through the mail'

3.  The doctor will 'review your records later' but give us your money now.

4.  Hotel doctors without actual offices.

5.  Doctors that ONLY do certs but no other aspect of medicine deserve a look.  Are their licenses intact?  Do they have a DEA registration.  Is their name listed in the clinic ad?  Are the office workers hesitant to tell you who the doctor is?

6.  No follow up offered or discussed

7.  Be cautious of dispensary doctors, they tend to disappear when you need them.

 

Just a couple of recommendations for safety, not requirements.  It is your freedom on the line and you can decide the level of risk you are willing to take.

 

Dr. Bob

[GregS]

My point being that the State has quantified something that cannot be recognized and/or understood except as quality. The two, in this case, are mutually exclusive.

[Dr. Bob]

Folks follow things when they understand them.  I try to explain things well to 'hopefully' have them make sense.  These are not hard to follow things, the problem is that many bad clinics were out there collecting money from patients without educating them or looking out for their safety.  There is also a group in this community that really views the certification signature as the important thing, a minor hurdle to jump through in order to get access to cannabis for medical and recreational use.

 

Just keep in mind, it is not what we can 'get away with'....there are MANY posts in here discussing loopholes and stretches, but what will 'keep patients safe' that I spend most of my time talking about.

 

Dr. Bob

[GregS]

Folks follow things when they understand them.  I try to explain things well to 'hopefully' have them make sense.  These are not hard to follow things, the problem is that many bad clinics were out there collecting money from patients without educating them or looking out for their safety.  There is also a group in this community that really views the certification signature as the important thing, a minor hurdle to jump through in order to get access to cannabis for medical and recreational use.

 

Just keep in mind, it is not what we can 'get away with'....there are MANY posts in here discussing loopholes and stretches, but what will 'keep patients safe' that I spend most of my time talking about.

 

Dr. Bob

Look Bob. There is and never was a contradiction in our comments. I'm not feeling particularly practical today, except to point out that I did warn patients with one sentence: "Be careful of doctors who fail to fully document your treatment and/or who choose not to follow you afterward."

 

My kids had only two rules. They were to do nothing that put them in the hospital, and nothing to put themselves in jail.

 

KISS

[Dr. Bob]

Look Bob. There is and never was a contradiction in our comments. I'm not feeling particularly practical today, except to point out that I did warn patients with one sentence: "Be careful of doctors who fail to fully document your treatment and/or who choose not to follow you afterward."

 

My kids had only two rules. They were to do nothing that put them in the hospital, and nothing to put themselves in jail.

 

KISS

I agree with you 100%, both on your assessment of our positions and our philosophies on raising kids.  Perhaps it was not coming through well that we are clearly in agreement.

 

Bob

Edited March 22, 2013 by Dr. Bob

[tricharious]

Well, I went to the Greenlite Clinic in Troy. They are promoted on this very website. I called them and asked if they offered follow-up visits and they said no. That I should just come back in a year to recertify. On their website it says the following under FAQ's:

 

 

Q:  Why should I choose GreenLite Clinic in Troy, MI as my certification clinic?

A:  Choosing the right certification clinic is an important task for a patient.  Here are just some of the reasons you should come to us.

• We are a registered Professional Corporation with the State of Michigan. Our corporate name is Dr. K. Singh, P.C., and our trade name is GreenLite Clinic. We are a licensed medical clinic that meets the Michigan Standard of Care requirements.
• We have been providing certifications and renewals for three years now in Troy, and are located in a permanent location.  We are always in the same location in Troy for medical follow-up, to provide you with duplicate paperwork in the event you lose yours, to address any issues that you may have, and for your renewal.  Our physician is On-Site at all times.
• Our clinic is owned and operated by Michigan licensed Board Certified physicians, so you can be sure all medical standards of care and the bona fide physician-patient relationship required by Michigan State Law are met.
• It is important for you to remember that the Michigan Standard of Care requirements and the bona fide physician-patient relationship required by Michigan State Law MUST be met by your certification clinic, or your certification will NOT provide you any protection in a Court of Law.

Firstly, I underlined the part about follow-up because when I called them and inquired about it they acted like they had no idea what I was talking about. Also, if you look at the last two bullets it talks about the bonafide relationship and the last one even emphasizes that the certification will not provide protection if this the requirements for said relationship are met. 

I spent $99 to get a piece of paper and am now feeling like I should have went somewhere else. I'm concerned that in the event that I end up in court, my defense will not be valid because there is minimal supporting evidence surrounding my condition and I will only have one recorded visit to the certifying physician. 

Ah well, I'm sure there are many people who see a doctor once a year to get certified without any follow-ups in between. That being said, it doesn't make it safe. 

 

[Dr. Bob]

I don't know what their policy is, nor can I vouche for the training of their office staff.  I do know the doc and he knows how to pick up the phone if there is an issue with one of the patients on a section 8 and who to call.

 

As a side note, the cards are 2 years as of 4-1-13

 

Dr. Bob

[tricharious]

And in all honesty, everything I've read by anyone who has gone to Greenlite says it's a great place. Though, it doesn't hurt to be overly-cautious as a patient. After all, it's our donkey on the line. 

[Hydraulic Jack]

There is some good stuff in this thread. We'll talk to Dr. Singh about his follow-up policy to clarify. Follow-up visits to the certifying doctor are not required by law, according to the legislators that have spoken on Planet Green Trees, including Senator Rick Jones, the follow-up care mentioned in the revised Section 3(a) defining "Bona-fide physician-patient relationship" is intended to be for subsequent biannual certifications.

 

So if you do a face to face with your doctor before every renewal your good to go?   HJ

[cristinew]

Before the renewal  , like the same day of the renewal  

[Dr. Bob]

I think it is safest to do it once a year.  I don't charge for that, but I think it would make the chart better in the eyes of the court.  What you have to do is not the same as what you should do.  

 

Dr. Bob

[GregS]

I agree with you 100%, both on your assessment of our positions and our philosophies on raising kids.  Perhaps it was not coming through well that we are clearly in agreement.

 

Bob

 

Okay. And don't sass.

 

Maybe three.

[asignman]

For what it is worth I went to the Green lite Clinic last week. I took the exact same information as I took the first 2 times I went for certification. ie. Copys of my blood work showing a positive test for Hep-c and discussed my semi recent cancer surgerys. Because I did not have the clinical diagnosis records in hand the doctor refused to sign a certificate for me pending recieving those documents. He at least is covering his butt.

 

Don't know if I will return there after I have the records in hand. Never tried to get copies of those records from the VA and quite frankly am getting fed up with the amount of hoops I have to jump thru to get "legal" to do the same thing I have been doing for 40 plus years with out ever once having a law enforcement issue because of that behavior.  I am sure I will end up dancing the dance for my honey's piece of mind. 

Edited March 25, 2013 by asignman

[tricharious]

I didn't have a clinical diagnosis either, all it showed in my record was that I had knee pain most likely relating to surgery I had very long time ago, the records of which are most likely non-accessible. It also showed back pain and muscle spasms. And of course the medication I was on ultram flexeril and robaxin. He was moist concerned with my knee and ended up certifying that I had a history of chronic left knee pain secondary to necrotizing fasciitis S/P reconstructive surgery pain unresponsive to tramadol/flexeril , pain relieved by marijuana.

 

I didn't see Dr. Singh though. I saw Dr Lang.

[Estimated Prophet]

I was just there last week and was offered follow up appointments as needed and for a pretty fair price IMO.

Was also given a treatment follow up form to fill out at 2 - 3 months and told that it's return was required.

Checked me out on the doc's table and gave me solid advice on some non medical cannabis related health issues. 

My 3rd visit to him, and have always had a good experience. 

I can't vouch for the experience level of the young ladies at the front desk, but Dr. Singh is legit.  

[itisi]

It baffles me that not one of the certifying Doctors I've seen or talked to will order simple lab test for some of these issues such as Hep c seems to me this would put to rest any question as to weather you had a bona fide relationship.  If you see the same Doc every year and he/she keeps records there should be no need to bring in more doctors notes every year that to me is a bona fide relationship.

[Dr. Bob]

The answer to your question is that by ordering the test, they are responsible for acting on the results.  Hep C is a reportable condition, which requires follow up and treatment, and the health department will be calling, frequently, to check on that follow up with the doctor.  It also adds liability for the doctor if they don't.

 

What about other issues, like taking vitals.  Suppose there is high blood pressure.  You recommend the patient go to the ER, they don't.  One of the complaints against Harwell is that he didn't act and follow up on elevated blood pressure readings.  Come in with an X-Ray showing your curved spine?  Want the doc to diagnosis it as scoliosis (and from then on own it)?  Are you going to show the X-Ray to the judge on your section 8 hearing?  What if there is a cancer down in the corner of the X-ray and the certification Dr. doesn't see it?  Can you sue the doctor for missing it?

 

Dr. Bob

Edited March 26, 2013 by Dr. Bob

[cristinew]

One of the clinics i was at , they took all the patients  BP one patients  was high, amd unaware of the condition ,,  the cert DR, did right out a script for the  high BP,, and then told him to go to his primary dr

[cristinew]

High Blood Pressure should be a condition to be added   , i think it is in Cal and another state ,

Edited March 26, 2013 by cristinew

[Dr. Bob]

Hypertension would be an interesting condition to look at with cannabis.

 

Dr. Bob

[cristinew]

http://circ.ahajournals.org/content/110/14/1996.full

 

 

 

• Hypertension

Endocannabinoids Acting at Cannabinoid-1 Receptors Regulate Cardiovascular Function in Hypertension

1. Sándor Bátkai, MD, PhD*; 
2. Pál Pacher, MD, PhD*; 
3. Douglas Osei-Hyiaman, MD, PhD; 
4. Svetlana Radaeva, PhD; 
5. Jie Liu, MD, PhD; 
6. Judith Harvey-White, MSc; 
7. László Offertáler, MD; 
8. Ken Mackie, MD; 
9. M. Audrey Rudd, PhD;
10. Richard D. Bukoski, PhD; 
11. George Kunos, MD, PhD
12.  
13.  
14. A good read on why it should be part of the treatment ,,

 

Background— Endocannabinoids are novel lipid mediators with hypotensive and cardiodepressor activity. Here, we examined the possible role of the endocannabinergic system in cardiovascular regulation in hypertension.

Methods and Results— In spontaneously hypertensive rats (SHR), cannabinoid-1 receptor (CB₁) antagonists increase blood pressure and left ventricular contractile performance. Conversely, preventing the degradation of the endocannabinoid anandamide by an inhibitor of fatty acid amidohydrolase reduces blood pressure, cardiac contractility, and vascular resistance to levels in normotensive rats, and these effects are prevented by CB₁ antagonists. Similar changes are observed in 2 additional models of hypertension, whereas in normotensive control rats, the same parameters remain unaffected by any of these treatments. CB₁ agonists lower blood pressure much more in SHR than in normotensive Wistar-Kyoto rats, and the expression of CB₁ is increased in heart and aortic endothelium of SHR compared with Wistar-Kyoto rats.

Conclusions— We conclude that endocannabinoids tonically suppress cardiac contractility in hypertension and that enhancing the CB₁-mediated cardiodepressor and vasodilator effects of endogenous anandamide by blocking its hydrolysis can normalize blood pressure. Targeting the endocannabinoid system offers novel therapeutic strategies in the treatment of hypertension.

Edited March 26, 2013 by cristinew

[Dr. Bob]

Don't post it here, write it up and submit it to the new conditions panel.  One member here just did a several hundred page treatment of bipolar that is being reviewed and edited for submission now.  We need a member here that is just as passionate about 'chronic persistent anxiety' if there is anyone interested.  Would be a great Spring project for you, you could submit under your name or not and we have folks that will help you get it ready if you do the legwork and gather the data.

 

Dr. Bob