The Medical Board of California has recently issued updated guidelines for physicians to avoid disciplinary action related to the recommendation of cannabis to their patients for medical purposes. The board explicitly states that these guidelines are not intended to mandate the standard of care, and that the board "recognizes that deviations from these guidelines may occur and may be appropriate depending upon the unique needs of individual patients." These guidelines, and similar guidelines by other states, however, serve as the foundation for an emerging standard of care for medical cannabis. In legal terms, the standard of care is how similarly qualified practitioners would have managed the patient's care under the same or similar circumstances. As medical cannabis becomes more widespread and accepted as a legitimate treatment by the medical community, a uniform standard is needed to ensure consistency of care and patient safety.
Along with close attention to medical documentation, essential components of the California guidelines include:
An established physician-patient relationship Adequate medical evaluation Informed consent A treatment plan and ongoing monitoring. The Physician-Patient Relationship and Patient Evaluation
The guidelines outline the key factors and considerations for assessing the appropriateness of a physician's recommendation of medical cannabis and require the establishment of a physician-patient relationship prior to the recommendation of cannabis. It is expected that the physician shall not recommend medical cannabis unless the physician is the patient's "attending physician," meaning that he or she has taken responsibility for an aspect of the medical care, treatment, diagnosis, counseling or referral of a patient. The board requires documentation of a patient's history and an initial medical examination that includes considerations such as the history of the patient's present illness, social history, past medical and surgical history, alcohol/substance abuse history, family history on addiction, psychotic disorders, mental illness, therapies with inadequate response and the diagnosis supporting a cannabis recommendation.
Qualifying Medical Conditions
Though the California Compassionate Use Act of 1996 names certain medical conditions for which cannabis may be useful (including cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis and migraine), physicians are not limited to those specific...