Do physicians view people seeking medical cannabis treatment as “complex patients”?

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The majority of people who use CBD do so for medical reasons such as pain management. That’s why states have favored legalizing medical cannabis use over recreational use by a wide margin.

But there’s a problem: medical cannabis assumes medical providers – but people within medicine say there’s a chronic shortage, for two reasons, each subtle and systemic.

The first is that doctors receive little or no training in cannabis medicine. A leading paper by University of British Columbia Medical School Instructor Caroline MacCallum, MD, spells it out:

Physicians of the world remain profoundly uneducated with respect to cannabis and the endocannabinoid system (ECS) that underlies much of its activity. A recent USA study documented that 89.5% of surveyed residents and fellows felt unprepared to prescribe, while only 35.3% even felt ready to answer cannabis questions. Additionally, only 9% of American medical schools documented pertinent clinical cannabis content in their curricula.

What’s more, the “profoundly uneducated” have been rebuked by no less a body than the Mayo Clinic in their report Clinicians’ Guide to Cannabidiol and Hemp Oils. It emphasizes the need for doctors to get up to speed on CBD and the endocannabinoid system and, importantly, to stop talking down to their patients who say it helps them and are seeking further information.

Which bleeds into the second reason for the dearth of cannabis practitioners: doctors are embedded in a system – “a culture of constant urgency” – that leaves too little time for you  

British Columbia physician Brandon Tang is blowing the whistle on this, what he calls the hidden pandemic in healthcare: assembly line medicine – the fast-paced high volume system that leaves a patient waiting hours for 10 minutes of the doctor’s time. The upshot, Tang says, is distracted time-stressed physicians who dread going to work because they know they’re not doing their job properly; for example, by the de facto limiting of patients to one issue per visit because there’s no time to probe the nuances of the “complex patient ” – who presents one too many issues for which the doc has too little time or knowledge to figure out.

Now combine the two reasons for want of proper care and look what can happen at the doctor’s office if you’re seeking medical cannabis. According to MacCallum, chances are 2 out of 3 your doctor won’t feel comfortable talking about it and even if he or she did, chances are 9 out of 10 they won’t know what to prescribe or recommend. So go ahead and make your case – you’ve got 10 minutes – and risk becoming a “complex patient,” according to Tang.

The point isn’t to assess blame; rather, it’s to say that if you’re feeling frustrated in getting the medical care you need it may help to know you’re not alone and that a growing number of doctors are beginning to acknowledge that. As MacCallum puts it:

Patients suffer when they don’t get adequate information. For example, they’ll take too much cannabis because they haven’t been taught how to use it. And so their gut reaction is, I’m never going to do that again. Which is really unfortunate because with some education they could have a very different experience. So the patient education is just so key.

Finally, if you’re someone who’s benefitting from medical cannabis don’t let a physician tell you any different. That comes from UCSF oncologist Donald Abrams, MD, who literally helped write the leading academic book on cannabis medicine, The Health Effects of Cannabinoids: The Current State of the Evidence.

After 40 years in the field his perspective on medical cannabis as a “very safe botanical . . . a different kind of medicine,” warrants close attention:

I [don’t] say take this strain, this much, this many times a day. I don’t think cannabis is a medication that needs a package insert. Most people can probably figure out how much to use it. Every patient is different, every strain is different – I think the best recommendation is ‘start low, go slow.’ …

I think we should regard it as a botanical therapy that’s been around for 5,000 years and has significant benefits. But to try to say that it’s a medicine using a pharmaceutically dominated paradigm might not be correct. I think it should be treated like saw palmetto and echinacea but regulated like tobacco and alcohol, and let responsible adults use it as they see fit.

In other words, it may not be so complex after all.

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