I have begun to believe my mind is full of tiny little topics that act like pimples.

No one can predict the order they start to fester in, or when they’ll get ripe and burst.

Thursday, 7 February 2013

The Doctoral Dilemma!

The Doctoral Dilemma!

Cover your Image, Cover your Wallet, or Cover your Ass?

What comes first?

For twelve years the Canadian Medical Association has been content to sit on its ass and show no concern about the risk of signing Medical Marijuana Applications. They adopted a position of benign disapproval as soon as the MMAR were published. Up until that point they had been proponents and had made recommendations regarding the doctoral role and recommended decriminalization. Unfortunately the Government didn’t swallow the bait and spit it back out. There wasn’t much they could do!

They could deter most of their membership from signing by promoting the false belief that there were unknown risks of harm from long term use. The liability risks for authorizing its use were unknown. While they did not disapprove of signing B1’s for Category 1 applications they could not recommend signing B2’s for anything less because of the possible consequences. Their membership followed along and created the almost impenetrable barrier of physician refusal to sign. Three Supreme Court justices just refused to recognize reality threw out the allegation of any barrier because of lack of evidence. Once upon a time I had the belief that judges were made judges because in addition to the letter of the law, they were expected to exercise some common sense. Another myth shot to hell.

Absolute bullshit: Why all the sudden opposition?

Because all of a sudden, if the new MMPR becomes law Doctors become responsible for their actions: 90% of CMA members have in all likelihood never seen a patient who requested their signature and have never ever read carefully what they were signing on a B2.
They prescribed nothing, recommended nothing, and were liable for nothing. They simply fulfilled a useless bureaucratic mandate

Per Form B2 the Physician signing simply certifies the following:

a. The applicant’s symptom(s) listed in Page 1 of this form falls under Category 2     (symptoms that do not fall under Category 1);
b. conventional treatment(s) for the Category 2 symptom(s) have been tried or considered, and have been found to be ineffective or medically inappropriate for the treatment of the applicant.
I am aware that a Notice of Compliance has not been issued under the Food and Drugs Regulations concerning the safety and effectiveness of marihuana as a drug.
a. If you are a medical specialist that your area of medical specialization is relevant to the treatment of the applicant’s medical condition; or
b. if you are not a medical specialist, please declare:
i. that the applicant’s case has been assessed by a specialist;
ii. the specialist’s area of specialization is relevant to the treatment of the applicant’s medical condition;
iii. that the specialist concurs that conventional treatments for the symptom are ineffective or medically inappropriate for the treatment of the applicant; and
iv. the specialist is aware that marihuana is being considered as an alternative treatment for the applicant.
   (Signature required on next page)

Any physician who signed an application for Medical Marijuana under the MMAR only certified that the instructions on the form had been followed. They consented to nothing and were not legally responsible for any risk. The risk is all Health Canada’s, they are the ones who review and approve the application, license possession and use, and they bear full responsibility for any future consequences.

The new MMPR makes the signing Doctor actually approve the application and accept responsibility for any consequences. While the probability of harmful consequences is extremely remote the CMA wants an environment similar to that which applies to physicians prescribing pharmaceuticals, total immunity from prosecution for iatrogenesis (medically induced harm) when they prescribe drugs they recommend to replace marijuana: the notorious Sativex and Marinol. Both of these have a list of nasty side effects with symptoms that are worse that those they are supposed to be minimizing. Is somebody pulling strings here?

                                        Big Pharma?

 The CMA has already pointed out to the Government that it wants immunity from prosecution for iatrogenic harm before it will even consider the MMPR proposal.

The CMA has more bugs up its ass when it comes to another MMPR proposal granting Nurse Practitioners the right to sign and approve Medical Marijuana Applications.

Horrors: Actually allow Nurses to prescribe on an equal basis with Doctors.

The Medical Profession would have to abandon its preferred position of respect and purported infallibility. They would be forced to assume the role of a Master competing with his former servants for customers and money. In my mind I have a picture of the CMA board of Directors sitting around their massive conference table scratching their heads wondering “What eve happened to the century’s old tradition of nurses grovelling before us like we were God on his rounds?”

Up until the middle of the last century, the first rule of survival for nurses was constantly stressed throughout their training:

”Never challenge or question a Doctor’s authority or treatment.”

Termination was almost inevitable if you did and any excuse was used as grounds for dismissal. The real unjustified cause was insubordination and lack of submissiveness to an inflated ego.

Besides being a big kick in the ego, now comes the real problem for Physicians: Money! As usual.

Suddenly they will be faced with competition from rivals not possessed and driven by greed but by actual compassion and empathy. They can only speculate on the damage that perception will create but what about the damage to the fee structure. Somehow I can’t conceive of a nurse making $50 an hour demanding pay for 5 hours work foe a 15 minute physical and signing of a paper. That would be unethical.

Nurses actually understand the Six Pillars of Character that doctors traded for training in Corporate Finance and Moral Indifference. Patients might actually value that.

What do you think?

Blaine Barrett