Medical Marijuana Dispensaries Offer Insight in Patient Care

Marcia Frellick

December 06, 2016

Many patients seek treatment at medical marijuana dispensaries because of the superb customer service and sense of control over illness they offer, not because they consider marijuana a wonder drug, said David Casarett, MD, chief of palliative care at the Duke University School of Medicine in Durham, North Carolina.

In 28 states, the District of Columbia, Guam, and Puerto Rico, patients can use medical marijuana in the way they want, when they want it. They don't need an appointment and, if the treatment doesn't work for them, they can make changes.

"If that sounds like a little thing for someone with a chronic illness, it's not," Dr Casarett told attendees at TEDMED 2016 in Palm Springs, California.

Although the patients he sees are facing the end of their lives and have much to fear medically, the thing that scares them the most is loss of control and the need to depend on someone else, he explained.

Dr David Casarett

Dr Casarett, author of Stoned: A Doctor's Case for Medical Marijuana, obtained a doctor's letter of recommendation for marijuana in California — illegally, he admits, because he isn't a California resident. He did not, however, use the access to make a purchase. Instead, he used the letter to go undercover as a medical marijuana patient and learn firsthand why patients are turning to dispensaries and away from mainstream medicine for the treatment of chronic illnesses.

Undercover Patient

"From the minute I walked into a dispensary, I felt like that clinic was there for me," he said.

His experience showed him the benefit of giving patients control over how they interact with clinics. "Some prefer email, some phone, some an online interface," he told Medscape Medical News. Flexibility in scheduling, although not practical in all settings, adds to the element of control. "That's something the marijuana industry does well," he added.

Another strength is education, said Dr Casarett. When he visited dispensaries, the people behind the counter often took more than an hour to discuss the various potencies of products, what to consider for a particular disease, and the pros and cons of edibles, tinctures, smoking, and vaping. This was without any promise of a purchase, he emphasized.

"When is the last time you went to any hospital or clinic and anyone spent an hour explaining those sorts of things?" he asked the audience.

 
The fact that patients are going to these clinics to get that kind of personalized attention, education, and service really should be a wake-up call for the healthcare system.
 

"The fact that patients are going to these clinics to get that kind of personalized attention, education, and service really should be a wake-up call for the healthcare system," he said. "And if that's a wake-up call to the medical establishment, it's one many of my colleagues are either not hearing or not wanting to hear."

Much of the information about products is discussed in dispensary waiting rooms by patients who share their experiences. That, he said, is a big part of the appeal. Finding ways to harness that insight, perhaps electronically, and to professionally curate the discussions so that harmful information is filtered out would be a worthwhile challenge for healthcare systems, he said.

Another lesson the dispensaries provided was the value of integrating a patient's hopes and personal goals into the care plan, Dr Casarett said.

As a palliative care physician, he said he always asks patients what they would like to accomplish and what they are afraid of, and pointed out that those conversations should start long before end-of-life care.

"I was really surprised to hear those questions asked in marijuana dispensaries," he said. "It's a perfectly legitimate set of questions to ask, for instance, in a hospital setting where a patient has pneumonia and has never been in the hospital before."

 
You've got these mom-and-pop dispensaries operating with people who have no medical training, a high-school education. How come they're delivering more patient-centered care than we are?
 

Healthcare systems would be wise to investigate the customer service of dispensaries, he said. "You've got these mom-and-pop dispensaries operating with people who have no medical training, a high-school education. How come they're delivering more patient-centered care than we are?"

Dr Casarett said his experience serves as a reminder that the best models for patient-centered care might not come from a federal grant for a clinical trial.

"Maybe we should take a field trip and look at a few dispensaries," he said.

Dr Casarett serves on the scientific advisory board for Curio Wellness and has authored a book called Stoned: A Doctor's Case for Medical Marijuana.

TEDMED 2016. Presented December 2, 2016.

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