Becoming a Registered Medical Marijuana Doctor

Patient Care

Qualifications for Medical Marijuana Doctors

MarijuanaDoctors.com has adopted strict standards in evaluating medical marijuana doctors and medical cannabis clinics allowed to join our network of trusted physicians. MarijuanaDoctors.com is committed to the advancement of cannabis as a medicine to treat a wide array of ailments and believes that medical marijuana use should be administered and monitored by qualified, board-certified medical marijuana doctors.

MarijuanaDoctors.com ensures that physicians meet each state’s specific requirements for the type of doctors that can recommend marijuana. All of our doctors adhere to state medical marijuana laws and supply medical marijuana recommendations, not phony marijuana prescriptions. MarijaunaDoctors.com has established the following procedures and criteria for compliance by physicians and clinics in order tobe featured on our site.

Qualification Criteria for Medical Marijuana Doctors

Only Qualified, Licensed Physicians Are Eligible

● We verify that each of our physicians has an active medical license in good standing
● We review each doctor’s record two times per year All Physicians and Medical Cannabis Clinics are Confirmed
● Each medical cannabis doctor and medical marijuana clinic is confirmed via telephone by a MarijuanaDoctors.com representative
● Each physician’s business phone number is verified via reverse number lookup
● Each physician must confirm that all information on file with MarijuanaDoctors.com is correct and valid Prescribing Medical Marijuana in Pennsylvania
● Doctors will need to be approved and registered by the Pennsylvania Department of Health to certify patients for medical marijuana use.
● Patients will receive certification from a physician and an identification card from the Department of Health.
● Information on certifications issued to patients by doctors is confidential and not subject to public disclosure. However, the names, business address and medical credentials of doctors authorized to provide patients with certification will be made publically available.
● Doctors will be required to attend a four-hour training course on medical marijuana, and continuing education credit will be given.
● There will be disciplinary actions against doctors that have violated the Medical Marijuana Act.
● It is a first-degree misdemeanor if a doctor intentionally, knowingly or recklessly certifies anunqualified patient for medical marijuana.
● Only certain forms of medical marijuana will be allowed.

How Can a Physician Participate in the Medical Marijuana Program?

  1. In order to participate in the Medical Marijuana Program, a physician must:
    First, create a profile in the Department of Health Physician RegistryOpens In A New Window. A validation of the physician’s Pennsylvania medical license with the Department of State will occur.
  2. Physicians will then be prompted to complete the required 4-hour training provided by a Department of Health approved training entity.
  3.  There will be a final review and approval by the Department of Health in order to become a Practitioner who can issue patient certifications.

What is the education process for physicians who want to register with the medical marijuana program and issue certifications to eligible Pennsylvanians to use medical marijuana?
Once validation of the physician’s license occurs with the Department of State, physicians will be prompted to complete a required 4-hour training provided by a Department of Health approved training entity. During the registration process physicians will need to complete 4 hours of Continuing Medical Education (CME) from an approved provider. The CMEs will count towards the physician’s licensure requirement.

Medical Cannabis Doctor Qualifications

A marijuana doctor is a physician with all of the rights and privileges to practice in your state. They may have a specific specialty like oncology, or they may be a general practitioner. A marijuana doctor is experienced in medical practice and is no different from the other doctors you see — except they are willing and qualified to recommend medical marijuana. Patients can see a medical marijuana doctor in person or online virtually depending on the state.…

“Getting On”: The New HBO Series Set in an Extended Care Hospital Unit

Hospital Unit

An American remake of a popular British TV series debuted Sunday, November 24. A late-night HBO comedy built around the idiosyncrasies of hospital extended care might seem like a strange idea, but we watched, and it does work.

(In fact, one has an inkling that the premise might actually be more believable in today’s U.S. healthcare climate than in any other time or place.)

Staff of the Billy Barnes Extended Care Unit of Mt. Palms Hospital in Long Beach, Cal., looks after aging female patients suffering from dementia, incontinence or heart problems. Meanwhile, staff themselves struggle with a broken healthcare bureaucracy and many of the issues facing real healthcare providers today.

The real healthcare/long term care issues at stake

The pilot episode “Born On The Fourth of July” deals with the universal themes of death, aging and breaking news of a loved one’s death to relatives. In fact the episode opens with 87-year-old “Lillian” already passed away in her hospital bed, with a birthday cake waiting at her bedside, untouched, and closes with Nurse Dawn (Alex Borstein) breaking this news to Lillian’s older sister in a surprisingly poignant scene.

Even in very old age, death can be unexpected and has real emotional consequences.

Meanwhile nurses and doctors deal with smaller but no less real issues. Mt. Palms is on the brink of losing Medicare reimbursement due to cleanliness violations, and patients on the ward struggle to understand their Medicare and Medicaid coverage, all the more difficult to explain given that many are experiencing cognitive decline.

Dr. Jenna James (Laurie Metcalf), committed to research and publishing studies, spars with nurses who think that patient care should take priority. James chases errant turds al over the hospital, hoping to add them to her “stool collection” for a “conference in Cleveland next month.”

“In this day and age, do you really think there are only seven categories of stool?” – Dr. Jenna James on her dream of expanding the Bristol Stool Scale from seven categories to 16.


While unclaimed feces floating about is a rather lighthearted problem, it could pose a real danger for hospital-acquired infections like Clostridium difficile, which the nurses mutter in hushed voices rather like a Hogwarts student might say “Voldemort.”

The nurses struggle to care for a new patient, picked up on the street – a case of “granny dumping,” perhaps – who does not speak English. Language barriers and access to healthcare is a real issue in hospitals today, and a shortage of medical translators further complicates the nurses’ efforts.

The hospital staff also struggles with limited bed availability, a symptom of hospital overcrowding. James even rushes the release of a patient who may not be able to care for herself independently in an effort to free up her bed for a prostate cancer patient, one of the darkest moments in the episode.

“You flushed away an important lump of information.”

The fact that extended-care workers are often thought of as “less than” other hospital staff will likely be the issue that defines this show in future episodes. Other hospital personnel call the Billy Barnes unit a “dead end” and say, “nobody with any self respect would take this job.” One doctor temporarily working on the unit tells a patient “I don’t only work here, I’m also a real doctor.”

That within-medicine hierarchy of respect hasn’t been explored in pop culture to date.

Is it a good show?

We’re working with a limited amount of evidence at this point, but tentatively, yes. The show’s lighthearted attitude about death may shock at first but soon feels like the only way to deal with working in an extended care ward day in and day out.

Lest we forget, “Getting On” is a comedy. We can decode its attitude toward aging and death through humorous scenes, like chasing the owner of an errant turd left in a chair in the waiting room. We also see it in meta details, like the carefully selected cast culled from award-winning comedies of the last 20 years, from broadly successful sitcoms to cult-inspiring web series.

Laurie Metcalf won three Emmys for “Roseanne.” Alex Borstein gained fame as a sketch player on “Mad TV,” later lending her voice to “Family Guy.” Niecy Nash, as compassionate Nurse DiDi, the emotional heart of the show, surprises viewers who remember her from the irreverent Comedy Central show “Reno 911!” And a sharp eyed viewer will catch Helen Slayton-Hughes, who stole the show as a bit player in “Burning Love,” in the final scene as Lillian’s devastated sister.…

A Plan to Resolve Conflict of Interest in Managed Care

Patient Care

Focusing on Medicaid eligibility in the quest for patient centered care.

Implementation of the Affordable Care Act is increasing the number of people eligible for Medicaid, which is fueling the debate about conflict-free case management in Managed Care programs.

The Root of the Problem

Historically, Medicaid beneficiaries who needed to access home- or community-based long-term services (HCBS) and support programs underwent an assessment by a care coordinator or case manager. That person helped them develop service plans or make arrangements to identify appropriate local providers, explained Frank Spinelli, vice president of long-term care solutions, Xerox.

“But when the HCBS programs started to take off, a number of providers besides being service delivery providers were also running case management agencies,” Spinelli said.

There’s an increased possibility for conflict of interest in that kind of system; when the assessor is also the provider, he may be more likely to recommend treatments and care options that are more expensive, whether or not they are necessary.

Even when the case management and provider (i.e. homemaker services or group home) units are separate but contained in the same organization, the risk is high.

“In a particular state, we noticed that a significant number of individuals were being recommended for group homes, and some could have functioned very well in independent living,” Spinelli said. “The provider was influencing their choices.”

As reimbursement models changed, providers had incentive to get individuals to choose more complex, expensive services.

Addressing the Issue

Over the last several years, leaders at the Centers for Medicare & Medicaid Services began to recognize areas where this type of conflict of interest was common. National health policy has reflected their discovery.

“When the Deficit Reduction Act was introduced in 2005, there was a provision that allows states to develop some plans, requiring that they adhere to conflict-free case management,” Spinelli said.

The Community First Choice Option in the Affordable Care Act allows communities to expand their services as well, provided that they adhere to conflict-of-interest-free case management.

So how can Medicaid health plans remove conflict of interest from case management, and separate managers from provider services? More than 30 states are facing that dilemma as they move the bulk of their Medicaid beneficiaries into Managed Care Organizations.

Guidance from CMS suggests two basic options for long-term managed care plans:

• The state retains control of assessment.

• The state contracts with an outside case-management entity. The company providing the initial assessment must not have any financial interest in the amount or type of long-term services the beneficiary ends up choosing.

• The state allows assessment and provider services to co-exist in one organization, as long as the organization agrees to set up firewalls separating the two units.

Where’s the rub?

“There’s an issue out there now about how states move to managed care, and a number of states over next two years will be doing this,” he said.

To adhere to conflict-free standards, plans must make sure the individuals are not related by blood or marriage to any of the caregivers, or are being paid by any them.

In many ways, plans are attracted to option three, the firewall approach. That would require the least change from the present system.

But will interior firewalls eliminate conflicts of interest, and will patients trust them?, Spinelli asked. He believes option two is the best approach.

An unbiased one-time assessment leaves the family with a detailed document of what the patient’s needs are, to what he is entitled, and what short- and long-term goals should be.

The family can refer back to this document if the level of care in their plan isn’t measuring up.

“The beauty of the independent entity is you’re putting it in the patient’s hands,” he said.

In other markets, when financial institutions need an audit or patients need a second opinion from specialist doctors, the best choice is always the most independent, he said.

“Companies don’t do an audit internally, they hire an outside CPA,” Spinelli said.

“The goal is giving people information so they can make unbiased, independent, informed choice about their lives,” he said.

“You want to empower people to be in a position to ask ‘Why this and not that?’”

Though many states are opting for the firewall approach, some states are choosing independent entities on the eligibility side, which Spinelli says is a good first step.

“I believe we should take this a step further and provide the family with recommendations for needs, goals, options – not just a stamp that says, ‘You are eligible.’”…

Here’s How One Team Got Health IT Right

IT Right

Based on the hit-and-miss performance of many current EHRs and similar solutions on the market, it’s clear that many tech experts don’t quite understand how to make a truly useful digital health application.

It makes sense that, in order to help doctors, nurses, surgeons and the like do their jobs, you need a thorough understanding of how that job works every day. According to the providers we’ve spoken to over the course of 2013, many developers simply lack that knowledge.

Many providers still struggle to fit emerging digital solutions into their workflows.

The Tide Turns

What if providers and designers teamed up from the start and developed a digital solution together? Couldn’t that solve the problem? We may soon know the answer, as cross-specialty collaboration becomes more and more common.

We’ve heard from Dr. Chris Kuzniak, a surgeon, an associate medical director for Xerox’s healthcare provider solutions and an entrepreneur who merges the worlds of technical innovation and healthcare experience in his life and various startups, like eClinic Healthcare.

Omada Health, an evidence-based digital health startup in San Francisco, includes a Harvard and UCLA-trained “Medical Director” on their core team of 10 technologists and entrepreneurs.

And experts from diverse areas of study, including working health professionals in hospitals, put their heads together to develop Xerox’s Digital Nurse Assistant (DNA). Let’s take a closer look at DNA, as an example of ground-floor collaboration between providers and health IT specialists.

Bridging the Divide

The pre-pilot-stage DNA device looks like an iPad Mini, according to Rufus Howe, a Xerox chief innovation officer and one of four Registered Nurses involved in the product’s design.

“It has all of the pertinent information a nurse would need to do their job during the day,” he said. Individual patient files include conditions, treatments received, lab results, imaging and vital signs updated in real time through the data streams the hospital produces.

“Nurses have carried around this info for years, periodically stopping at the EMR workstation on their floor and jotting down shorthand notes on paper, in a binder or notebook,” he said.

Nurses call these handwritten notes their “paper brain.”

“That isn’t broken, because it works to a certain degree. But it doesn’t get updated,” Howe said. Nurses have to continually check the EMR for updates.

The DNA device transcends the paper brain. It updates in real time and sends alerts when a medication status or vital sign changes. Nurses don’t have to continually check in with the EMR workstation anymore.

“It seems like a small thing, but it’s huge for nurses,” Howe said. Nursing is a hellish job sometimes, and they can find themselves running around “like a chicken with its head cut off,” he said.

Ethnography

Taking that first step from existing process to digital innovation can be tough, even when the advance seems logical. It requires the collaboration of diverse experts.

“A number of nurses were involved in the initial research conducted by Palo Alto Research Center (PARC) researchers and ethnographers,” Deri Plummer, a Xerox product leader and another of the nurses collaborating with the design team, said.

“In addition, we donned our scrubs and pulled a few 12-hour shifts at a local hospital to shadow and interview several staff nurses and charge nurses throughout the design process to ensure we were on the right track,” she said.

PARC employs experts in intelligent workflow design, including one who designed the Mars Curiosity rover mission control software.

“You can imagine, when you bring together that expertise with nursing, it’s like a match made in heaven,” Howe said.

Initial research found that more than 30 percent of a nurse’s day is spent checking documentation and overcoming inefficiencies inherent in the system. Based on those findings, the research team decided to try to make something to smooth out the system.

The research scientists worked with nurses, like Howe and Plummer, and a team of ethnographers – specialist researchers who study the way people live and work. Based on their findings, it wasn’t hard to see why nurses need help.

“Most times, what people think they do isn’t what they actually do” Howe said. “Ethnographers painstakingly record all of your actions, categorize them and make sense of them.”

The ethnographers made “cognitive load” diagrams for the nurses.

“At any one time, a nurse is thinking of 15 to 20 things at once,” Howe said. “Often times the tasks that would be missed are comfort level,” like getting blankets or assisting in the bathroom, he said.

By detaching nurses from the EMR station, fewer comfort level tasks will be missed, he hopes.

Time Will Tell

“Once the initial pilot is launched, we will take validated learnings, make modifications and enhancements as necessary, and the product should hit the market soon afterward,” Plummer said.

Howe looks ahead at what will come post-launch: Specialized models for other providers, like respiratory therapists, physical therapists, lab and imaging technicians and hospitalists. All these specialists have similar workflows? in the hospital and could use a tool like the DNA device to access central databases.

“This is just the beginning,” Howe said.

Don’t undervalue business experts on a development team. Even if an innovation like DNA improves the days of patients and providers on the surface, there is still one hurdle to overcome: Why would a hospital administrator shell out scarce money for this new product?

“There are real business reasons why you would want this on your floor,” he said.

Innovations like the DNA device help reduce medication errors, complications, and reduce length of stay. That makes them an attractive investment for hospital buyers.

It might even reduce hospital readmissions, the “holy grail.” Streamlining the system helps keep discharged patients from re-admitting and hospitals from paying penalties. On an innovation team, the last piece of the puzzle is sound business sense.…

Digital Cadavers Create Opportunities for Learning

Digital Cadavers

A defining moment in many medical students’ academic career is their first experience handling a cadaver. For many doctors, the memory of feeling and touching human organs for the first time is symbolic. It’s the moment many face mortality for the first time in their medical careers. Many also recall the experience with a feeling of gratitude toward those who donated their bodies so that they could learn.

Advancements in imaging technology have led to some anatomy education going digital through so-called virtual cadavers. The experience of using a virtual cadaver may not elicit the same emotional reaction as human cadavers, but it could offer students a chance to have a unique learning experience.

There’s only so much time students can spend in cadaver labs.

Virtual cadaver programs can range from basic tablet applications to complete 3-D dissection tables. Designers build them from scans of real cadavers. As scanning technology improves, so do virtual cadaver programs.

The growing trend has its critics, but proponents of virtual cadavers say they are a valuable teaching tool not meant to replace human cadaver training, but supplement it.

The biggest advantage to virtual cadavers, proponents say, is that they make the study of anatomy possible at any time, from anywhere. There’s only so much time students can spend in cadaver labs. The virtual programs provide a bridge between lab visits. Material learned in the lab can be reviewed as often as needed on a virtual device.

Portable Cadavers

“They are cadavers that students can carry with them, is one way to think about it,” said Jon Jackson, assistant professor of anatomy and cell biology in the Department of Basic Biomedical Sciences at the University of North Dakota School of Medicine.

“It allows us to sit in our living rooms, or if your are a student, your apartment, and you get to hang out at your table and essentially do the same kind of dissection work we ask them to do in the lab,” said Jackson, who has a doctorate in anatomy and cell biology.

“They are cadavers that students can carry with them, is one way to think about it.”

However, there are some limitations to the virtual cadavers, said W. Paul Brown, consulting associate professor at Stanford School of Medicine’s Division of Clinical Anatomy.

“There are some things you can do with a cadaver that you can’t do virtually. You can lift up a muscle and look underneath it, or you can follow a blood vessel. You can actually feel things, you can have those sensations and wrap your hands around an organ to help with your mental modeling.”

Those experiences are very valuable to students, Brown said.

Virtual Dissections

The virtual cadaver program at Stanford was Brown’s brainchild. His idea became the virtual dissection table, developed by Anatomage in San Jose, Calif. Other virtual cadaver software, such as tablet apps, only give a limited view of the body. The dissection table shows the entire body on one screen, in 3-D.

The virtual dissection table gives students the ability to look at the human body in multiple layers that can be viewed at one time, or pealed back to focus in on certain layers, Brown said. The virtual cadavers have also created opportunities for students to diagnose and learn about certain conditions. With a library of virtual patients, students can look at two data sets at one time to compare normal scans to those with abnormalities. You can’t do that with real cadavers, he said.

When the program was first introduced at Stanford, there were a couple of “traditional anatomists” who didn’t see the need for the virtual cadavers, according to Brown. But they slowly changed their minds once they saw the program in action.

The Body Library

Stanley Jacobson, professor of anatomy and cellular biology at Tufts University School of Medicine, has been building a library of virtual patients for several years. His students aren’t required to use the virtual patients. Some students use them, some do not, he said.

Once those scans are made, they are always there for future use. Students can examine the virtual patients to determine cause of death or to see how certain conditions affect the body. Jacobson has virtual scans of a malaria patient, for example – something many American doctors wouldn’t see throughout their entire careers. As more scans are added, the library of conditions and abnormalities grows.

A Healthy Supplement

Virtual cadavers aren’t necessarily better or worse than real ones, Jacobson said. In cases where cadavers simply aren’t available, either because they are cost prohibitive, or against the law (some foreign countries forbid the use of cadavers), a virtual cadaver could be an acceptable alternative.

It could also allow some schools to incorporate anatomy training in to programs for which it was traditionally not part of the curriculum.

Like Brown, Jackson said he would be critical of any medical school program that used only virtual cadavers. But virtual cadavers could make entry-level anatomy education possible for more students, such as undergrads. It could also allow some schools to incorporate anatomy training in to programs for which it was traditionally not part of the curriculum, Jackson said.

Jacobson said use of virtual cadavers can extend beyond medical students, too. Some physicians use them for patient education, he said. It’s one thing to tell a patient what their torn ACL looks like, he said. It’s another thing to show them.…

Hospitals Are Too Dull: Turn Up The Lights, Say Experts

Hospital Lights

Patients aren’t getting enough light during the day, says new research, which can affect their overall well-being.

It’s pretty much a no-brainer that we feel better on a clear and sunny day than we do when the clouds are overcast and thick with impending rain. The link between feeling good and feeling the sun is thought to be vitamin D. Could something as simple as improved hospital lighting alleviate patient pain and discomfort?

This was what Ester Bernhofer and a team of fellow researchers at the Cleveland Clinic in Ohio wanted to know. Her study included 40 patients at the clinic (23 female and 17 male), and sought to establish whether any relationships existed between hospital lighting and patient mood, sleep, and or pain.

The study participants wore an electronic wrist device for three days and three nights straight, which allowed Bernhofer to continuously measure light exposure and the patients’ sleep-wake regimes. Participant mood was assessed daily with questionnaires and pain levels were estimated from their medical records.

How dim are hospital patient rooms?

In a paper published in the Journal of Advanced Nursing, Bernhofer revealed that light exposures throughout the day were universally low, fluctuating between 104 and 180 lux, the standard measuring unit of luminance. To give context, the shade beneath a tree on clear blue-sky day would chalk in at around 20,000 lux. Patients slept a pitiful average of under four hours a night.

Although sleep levels were low across the board, it was statistically significant that the less light they were exposed to during the day, the more fatigued the patients felt. Pain levels were also higher when participants were especially tired, but there was no observation of a direct relationship between pain and light. “One of the things I thought I’d find was a direct relationship between exposure and pain,” said Bernhofer, “instead it went: light – fatigue – pain, but I was expecting: light – pain.”

Should hospitals alter their lighting?

“If you or a loved one are in hospital and feeling fatigue-laced-pain and discomfort, it’s not a bad idea to move to the window, it’s certainly not a bad idea to get some sun exposure,” said Bernhofer.

Bernhofer hopes to continue research in pursuit of the optimal dose of lighting for patient wellness.

“When we have a better handle on this, I think there will be major implications for strategic and therapeutic lighting. I don’t foresee a big bulb at the end of a bed, it’ll be lights in the ceilings at different spectrums, larger windows, and brighter lighting during the day,” she said.

Bernhofer doesn’t necessarily want to impose her findings on a new hard and fast hospital policy on lighting, but she did add that hospitals needn’t wait for her to find the precise figure for the optimum light level of a hospital ward. After all, when we know that the world outside is often brighter by factors of thousands, it’s “hardly a risk” to get more sunlight, she said.…