‘If you cannot satisfy yourself it is appropriate, get out’: Medicinal cannabis, telehealth and junior doctors
The Medical Board of Australia wants doctors working for medicinal cannabis clinics to reflect on whether their work is good medical practice, and if it is not, to find a new job.
New guidance on cannabis prescribing for doctors and nurses warns against consultations lasting mere seconds, writing repeat scripts early in the therapeutic relationship and prescribing an assortment of products for patients to try out.
“My overriding goal is that all of the doctors involved in this space take notice of this guidance and reflect on their practice to determine for themselves whether or not their practice aligns with what we consider is good medical practice,” medical board chair Dr Susan O’Dwyer told 6minutes.
“If it doesn’t, they should reform their practice.
“If they’re in a certain environment or an employment situation where that is not possible, then perhaps they could or should consider another role.”
She added: “Doctors have agency. I think they should avail themselves of that agency to make good decisions about their employment.”
The board has made it clear that clinics which prescribe only one drug represent ethically challenging territory, with evidence showing some practitioners issuing more than 10,000 scripts in just six months.
While high-profile clinics that only prescribe cannabis are mostly telehealth-only, Dr O’Dwyer said it was the nature of the S8 drugs which was the primary source of medicolegal risk, rather than the consultation type.
“Face-to-face consultations can equally be done poorly when they’re prescribing high-risk medications,” Dr O’Dwyer said.
However, she said doctors should continually assess whether the type of consultation was suitable for the work.
“If you can’t satisfy yourself that this is an appropriate mode to conduct a consultation, then you should get out of it.”
She said many notifications to AHPRA about medicinal cannabis prescribing ended with doctors changing their practice after a case discussion, without formal regulatory action.
While she could not give specific details, she said that AHPRA responded to one notification about a doctor prescribing medicinal cannabis and ended up commending the practitioner for their high-quality practice in a complicated situation.
However, there were concerns that junior doctors working for telehealth corporates may not have the experience or skill set to navigate medicinal cannabis prescribing.
Dr O’Dwyer said education for medical students and junior doctors needed to cover the health system knowledge necessary to practise safely in new clinic types.
“When I was a junior doctor, the only option was public hospital employment,” she said.
“Now, they can be locums, after-hours GPs, do telehealth.
“I do know that junior doctors like flexible work, to be able to work part-time if possible and sometimes to have a break from acute hospital work. They want to do different things.
“A lot of junior doctors are more senior in years than in the past, with different family circumstances.
“There is a range of reasons why people pick up this work, including people who genuinely believe in these products and patients’ right to access them.”
She said that the medical board’s newsletter now went to medical students, putting information on medicolegal issues in front of them sooner in their careers.
“But we can always do more,” she said.
Medical regulation had generally focused on individual doctors making poor choices, rather than models of care, she said.
“The issues with medicinal cannabis are broader than individual medical practitioners and extend beyond our scope.
“We are working with our partners such as the TGA and Commonwealth, state and territory health departments in relation to whether we have the correct regulatory framework to deal with the medicinal cannabis issues we are seeing.”
Read more: Cannabis doctors prescribing multiple products so patients can ‘test what they prefer’
