I would like to tell you about the most embarrassing thing
that is ever happened to me
in my years of working as a palliative care physician.
This happened a couple of years ago,
I was asked as consultant to see a woman
in her 70s retired English professor, who had pancreatic cancer.
我被找去是因为她疼痛 恶心 呕吐
I was asked to see her because she had pain, nausea, vomiting.
When I went to see her,
we talked about those symptoms
and in the course of that consultation, she asked me,
whether I thought that medical marijuana might help her.
I thought back to everything
that I’ve learned in medical school about medical marijuana,
which didn’t take very long because I had learned absolutely nothing.
And so I told her that as far as I knew,
medical marijuana had no benefits whatsoever.
And she smiled and nodded
and reached into the handbag next to the bed,
and pulled out a stack of about a dozen randomized control trails,
showing that medical marijuana has benefits for
减缓恶心 疼痛 焦虑的症状
symptoms like nausea and pain and anxiety.
She handed me those articles and said,
“医生 或许你应该先看看这些 再发表你的观点”
“Maybe you should read these before offering your opinion, doctor. “
So I did. That night I read all of those articles
and found a bunch more.
When I came to see her the next morning,
I had to admit that it looks like
there is some evidence that marijuana can offer medical benefits.
And I suggested that if she really was interested,
she should try it.
You know what she said?
This 73-year old retired English professor.
She said, “I did try it about six months ago.
太神奇了 从那之后 我每天都要用
It was amazing. I’ve been using it every day since,
it’s the best drug I’ve discovered,
I don’t know why it took me seventy-three years
to discover this stuff. It’s amazing.”
That was the moment at which I realized
I needed to learn something about medical marijuana,
because what I was prepared for a medical school
board no relationship to reality.
So I started reading more articles,
I started talking to researchers,
I started talking to doctors and most importantly,
I started listening to patients,
ended up writing a book based on those conversations.
And that book really revolved around three surprises.
Surprises to me, anyway.
One I already alluded to,
but there really are some benefits to medical marijuana.
Those benefits may not be as huge or as stunning,
as some of the most avid proponents of medical marijuana
would have us believe, but they are real.
Surprise number two,
medical marijuana does have some risks.
Those risks may not be as huge and as scary as
some of the opponents of medical marijuana would have us believe.
But they are real risks nonetheless.
But it is the third suprise that was most surprising.
And that is that a lot of the patients I talked with
whose turned to medical marijuana for help,
weren’t turning to medical marijuana
because of its benefits or the balance of risks and benefits,
or because they thought it was a wonder drug,
but because it gave them control over their illness.
可以更有成效的 有效率的 舒服的
It let them manage their health in a way that was productive
and effective and comfortable for them.
To show you, I mean let me tell you about another patient.
Robin was in her early 40s when I met her.
She looked though like she was in her late 60s.
She had suffered from rheumatoid arthritis for the last twenty years,
her hands were gnarled by arthritis,
her spine was crooked.
She had to rely on a wheelchair to get around.
She looked weak and frail
and I guess physically she probably was,
但是在情感 认知 心理方面
but emotionally, cognitively, psychologically,
she was among the toughest people I’ve ever met.
And I sat down next to her
in the medical marijuana dispensary in Northern California,
to ask her about why she turns medical marijuana,
what it did for her and how it helped her.
She started out by telling me things
that I had heard from many patients before.
It helped with her anxiety.
It helped with her pain.
When her pain was better, she slept better.
I’d heard all that before,
but then she said thing that I’ve never heard before.
And that is that it gave her control over her life
and over her health.
She could use it when she wanted,
in the way that she wanted,
at the dose and frequency that worked for her,
and if it didn’t work for her,
then she could make changes.
Everything was up to her.
Most important thing she said
was she didn’t need anybody else’s permission.
Not a clinic appointment, not a doctor’s prescription,
not a pharmacist order.
It was all up to her.
She was in control.
And if that seems like a little thing
for somebody with chronic illness?
It’s not, not at all.
When we face a chronic serious illness,
whether it’s rheumatoid arthritis or lupus,
癌症 糖尿病 还是肝硬化
or cancer, or diabetes, or cirrhosis,
we lose control.
And know what I said when, not if.
All of us, at some point in our lives
will face a chronic serious illness that causes us to lose control.
We’ll see our function decline,
some of us see our cognition decline,
will be no longer able to care for ourselves,
to do the things that we want to do.
Our bodies will betray us,
and in that process we’ll lose control.
And that’s scary.
不仅仅是吓人 简直令人恐惧 寝食难安
Not just scary, that’s frightening, it’s terrifying.
When I talk to my patients,
my palliative care patients,
many of whom are facing illnesses that will end their lives.
They have a lot to be frightened of.
痛楚 恶心 呕吐 便秘 疲倦
Pain, nausea, vomiting, constipation, fatigue,
以及即将到来的死亡 但和其他事情相比 更让他们恐惧的是
their impending mortality, but what scares them more than anything else
is this possibility that at some point
tomorrow or a month from now,
they’re going to lose control of their health,
of their lives, of their health care,
and they’re going to become dependent on others,
and that’s terrifying.
So it’s no wonder really
that patients like Robin who I just told you about,
when that in that clinic turned to medical marijuana
to try to claw back some semblance of control.
How do they do it though?
这些配药局 就像我遇见罗宾的那间 他们是怎么做的呢？
How did these medical marijuana dispensaries like the one where I met Robin?
How do they give patients like Robin back
the sort of control that they need?
And how did they do it in a way that
mainstream medical hospitals and clinics at least for Robin weren’t able to?
What’s their secret?
So I decided to find out.
I went to a CD clinic in Venice Beach in California
and got a recommendation
that would allow me to be a medical marijuana patient.
I got a letter of recommendation that
would let me buy medical marijuana.
I got that recommendation illegally
because I’m not a resident of California.
I should’ve know that.
我应该声明 以供记录 此前我从未
I should also know for the record that I never used
that letter of recommendation to make a purchase.
And all of you DEA agents out there,
loved the work that you’re doing.
Keep it up.
Even though it didn’t let me make a purchase though,
that letter was priceless because it let me be a patient.
It let me experience what patient like Robin experience
when they go to a medical marijuana dispensary.
And what I experienced, what they experienced everyday,
就如同成百上千位 像罗宾一样的人每天体验的 太让人惊奇了
hundreds of, thousands of people like Robin, was really amazing.
I walked in with the clinic and from the moment that I entered
many of these clinic dispensaries,
我觉得 这间药局 这间诊所就是为我设立的
I felt like that dispensary, that clinic was there for me.
一开始的时候 他们会问一些问题 我是谁
There were questions at the outset about who I am,
what kind of work I do,
what my goals are,
in looking for a medical marijuana prescription or ehh…product.
What my goals are, what my preferences are,
what my hopes are, how do I think,
how do I hope, this might help me, what am I afraid of.
These are the sorts of questions
that patients like Robin get asked all the time.
These are sorts of questions that make me confident
that the person I’m talking with really has my best interests at heart
and wants to get to know me.
The second thing I learned in those clinics is the availability of education.
Education from the folks behind the counter,
but also education from folks in the waiting room.
People I met were more than happy.
As I was sitting next to them, people like Robin
to tell me about who they are,
why they use medical marijuana,
what helps them, how it helps them
and to give me advice and suggestions.
Those waiting rooms really are
提供交流 建议 支持的场所
a hive of interaction, advice and support.
And third, the folks behind the counter
I was amazed at how willing those people were
to spend sometimes an hour or more,
talking me through the nuances of this strain versus that strain,
smoking versus vaporizing, edibles versus tinctures,
all remember without me making any purchase whatsoever.
Think about the last time you went to any hospital or clinic
and the last time anybody spent an hour
explaining those sorts of things to you.
The fact that patients like Robin are going to these clinics,
are going to these dispensaries and getting
that sort of personalized attention and education and service,
really should be a wake-up call to the healthcare system.
People like Robin are turning away from mainstream medicine,
turning to medical marijuana dispensaries,
because those dispensaries are giving them what they need.
If that’s a wake-up call to the medical establishment,
it’s a wake-up call that many of my colleagues are
either not hearing or not wanting to hear.
When I talk to my colleagues, physicians in particular
about medical marijuana, they say “Oh we need more evidence,
we need more research in the benefits,
we need more evidence about risks.”
And you know what? They’re right.
They’re absolutely right.
We do need much more evidence about the benefits of medical marijuana.
We also need to ask the federal government
to reschedule marijuana to schedule to
or to deschedule it entirely to make that research possible.
We also need more research into medical marijuana’s risks.
Medical marijuana’s risks, we know a lot about the risks of recreational use.
We know next to nothing about the risks of medical marijuana.
So we absolutely do need research.
But to say that we need research
and not that we need to make any changes now,
is to miss the point entirely.
People like Robin aren’t seeking out medical marijuana,
because they think it’s a wonder drug
or because they think it’s entirely risk-free.
They’re seek it out because the context in which it’s delivered
and administered and used
gives them the sort of control they need over their lives.
And that’s a wake-up call we really need to pay attention to.
The good news though is that there are lessons
we can learn today from those medical marijuana dispensaries.
And those are lessons we really should learn,
these are often small mom-and-pop operations
run by people with no medical training,
and while it’s embarrassing to think
that many of these clinics and dispensaries are providing services and support
and meeting patients needs in ways that
billion-dollar healthcare systems aren’t.
We should be embarrassed by that,
but we can also learn from that.
They’re probably three lessons at least
that we could learn from those small dispensaries.
One, we need to find ways to give patients more control
in small but important ways,
how to interact with healthcare providers,
when to interact with healthcare providers,
how to use medications in ways that work for them.
In my own practice,
I’ve gotten much more creative and flexible
in supporting my patients in using drugs safely
to manage their symptoms.
But the emphasis on safely, many of the drugs that I prescribe
are drugs like opioids or benzodiazepines,
which can be dangerous if overused.
所以这里就是重点 如果他们服用过多 可能就会出现危险
But here’s the point, they can be dangerous if they’re overused,
but they can also be ineffective
if they’re not used in a way that consistent with what patients want and need.
So that flexibility if it’s delivered safely
can be extraordinarily valuable for patients and their families.
That’s number one.
Number two, education.
Huge opportunities to learn
from some of tricks of those medical marijuana dispensaries
to provide more education that doesn’t require
a lot of physician time necessarily or any physician time.
But opportunities to learn about what medications were using
and why prognosis trajectories of illness
and most importantly opportunities for patients to learn from each other.
How can we replicate what goes on in those clinic
and medical dispensary waiting rooms,
how patients learn from each other,
how people share from each other.
And last but not least, putting patients first,
the way those medical marijuana dispensaries do,
making patients feel legitimately like what they want,
what they need is why as healthcare providers we’re here,
我们询问患者它们的希望 担心 目标和偏好都是什么
asking patients about their hopes, their fears, their goals and preferences.
As a palliative care provider I ask all my patients,
what they’re hoping for and what they’re afraid of.
But here’s the thing, patients shouldn’t have to wait
他们身患慢性绝症 快要走到生命的尽头时候 才被问这些事
until they’re chronically seriously ill, often near the end of life.
They don’t have to wait,
they shouldn’t have to wait
until they’re seeing a physician like me,
before somebody asks them.
What are you hoping for? What are you afraid of?
That should be baked into the way that health care is delivered.
We can do this, we really can.
Medical marijuana dispensaries and clinics
all across the country are figuring this out.
They’re figuring this out in ways that
larger more mainstream health systems are years behind.
But we can learn from them
and we have to learn from them.
All we have to do is swallow our pride,
put aside the thought for a minute
that because we have lots of letters after our name,
because we’re experts,
because we’re chief medical officers of a large healthcare system.
We know all there is to know about how to meet patient’s needs.
We need to swallow our pride,
we need to go visit new medical marijuana dispensaries.
We need to figure out what they’re doing.
We need to figure out why so many patients like Robin
are leaving our mainstream medical clinics
and going to these medical marijuana dispensaries instead.
We need to figure out what their tricks are,
what their tools are and we need to learn from them.
If we do and I think we can,
and I absolutely think we have to,
we can guarantee
all of our patients will have a much better experience.