Khare said that, after a basic screening process to eliminate those who don't appear to have a qualifying condition or proper medical records, he seeks to "build a relationship" with patients, talking about their medical history, how the certification works and what the admittedly limited body of scientific study says about the effectiveness of marijuana to treat pain, nausea and other symptoms. Khare said he sees patients at least twice before agreeing to do a cannabis referral and has turned many people away.