Just got out of hospital.
Do not know what is actually happening the past few days except our uric acid reading got up to as high as 680. That is a dangerous level as any higher it could advance to kidney problem and need for dialysis.
This event ad came in our Whats App groups. It strike upon us as to the inconsistency between the question the event seek to answer and the collaborator of the event.
The pharmacists would think that Puteri UMNO is bias and got bought by doctors. That is no way to go for a political party, more so the ruling party.
Have they heard the pharmacist side of the story?
Mainstream media seemed bias to promote the doctors's interest using concern for rising healthcare cost as excuse. That is far from the truth.
Some of the Malay social media are using the chinese bogey by claiming chinese monopolised the pharmaceutical industry. Hmmm ... isn't it foreign pharmaceutical companies?
With the doctors are campaigning hard and the Malaysian Medical Association (or MMA) being a powerful and influential group that could dictate public health policies, the pharmacist are a seriously disadvantaged lot.
The plight of pharmacist as professional in the medical field seemed not given the space to speak thus we emphatise with them. They are professionals and should not be reduced to cashiers at pharmacies.
For someone on regular medication and regularly hospitalised, we can relate to the pharmacist side of the story.
Our experience made us believe that doctors should not takeover the role of pharmacists.
Our respirologist prescribed for our COPD problem with something like 8 or 9 types of medicines and inhalers at one time. A friend realised this and told us that it is strange. We will end up immuned to medicine that there will be no medicine when our condition escalate.
For his much worse asthma condition, he was limited to few medications.
During Haj, a pharmacist at the Tabung Haji makeshift hospital alerted us that most of the medicine prescribed were duplication. Without saying it, she inferred that we were overdosed and prescribed unnecessary steroids yet the cough never subsided.
It was in one occasion of an asthma attack over Hari Raya that we switched specialist at another hospital. Finally, he was able to address the incessant cough of many years. All that was needed was one regular Symbicort inhaler and in the event of attack, only a Ventolin inhaler and a type of pill.
We realised that not only we were overdosed, we were wrongly prescribed over the past few years.
So doctors should not be dispensing medicine because the pharmacist is more qualified for this role. And, Doctors have limited knowledge on drugs, chemical content of medicine, side effects, and issue of safety.
Pharmacist must be involved in curing patience. As per our experience, they could reduce mistakes and side effects of wrong prescription of medicine.
The reason private clinic doctors were allowed to dispense medicine and encroach into the area of pharmacist must be the situation of insufficient number of pharmacists of the time.
That ratio is now down to 1:2,400. WHO requirement is 1:2,000. By 2020, it will be 1:1,600 so it is high time.
As we believe, there is also the consideration to keep cost of private sector health cost low by doctor's consultancy in private clinic being partly subsidised by medicine sale.
It is no more the case today as doctors are not not only taking percentage profit on top of the supplier's cost but selling it at few multiples of the supplier's cost.
It reminded me of late father's ulcer medicine. The doctor had accidently left the original package with the brand name of the medicine. Father made the effort to compare prices and he found out that the doctor had charged three times the pharmacy price.
There was an incident that we got a clinic to issue a note to get a particular medicine from the next door pharmacy. For only RM8 for the doctor's note, we were able to reuse the note and buy medicine at the pharmacy for 30 to 40% lower than that charged at doctor's clinic.
This procedure was a way for doctor's to take a ride on the lower medicine cost at pharmacy. By right, it should be left to the pharmacy to do so.
Demarking the line between medical consultancy and dispensing medicine should bring about lower cost for medication, and more advantageous to patients and consumers.
Doctor role would be to diagnose and recommend the medicine but it is the pharmacy that authorise the dispensing medicine to ensure safety. This way there is counter checking of a professional by other qualified professional.
By separating dispensing role from doctors, the pharmacist profession can flourish and grow like mushroom throughout the country. It is time that we have a more professional and dynamic public healthcare system like in other developed country.
For too long, pharmacist have been reduced to sales person at pharmacy.
In government hospitals, one will notice pharmacist playing their role and explaining the medicine prescribed to patients. Doctors will follow the medicine prescribed by pharmacist.
Malaysia has been recognised by world health organisation as having one of the best health system because of the government facilities. It is well planned as it covers for rural and urban population.
The government hospital have been practising the separation between diagnosing by doctors and dispensing of medicine. Why can't that model be applied to private clinics?
It is the private clinics that is resisting the separation of diagnosis and resisting the change because private health practise have turned these healthcare professional tending to the sick into heartless businessmen.
These clinics have been shortchanging consumers and put patients in danger by hiring unqualified assistants to handle medicine.
It is also time that healthcare consumers at private healthcare institution be given itemised bill. They should know the cost of their medicine and able to compare prices. There should not be any more hiding of brand and package from patients as happened to late father.
Maybe it is time to do away with these small neighbourhood clinics with limited role which only contribute to rising healthcare cost.
Is Puteri UMNO listening and able to comprehend?
49 comments:
Doctors prescribe medicines, it's their job to learn about drugs. Always. Keeping up to date via journals and seminars and such. They don't just recommend, the prescription is part of the treatment and they are liable for it.
I think what you're trying to say is that private clinics should not be acting as pharmacies as well, if they don't have the actual pharmacists.
Well, minus the sideline from dispensing medicines, I guess the people should get used to paying doctors just for consultancy fees and then buying the medicines themselves from pharmacies. More freedom of choice, but more hassle too.
In Indonesia, they already have this system. Sometimes, it's the pharmacy that employs doctors instead of the other way around. Pharmacists are able to dispense certain medicines only if there is a doctor prescription. You can use a doctor's prescription to buy those medicines in any pharmacy that happens to stock them. The prescription always has the doctor's name, practice, phone number and his registration number. They're not just any notes, they're a legal requirement.
There is even a specific way of writing the prescription down that both doctors and pharmacists use and understand. They may use generic or specific brands, sometimes certain doctors may even give special recipes that is prepared a certain way by the pharmacist.
With the current practice, patients are forced to take whatever medicines the doctor prescribe without having the chance of consulting pharmacists and buying the option that suits them, for example financially by buying cheaper generics.
So I agree that the current practice needs to change. Seems like there are also other problems regarding prescribing of drugs with doctors here as well.
What I don't agree is changing it in order to get votes. Doctors being the wealthier, always make better lobbyists. You're gonna lose if that's how you choose to play.
What you are saying is full of lies and embellishments. Your real motive is this;
" By separating dispensing role from doctors, the pharmacist profession can flourish and grow like mushroom throughout the country. It is time that we have a more professional and dynamic public healthcare system like in other developed country." From your own words. Not concern for other people, but your pockets.
You said for safety, but my relatives were sold dangerous items from pharmacies without doctor's prescription.
If you want to be doctors, go to medical schools.
As a pharmacist, mohon izin kongsikan pandangan bernas saudara. Terima kasih kerana memahami dilema kami
Anon 6:41
You wanna deal with drugs and medicine, dont go to medical school/
Take up pharmacy.
One incident at a pharmacy does not substantiate the over charging private clinincs have been imposing on concumers.
To accuse the bloggers as lies and full of embellishments only reflect your refusal to face fact and hide the reality from consumers.
You must be a money minded doctor
Obviously doctors and pharmacists are only in for the money!
Why not appoint a consultant to advise the patient to decide on whether to use which? At a 10% fee of course.
My relatives died because of doctors mistake. If u want to do pharmacist's job, go to pharmacy school.
Hi! just so u know, first, that was a wrong poster u put up there. we had updated a newer one. MDC did not coorganised the event with us and it was supposed to be Dispensing Separation. Second, we did request for input of questions and response that will help the dialogue from the pharmacists yang cancelled but.........
Anyway, Puteri UMNO tried our very best to engage with the pharmacists for this dialogue. Unfortunately the 2 speakers ( En. Amrahi Buang and one of your academicians ) cancelled at the very last minute due to reason tak mahu memburukkan keadaan yang sedia tegang and because the possibilities of people hijacking the event and causing riot ( hmmmm...! ) Fortunately your students turned up and guess what? They were superb! One of the girls spoke very well and shed some lights to us. we were very impressed, Puteri and the doctors!
We want to hear more from the pharmacist and the doctors, hence the dialog. we want the rakyat to hear the info "first hand" and not just wondering and making speculations why in the world this 2 professions gaduh gaduh sana sini in media. i lived in Ireland before where they used ds and i liked it! But we just wanted to know the pros and cons implementing it in Malaysia. Those who attended the dialog yesterday would know there was joke that Puteri pro DS but yet those who opposed came! Of course we appreciate the concern from ur higher level authority about the risk of unwanted event. We took precautions! Puteri was willing to take the risk and so did the doctors. But why didn't the pharmacies. This is not about the vote per se. We genuinely wanted to educate the rakyat, to instill budaya pemikir dalam diri rakyat Malaysia. Even after the dialog yesterday, we advised to get more info, read up and WAIT for the official announcement calmly. A simple sharing session was all we wanted from all parties so that the rakyat get a basic understanding about DS as well as to clear the misconception about DS and the "war" between the 2 professions. Was that too much to ask? any indication Puteri being "bought" by the Doctors? We will continue to engage with all parties for the benefit of all but at the end of the day...yes, the vote is yours. - EXCO PUTERI UMNO MALAYSIA
dont go to GP's unless y got a lot of money n ur in a hurry. better go to gov clinics. jimat. not all GP's are money orientated. but many of them are.
Read this to hear the other side.
http://m.english.astroawani.com/malaysia-news/pharmacy-bill-what-do-doctors-say-55103
So u want our healthcare system to follow as what the Indonesian is doing ?? Mind you, our healthcare standard is much better than the Indonesian which has become hay wire so as India and Korea who did DS without proper study.
My late grandmother was prescribed medicine to lower her blood pressure, and some strong painkillers after a urinary tract infection (if I'm not mistaken). After several incidences of her falling, a pharmacist reviewed all her medication and realised that she was being given multiple different anti-hypertensives from different doctors which made her blood pressure too low.
To this day, I believe that because of the unnecessarily strong painkillers which my family did not realise my grandmother was being fed, my late grandmother was never quite the same - she was there but she was just a shell of her former self. The overlapping and unnecessary medicines were stopped but she never really recovered.
Please, please work together for the safety of your patients. Who knows how many people out there experience the same thing?
In the western world..big pharma is a dominant entity influencing plotics. If having docs and pharmacy services separated mk things better..the west didnt really help the consumers or pts..as the cost was still prohibitive and they still hv bloating cost of medicare
The pharma claimed doc is just making profits. The docs said pharma is actually wanting to do that. The pharma controls behaviour or market behaviour of pharmacist..in that they can potentially enforce buying of branded meications which are extremely expensive. So both had issues. But i tend to believe the pharma entity would like to hv a strong foothold on the market so that they can eventually monopolise the industry
Why? Because the current system work well, although not perfect in isokated cases. There is no need to force on docs or pts to adopt what they think is right, if their suggestion is way better and more beneficial to the cutizens. The (open) market can decide on that. Let the citizens decide which clinic they want to go..the one with only doc or the one with doc and pharmacy counter.
It is crucial that the politicians are not bought by any parties on this issue..and the best solution us to let both system being implemented ..and doc/pharmacist must compete fairly and openly ..if any party wish to monopolise and refuse an open market..i say to them..take a hike!
I wonder why all of sudden the doctors are concerned about patients convenience. You don't even respect us even when we pay consultation fees. Now u should start to have some respect for us since u have realised the reason behind your rice pot
The pharmacist have yet to make anything and already they are being levelled as money minded.
This must be doctors trying to make villains out of innocent pharmacist when in fact the crooked ones are doctors!
I am only concerned with having the dispensing of our medicine be done professionally, comprehensively and safely so that the risk of having the cases mentioned are avoided.
Both can make their fair share of living but not by oppressing the consumers as being unethically done by many doctors!!!
The experience is japan shows cost of drugs to consumers decreasing. Read:
http://www.jcer.or.jp/eng/pdf/kenrep040325e.pdf
Korean experience showed reduced in abuses by both doctors and pharmacists as well promoted healthy competition from the transparency and encourage R&D.
Read
http://english.mw.go.kr/front_eng/jc/sjc0101mn.jsp?PAR_MENU_ID=100301&MENU_ID=10030105
The study by consumer association of penang support the popularly held believe that dispensing by pharmacy is more economical:
http://www.consumer.org.my/index.php/health/healthcare/105-separation-of-dispensing-rights-start-in-major-towns-first
Doctors should stop resisting this change and be selfish. It deny their family annual ski holiday in switzerland but help the mass rakyat.
Is this the only 'contribution' by Puteri UMNO. I have not heard of any real constructive contribution from them.By the way,it doesn't matter about the vote of Pharmacist as most of them are chinese and we know where their vote will go to no matter what we say.A chinese business can prosper in a malay area but a malay business can never survive in a chinese area. They are just damn racist!
Increase of uric acid is due to proteins unable to be digested and thus released into the bloodstream. To counter this take more pineapples which has enzymes to convert the protein into harmless waste.
Seriously, the big pharma spends money on BOTH doctors and pharmacists for promoting their products even with the system now.
All those medicines, both doctors and pharmacists get them from pharmaceutical companies.
Difference is, when you go to pharmacies for example to buy some off the counter medication, you could choose what you want. You could compare prices, ask the pharmacist, because, hell, it's the pharmacist, it's his freaking job. Compare with when you go to the doctor. How many of you even thought of asking the doctor to switch to some other medicine, or even ask about the taking of, the precautions and such?You only know when you get whatever is dispensed by whoever doing the dispensing in that clinic. It boggles my mind people would want to still stick to this kind of standard.
Have you ever realized that the pharma companies could have their sales people giving incentives to doctors to prescribe their brand instead of others?This actually happens. It's not even considered bribery. No wonder some of you even tell stories of patients being over prescribed. Gee, I wonder why.
One thing you need to understand, doctors have varying skill levels. Some of them might not even be real doctors and you wouldn't even know it. The real doctors have been educated in different countries. For example you might think the UK educated ones would be better, but have they the more experience in treating dengue compared to a locally educated one?Errors, even fatal errors could always happen. This could be lessened with identifying what is wrong, and making rules that address it that health practitioners need to abide to. For example, making rules that pharmacies are not allowed to sell dangerous medicines without a prescription, or making sure that doctors ask whether their patients have drug allergies, or have been taking other medicines before seeing them.
About doctors making money, well, no shit Sherlock. Medical school is not cheap. You can go to government funded(what makes them cheap for you) public hospitals and drive up the workload of government hospital doctors, with their kind of pay I wouldn't be surprised if most of them get into private practice as soon as they can. Some even would risk the fine of violating their JPA loan/scholarship, the senior ones who also teach in the government funded universities would also find private hospitals and universities more attractive to practice in.
Local universities have been offering pharmacy courses, besides other allied health courses, for a long time already. By now we should have a pool of pharmacists, who should be allowed to do what they are supposed to do, instead of having doctors trying to fill the same role and profiting off it. Yeah, they certainly make money off it.
Implementing this means they ave to rely more on consultancy fees.
So does the pharmacist, it's their freaking livelihood! You don't want pharmacists and want doctors doing the dispensing, don't train pharmacists.
I don't know how people gets the impression pharmacists will be doing doctor's job, they're supposed to work together and complement each other!Just like with nurses, radiographers, lab technicians, therapists, a whole lot of people working within the health industry!It's not just doctors!
Well, if you want to say Malaysia is a third rate country unable to implement this properly and better off stagnant with how the old things are run, eh, why not, wouldn't want to argue.
Maybe you are right.
Maybe GST also sucks and Malaysians simply are not prepared and won't be able to handle GST as well.
If doctors really care about patient convenience they should allow pharmacists to operate in their clinics without working for the doctor.
Yes, make it like that, especially in urban areas.
Only doctors who operate in rural and other areas that lack pharmacists be able to dispense and sell medicines.
DS is already implemented in government hospitals. It's in private doctors sector where they diagnose disease and then sell medicines to treat the disease they diagnose.
I guess the healthcare standard for government hospitals must be bad and haywire like Indonesia, since DS already exist in government hospitals.
No, no no. Doctors know about the ailments as they are the only ones qualified and experienced to diagnose and, based on that, prescribe.
Pharmacists don't. They can't. They know only the general uses of the medicines.
But if anyone wants to buy from pharmacies, stating their medical complaint, yes, the pharmacists must be allowed to "sell" - not "prescribe", as only doctors can do that.
Panadol is basically a pain killer but has been used for all sorts of medical complaints. Until the Health Ministry did a crackdown (? or was it just a blistering attack) on the over-prescription of the use of panadol recently.
Me? Slight headaches and rheumatic pains, I'll just take panadol. But if I have flu that doesn't clear after 3 days, I go to the doctor, not the pharmacist for alternative medicine, man.
Let doctors sell the medicines that they prescribe. Nothing wrong with that. They are professionals and must want their patients recover quickly and therefore not likely to do hanky panky.
After all, pharmacies can sell non-medical products to increase their revenue. Doctors can't even sell herbal remedies, can they?
Dear Puteri-Puteri UMNO.
Append herewith some information for the Rakyat on the issue of Dispensing Separation:
Hope you will circulate this to your members and the public too.
Dispensing Separation - Information for the Rakyat:
1. Medicine Dispensing is NEVER the duty of medical doctors because they are not FORMALLY trained or qualified in this subject. There is no justification to delay the implementation of the prescribing and dispensing functions for doctors and pharmacists in Malaysia, unlike in the government sector where doctors are prescribing and pharmacists are dispensing for the full safeguard and the utilization of the pharmacists training and knowledge towards optimizing of the public health. Likewise the doctors and Specialists in private hospitals and health-institutions are already working towards the maximum benefit of the patients under the system of dispensing separation. Why are pharmacists in the private sector community pharmacy practice continued not to be treated the same especially when the Health Ministry has no hesitation to upgrade and expand the various specialties and services of the same profession in the government service to almost full intake to saturation? Why the double standards?
2. We do not quite understand what some people mean when they said “when we separate the dispensing, that’s when the patient’s rights will be robbed”? Have they forgotten what their MMA had promised when they had signed the Patient charter in the 1980s? On the contrary the patient’s right to prescription screening, medication counselling and advice will be restored. With due respect, please note that just because doctors have learn a bit of pharmacology plus the human anatomy as one subject in their MBBS degree course it does not mean doctors are very well versed or trained to do the work of a pharmacist. Pharmacologists spent several years learning pharmacology but they are not allowed to prescribe or dispense medicines unless they are clinical pharmacologists (i.e. they are also doctors) right?
The pharmacists too are trained in clinical pharmacy where they also learned about diseases, symptoms and treatment. They also learn in the clinical ward rounds but all these do not mean they can do all the work of the doctor’s right? Pharmacists and Doctors are two distinct and different professions. One does not want an accountant to do the work of an auditor or an engineer to perform as an architect and vice-versa right? It is only right that a very ill person should see their doctor first. However after seeing the doctor they should be sending their patient with a prescription to the pharmacist and not get their untrained and unqualified clinic assistants to dish out the medications to their patients without proper screening, checking and medication counselling.
Pharmacists are the only professionals who are formally trained and professionally qualified and recognised in medicine dispensing. Doctors only have some lectures on pharmacology (i.e. the subject that deal with the effects of medicines in the body) in one year of their 5 year medicine course while the pharmacists are trained in ALL aspect of medicines, starting right from the formulation, production, indications (the right usage), dosages, monitoring of side and adverse effects, remedial actions in cases of overdosage or toxicity. Other than Pharmacology which the pharmacists study in depth over their four years pharmacy course, the pharmacists are taught subjects like Pharmaceutics & Dispensing, Pharmaceutical Technology, Pharmacotherapy, Pharmacodynamics, Pharmacokinetics, Pharmacognosy, Pharmaceutical Chemistry, Pharmaco Economics, Medication Therapy Review, Medication Counselling, Patient Medication Monitoring, Pathophysiology and last but not least Clinical Pharmacy. Not to mention that Pharmacists need to be in possession of a Poison License (renewable yearly) to be able to dispense and one of the conditions to qualify for this Poison License, pharmacists have to pass the Forensic Exams. This, i.e. to pass the Forensic Exam and to be in possession of a poison license, the dispensing doctors have the privilege of not having to go through.
Medicine Dispensing appears ‘easy from what a patient can see’, but it involves pharmacists’ mind (that works rapidly) to screen every dispensed drug against any possible ‘drug-drug interactions’, drug-food interactions, drug-substances incompatibility, correct doses, and right indications etc. before the medicines are given to the patients. It is not just the physical act of dishing out the medicines to the patients. As it is, in Malaysia many clinic assistants are dishing out the medicines without even the proper labeling of the medications been supplied and this include omitting the names of the medicines that had been supplied. For your information, under our current Poison Act 1952 (Controlled Medicines Act) all controlled medicines are required to be labelled with the name of the patient, name of the medicines, dosage instructions etc.
3. Private Doctors are qualified in the diagnosis of various diseases, and it is necessary for them to do what they had been trained and qualified to do and that is to diagnose and prescribe. It is never in the patients’ interests for private doctors to dispense drugs.
4. For those private medical doctors who are afraid of the new Healthcare Plan, we feel they need to go back to the basics in their medical studies. More CME will prepare them to serve the patients better and they will enjoy their work as respected Clinicians. All the registered pharmacists want is to complement the Professional Role of Clinicians but not the Dispenser-Doctors role! The TIME Has Come For A CHANGE, and ‘Change We Must’.
5. ‘Dispensing Separation’ will be for the Patients benefits. It is not true that the patients Will Pay More unless the doctor charges the Rakyat more for the consultation which some had already threatened to do so. This threat the rakyat do not have to worry for reasons of competition. Those private doctors who increase their consultation fees will soon have to close down as more and more doctors set up their clinics (the country is overproducing doctors and pharmacists). MPCAM had itself admitted that many clinics had closed down because of the stiff competition amongst the private clinics. Moreover why should the people be subjected to such threats which is akin to blackmailing or holding the rakyat to ransom.
6. With D.S, the patients’ medications prescribed by their Doctors will be double checked by professionally trained pharmacists and any medication problem or prescription error will be rectified before the medications are dispensed to the patients. The patients will be given the necessary information when they receive their medications. They will be alerted on possible side effects and be provided with advice on how to counteract or minimise any of these side effects if it do happen. In addition, patients will be informed on the best way and time to take their medications, to maximise the efficacy and minimise the side effects. Moreover the patients will be able to discuss with their pharmacists on any other issues related to their medications.
7. Dispensing Separation is necessary for any effective and beneficial transformation of the country health system. Pharmacists want ‘Dispensing Separation’ to bring greater benefits to patients. To those who oppose this ‘Dispensing Separation’ (including YB LKS), we would like to ask them “WHY are they always talking about the need for “Transformation” but when it come to the transformation of the country healthcare system they are so opposed to it? Are they championing for their own (and their friends’) selfish interests or for the benefits of 28 million Malaysians?
8. The arguments offered by some quarters since a few decades ago that dispensing by pharmacists will cause inconvenience to the public or that there are insufficient pharmacies in the rural areas or that there are no 24 hours pharmacy or that what works for other countries may not work in our country are nothing but history. As for the insufficient number of pharmacies in the rural areas or that there are no 24 hours pharmacies, have they not heard about the spontaneous progression on Supply-and-Demand economic dynamisms? With the private clinics not issuing out prescriptions for supply of medicines, do these people expect pharmacies to be set up in the rural areas or to open 24 hours. It is a chicken and egg situation, but certainly this is not the case elsewhere! In fact, to the contrary, increasingly more and more people are seeking the services of pharmacists, in both the government hospital as well as in the Community Pharmacies. Only the uniformed and the apathetic would still be of the opinion that it is inconvenient for the public to go to pharmacies. Community pharmacies are the most accessible and affordable healthcare facilities to the rakyat. Any person can walk in to a pharmacy and see the pharmacist in attendance without the need for an appointment or to be registered and wait in line.
As for the doctors’ argument that there will be situations where the patients will require medicines urgently and cannot be seeking for a pharmacy to get the medicines, do be informed that in those countries where D.S had been practised private clinics are allowed to keep and supply those medicines that are considered as necessary for emergencies. In addition private clinics doctors in the rural areas where there are no pharmacies too can apply for approval to dispense medications to their patients.
9. Dispensing separation is NOT a western phenomenon. Countries from the Middle East had practised Dispensing Separation from the early days, later adopted by the western world and most countries in Asia. Indonesia and India had been having this system in place for a long time and these countries have much larger rural areas compared to Malaysia. Other Asian countries like Taiwan, Korea and Japan too over the past decade had opted for the separation of these two functions for doctors and pharmacists. There is therefore no reason why we should lack the commitment to emulate this best practise while denying the public the rights to better care and equitable access of patient counselling. If the practice of prescribing and dispensing separation is bad and not good for the people why are more and more countries adopting this Dispensing Separation? NO country that had opted for Dispensing Separation had reverted back to the doctor prescribing and dispensing, even after changes in government.
7. Dispensing Separation is necessary for any effective and beneficial transformation of the country health system. Pharmacists want ‘Dispensing Separation’ to bring greater benefits to patients. To those who oppose this ‘Dispensing Separation’ (including YB LKS), we would like to ask them “WHY are they always talking about the need for “Transformation” but when it come to the transformation of the country healthcare system they are so opposed to it? Are they championing for their own (and their friends’) selfish interests or for the benefits of 28 million Malaysians?
8. The arguments offered by some quarters since a few decades ago that dispensing by pharmacists will cause inconvenience to the public or that there are insufficient pharmacies in the rural areas or that there are no 24 hours pharmacy or that what works for other countries may not work in our country are nothing but history. As for the insufficient number of pharmacies in the rural areas or that there are no 24 hours pharmacies, have they not heard about the spontaneous progression on Supply-and-Demand economic dynamisms? With the private clinics not issuing out prescriptions for supply of medicines, do these people expect pharmacies to be set up in the rural areas or to open 24 hours. It is a chicken and egg situation, but certainly this is not the case elsewhere! In fact, to the contrary, increasingly more and more people are seeking the services of pharmacists, in both the government hospital as well as in the Community Pharmacies. Only the uniformed and the apathetic would still be of the opinion that it is inconvenient for the public to go to pharmacies. Community pharmacies are the most accessible and affordable healthcare facilities to the rakyat. Any person can walk in to a pharmacy and see the pharmacist in attendance without the need for an appointment or to be registered and wait in line.
As for the doctors’ argument that there will be situations where the patients will require medicines urgently and cannot be seeking for a pharmacy to get the medicines, do be informed that in those countries where D.S had been practised private clinics are allowed to keep and supply those medicines that are considered as necessary for emergencies. In addition private clinics doctors in the rural areas where there are no pharmacies too can apply for approval to dispense medications to their patients.
9. Dispensing separation is NOT a western phenomenon. Countries from the Middle East had practised Dispensing Separation from the early days, later adopted by the western world and most countries in Asia. Indonesia and India had been having this system in place for a long time and these countries have much larger rural areas compared to Malaysia. Other Asian countries like Taiwan, Korea and Japan too over the past decade had opted for the separation of these two functions for doctors and pharmacists. There is therefore no reason why we should lack the commitment to emulate this best practise while denying the public the rights to better care and equitable access of patient counselling. If the practice of prescribing and dispensing separation is bad and not good for the people why are more and more countries adopting this Dispensing Separation? NO country that had opted for Dispensing Separation had reverted back to the doctor prescribing and dispensing, even after changes in government.
10. We believe most of the doctors had worked in the Government General Hospitals before (this writer had been a pharmacist in Government Hospitals for 33 years). To recapitulate in the event that some of these doctors had forgotten or chose to forget, in most Government Hospitals there are:
a) The Drug Information Service (D.I.S) and this D.I.S is one of the busiest units within the Pharmacy. The clients that are using this D.I.S are mostly doctors who require information not only on what are the most appropriate medicine to use but also on other info like the proper indications, time of administration, appropriate dosing, side & adverse drug reactions to look out for and in the event of wrong prescribing/overdosing what remedial measures are required.
b) Medication Therapy Adherence Clinics (M.T.A.C) manned by pharmacists had been set up in many government hospitals. These M.T.A.C s operate side by side with the doctors clinics in the specislt clinics of the hospitals. At these clinics, patients who are on long term medication therapy are referred to the pharmacists manning the MTAC for the required drug and medication counselling. The Pharmacists Medication Therapy Adherence Clinics (M.T.A.C) are very much in demand as the doctors want the pharmacist’s intervention to see better compliance to medications. Better compliance to medication lead to better outcomes. This I am speaking from my own personal experience after having been the Chief Pharmacist in Government General Hospitals for more than half of my 33 years in government service. Government doctors and specialists have no qualms working together with pharmacists not only in the MTAC but also in many other areas with many other health care professionals to provide the best healthcare for the patients
c) The Medication Counselling Service that are being carried out in the outpatient pharmacy department and the bedside medication counselling service in the wards for the past decades or so had assisted to improve patients medicines compliance after discharged. The pharmacists are also a part of the Hospital Home Visit Team. This Home Monitoring of the patients are mostly been done for the very severe or very under privileged group of patients.
d) Pharmacists, dieticians, physiotherapists and other healthcare professionals had been working very closely with doctors as members of the healthcare team to provide a comprehensive healthcare in the hospitals and other health institutions. In these government hospitals and the other healthcare institutions, the doctors, including all the Consultant Specialists have no hesitation to seek the pharmacist’s professional advice when it comes to medications. What we do not understand nor comprehend is why when some of these doctors quit government service and go into private practice, suddenly the pharmacist’s services are no longer of use to them or to the patients?
e) The government and the doctors in government hospitals and healthcare facilities know and acknowledge that the patients can benefit greatly from the practice of pharmacy and that is why the doctors in these health institutions are more than willing to work together with pharmacists for the benefits of the patients and not for the benefits of any sector of the health professionals.
The government has the facts and figures on the number of fatal prescribing errors like wrong dosages, inappropriate/irrational or excessive prescribing, drug-drug interaction, drug-food/herbs/supplements interactions. The numbers of the pharmacists intervention on these errors prior to dispensing to the patients are also documented. These data are collected from both the government outpatient and inpatient pharmacies as part and parcel of the Ministry of Health’s Quality Control Program (QAP) to ensure medication safety to patients are been maintained. The general members of the public may not be aware that these pharmacists are working quietly behind the counters to ensure medications safety for the patients. These data can be only be collected in settings where there are dispensing separation, i.e where the doctors prescribe and the pharmacists screen before dispensing to the patients.
f) The allegations by some doctors that dispensing in government hospitals and clinics are not been carried out by pharmacists only showed how ignorant and outdated some of these doctors are as to the progress that the government pharmacy practices had made since the 1970s, not to mention the grave injustice that they had committed against the government pharmacists who had been diligently providing the best pharmaceutical care to the rakyat.
11. There is no provision in the Poison Act for the private clinic doctors to delegate the dispensing in the clinic to other qualified personnel. In short the "dispensing" doctor/s is required to supply the medicines personally to their own patients. Is this been practised in most private clinics? FYI dispensing in government hospitals ARE DONE by pharmacists. And in the Community pharmacies dispensing are also been carried out by the pharmacists and/or under the personal supervision of the pharmacist (and this is provided for under the Poison Act.). There may be some black sheep pharmacist who may not be around when dispensing are been carried out. For these black sheep pharmacists, please REPORT to the authorities. Similarly for those black sheep pharmacists who diagnose and prescribe Group B poisons please report to the authorities. We do not CONDONE such practices of these pharmacists.
12. Some doctors are frank enough to admit that in the final analysis it’s the money that counts for their practice to be viable. However we hope all healthcare professionals will always be mindful that we as professionals, we should be earning the money in the professional way, always taking into consideration the people’s welfare first. Healthcare professionals should never behave like an ordinary lay businessman!
Perhaps we should all listen to what the late Dr. Richard Teo has to say at http://www.youtube.com/watch?v=umLkfADe17s&sns=fb.
Quote Dr. Richard’s own words: “Whether it is in the medical, the dental fraternity, I can tell you, right now in the private practice, sometimes we just advise patients on treatment that is not indicated. Grey areas. And even though it is not necessary, we kind of advocate it. Even at this point, I know who are my friends and who genuinely cared for me and who are the ones who try to make money out of me by selling me “hope”. We kind of lose our moral compass along the way. Because we just want to make money”
That is another good reason why the patients need pharmacist to be their check and balance. If the doctor is both the prescriber and the dispenser, who will act as their screener to ensure that the medications given to the patients are correct in all aspects, for their health?
13. In the current discussions some private practitioners had been portraying the picture that ALL Medicines require a doctor prescription and had accused Pharmacists of selling medicines without prescriptions from the doctors!
For the information of the Rakyat, in our country, medicines are classified into Group B, C and others. Many medications including the various cough & cold remedies, creams & Ointments, eye drops, medicines for diabetes, asthma, painkillers, etc. etc. are under Group C classifications. Group C medicines are medicines which pharmacists can supply without doctors prescriptions. For Group B medicines, one needs a prescription to be dispensed by the pharmacists. But without Dispensing Separation, community pharmacists in Malaysia do not receive many direct prescriptions from the private clinics doctors. No pharmacy or pharmacist can hope to sell any group B medicines to any walk in patients like “kacang-puteh”.
At one meeting a senior MOH officer had stated that our Country Group C lists appear very limited compared to those that they see in the developed countries. In any case in the developed world more and more medicines are been allowed to be prescribed by the pharmacists. In several countries like the US, pharmacists are allowed to prescribe many of these Group B medicines without the need of doctors. In the U.K, they had even allowed physiotherapists to prescribe certain group B analgesics. Is there a difference how we are trained, those employed in the service and those of us in the community pharmacy? Is there an inadequacy in our pharmacy training – accredited by these countries – that we are deemed as worse than the physiotherapists in UK?
In any case doctors do not have the sole prerogative in prescribing. More than halve of all the medicinal products that are registered in Malaysia are classified as “Non Poisons”, i.e. these medicines are not under the “Controlled Medicines” group. Pharmacists are legally allowed to prescribe and supply those Group C poisons (in some other countries these are called “Pharmacy Items” and the many other OTC or Non Controlled Medicines categories of medicinal products. The traditional practitioners are allowed to prescribe these non-controlled medicines. In fact any uncles, aunties, grandfathers or grandmothers can and have been “prescribing” these non-controlled medicinal items since time memorable!
14. Several private clinic doctors too had objected to pharmacists conducting blood sugar level and blood pressure measurements with those home monitoring devices. There is absolutely nothing wrong with pharmacists performing blood tests using those home monitoring medical devices. Non doctors like nurses, medical assistants and laboratory technicians had been conducting all these measurements in hospitals as part of their work to screen the patients before the patients see their doctor in the hospitals or clinics. Government doctors in the hospitals and clinics are encouraging patients to monitor their own health parameters like blood sugar levels and blood pressure. Are the private clinics doctors also saying that the patients who are using these home monitoring devices to monitor these important health parameters are also guilty of "playing doctor"? The Pathology Lab had also not disallowed pharmacies to carry out such measurements with the home monitoring devices. Are the private clinic doctors ignorant of these as well? Haven these private clinic doctors NOT read those news report on the high percentage of our population been walking time bombs as they are not aware that they are having high blood pressure and/or high blood sugar levels? One typical news report on this matter is “The Star” Headline report on the 28th Feb 2015 at http://mystar.newspaperdirect.com/epaper/viewer.aspx
Al healthcare professionals are encouraged to assist in the screening of our rakyat for early detection of these two most frequent non communicable diseases. And again pharmacies are the most accessible and most affordable health facilities for patients to seek the assistance of a health professional to monitor their health parameters. Thus instead of trying to portray the pharmacies as doing something very wrong with their assistance to monitor these important health parameters, private doctors should be encouraging the pharmacies to work harder and to have a larger section of the population to be screened. Many community pharmacists had been doing such screening and had referred several cases of their patients which had readings that are out of the normal accepted range to the private doctors clinics for a more thorough investigation and treatment.
15. These days more and more educated and the well informed members of the public are seeking the services of the pharmacies, not only in the government health facilities but also the services of the pharmacists in the private sector.
This perhaps explain why “smart” self-paying private patients without medical coverage prefers to get a prescription (especially from private hospitals with dispensing separated administration) and have it dispensed from a pharmacy. They have a choice to hop from pharmacy to pharmacy in an open market for the best price; or to request for much cheaper generic equivalent registered with Ministry of Health. Even as victims to discriminatory price inducement, the open free market competition would force upon pharmacies to yield away most of their margins; more often, they make less than the standard price-off (>20%); to a greater part by the proliferation of the illegal “runner-sourced” goods originated from the same sole distributors selectively promoted by the principles and sold to/through favoured practices or outlets. We believe many of these principle-companies justify these inducement acts on the basis of group B medicines for doctors only; hence the people have to pay (without choice or contest?).
No 16. Malaysia has one of the best healthcare systems in the world. So why the need to change?
The positive ranking that the World Health organization (W.H.O) has given Malaysia is due to our healthcare delivery system by the PUBLIC Sector and not the Private Clinic Sector. The rankings are based on an index of five factors — health, health equality, responsiveness, responsiveness equality, and fair financial contribution. The Health Care category in the Index considers the cost of care and the quality. Also considered are the number of people per doctor, the number of hospital beds per 1,000 people, the percentage of the population with access to safe water, the infant mortality rate, life expectancy, and public-health expenditure as a percentage of a country’s GDP. The Doctors associations like MMA and MPCAM attempts to attribute Malaysia’s good ranking to the Doctor Dispensing system in our country is indeed very pathetic and misleading. In any case please take note that a large majority of the countries with rankings which are better than Malaysia had been practicing Dispensing Separation for a long time (Kindly refer to http://thepatientfactor.com/.../world-health.../ )
If at all anyone would like to know what the W.H.O thinks of dispensing doctors, please refer to Section 10 of the W.H.O report at http://apps.who.int/medicinedocs/pdf/h3011e/h3011e.pdf
That World Health Organization paper on Policy Perspectives on Medicines had listed 'perverse financial incentives' as one reason why 'worldwide more than 50 per cent of all medicines are prescribed, dispensed or sold inappropriately'. It found that 'prescribers who earn money from the sale of medicines prescribe more medicines, and more expensive medicines, than prescribers who do not…'
Another W.H.O report had stated that ”Drugs cannot be viewed as ordinary commodities of commerce as they are not like most other commodities. Drugs are not chosen directly by the buyer (the patient), the buyer is not always the responsible payer, and the buyer often has no background or the necessary information to evaluate or make a choice which can have hazardous or even deadly consequences for the patient….”.
17. Some would probably be demanding for proofs on what we had mentioned about the inducements of medical prescribers by the unethical drug companies. Let us highlight the example of Panadol 650mg to clearly illustrate this discriminatory practice that is widely practiced by most drug companies in Malaysia.
PANADOL 650mg is also a very good example to highlight on how many drug companies in Malaysia had short changed the people of Malaysia. For your information, prior to 2012, GSK only make their PANADOL 650mg to private clinics.
In 2011 PANADOL 650mg had been sold to private clinics at prices ranging from RM3.84 to RM7.16 per box of 80 Caplets (i.e. the clinic cost price of the PANADOL 650mg was less than 9 cents per Caplet.
PANADOL 650mg was NOT available to any pharmacies and pharmacies can only purchase their Panadol 500mg Tablet at about RM2.15 per strip of 10 Tablets, i.e. the cost price of the Panadol 500mg for pharmacies was at 21 sen per Tablet.
In 2011 the Panadol 650mg regular price for private clinics was at RM7.16 per pack of 80 Caplets (i.e. at 9 sen per caplet) with bonus 8+1 (meaning buy 8 packs get 1 pack f.o.c) which will bring the cost to about 8 sen per caplet. There will be the usual occasional promotion where the private clinics are encouraged to purchase bigger lots at very much discounted price, like the promotion in late 2011 where the PANADOL 650mg was offered to the private clinics at RM3.84 per pack of 80 caplets but the private clinics have to purchase 80 packs of 80 caplets and 10 packs will be given f.o.c. The price after this 80+10 bonus offer at RM3.84 will bring down the cost of the PANADOL Caplet to less than 5 sen per Caplet!
Then in 2013, after our official complaint to the GSK Headquarters in the United Kingdom and also to the Malaysian Competition Commission GSK decided to make the PANADOL 650mg to Pharmacies but at RM26.67 per pack of 80 Caplets i.e. at 33.33 sen per Caplet compared to the regular Doctor’s price of 8 to 9 sen per Caplet! The Recommended Selling Price (RSP) was fixed at RM32.00 per pack of 80 Caplets or 40 sen per Caplet.
In summary, pharmacies have to pay about 33sen one Caplet of the Panadol 650mg while clinics pay only 8-9 sen for 1 Caplet of the Panadol 650mg! With the RSP set at 40 sen per Caplet by GSK, the margin for pharmacies was fixed at maximum of 7 sen per Caplet while the maximum margin for clinics vary from 31 to 35 sen per Caplet (depending on their quantities purchased). Kindly see the attached files for copies of the relevant documents related to GSK Unethical practices. Please take note that GSK may have adjusted their prices after 2012.
Now if that Panadol 650mg was also available to pharmacies at 8 to 9 sen per Caplet, then the rakyat will be able to buy the Panadol 650mg at less than 15 cents per tablet of the Panadol 650mg, compared to the 25 cents that they are paying for the Panadol 500mg! Why should drug companies want to deny the public an equitable access to more affordable medicines if not because they want to induce the prescribers to use more of their products.
Last but not least lest you think that the Panadol case is just an isolated case do see what several articles on these unethical practices of drug companies. You may say that “all these are also happening in other countries so what is the big deal”? The difference is that in all the other countries, the authorities are at least doing something to address this issue or at least to punish those errant countries unlike in Malaysia no actions had been taken against these errant drug companies.
18. Recommended websites to visit:
1. Marketing to doctors – John Oliver 8th Feb 2015
https://www.youtube.com/watch?v=YQZ2UeOTO3I&feature=youtu.be&t=15m21s
2. Another Glaxo Scandal In China: Bribing Docs To Prescribe Meds? 06/13/2013
http://www.pharmalive.com/another-glaxo-scandal-in-china-bribing-doctors-for-prescribing/?cid=nl_pharma_pharmalot
3. GSK: Drug company sued for unethical conduct
http://www.cafepharma.com/boards/showthread.php?t=70434
4. GlaxoSmithKline fined $3bn after bribing doctors to increase drugs sales http://www.guardian.co.uk/business/2012/jul/03/glaxosmithkline-fined-bribing-doctors-pharmaceuticals
5. GlaxoSmithKline fined $3 billion by FDA for improper marketing and unethical behavior
http://www.skepticalraptor.com/skepticalraptorblog.php/glaxosmithkline-fined-3-billion-fda-improper-marketing-unethical-behavior/
6. Glaxo Pleads Guilty, Fined $1 Billion in Drug-Marketing Case http://www.businessweek.com/news/2012-07-05/glaxo-pleads-guilty-fined-1-billion-in-drug-marketing-case
7. Drug firm GSK fined for collusion
http://medicalxpress.com/news/2011-10-drug-firm-gsk-fined-million.html
8. Glaxo slapped $750mn fine over tainted medicines http://www.themoneytimes.com/featured/20101027/glaxo-slapped-750mn-fine-over-tainted-medicines-id-10133179.html
9. Chinese police charge British former head of GSK in China with bribery, Wed May 14, 2014
http://www.reuters.com/article/2014/05/14/us-china-glaxosmithkline-idUSBREA4D03720140514
10. A Short Explanation of Medicine and Bribery
http://criminal.laws.com/bribery/medicine-and-bribery
11. People & Power - Drug Money U Tube 2010
https://www.youtube.com/watch?v=1TwdsYVHjGA
12. Dollars for Docs: How Industry Dollars Reach Your Doctors
http://projects.propublica.org/docdollars/companies/merck
13. Dollars for Doctors
http://www.propublica.org/series/dollars-for-docs
14. Pharmaceutical companies spends $30m wining, dining doctors
http://www.theaustralian.com.au/news/health-science/pharmaceutical-companies-spends-30m-wining-dining-doctors/story-e6frg8y6-1226447086707
15. Big Pharma criminality no longer a conspiracy theory: Bribery, fraud, price fixing now a matter of public record
http://www.naturalnews.com/036417_Glaxo_Merck_fraud.html
16. Doctors with financial conflicts often have big say in developing medical guidelines, journalists find
http://www.minnpost.com/second-opinion/2012/12/doctors-financial-conflicts-often-have-big-say-developing-medical-guidelines-
17. U.S. to Force Drug Firms to Report Money Paid to Doctors
http://www.cchrint.org/2012/01/16/u-s-to-force-drug-firms-to-report-money-paid-to-doctors/
18. Dr John Rengen Virapen, Whistleblower of the Psychopathic Pharmaceutical Industry, Speaks Out http://www.youtube.com/watch?v=6QMYFgC_YSo&feature=player_embedded
19. Confessions of a Pharma Rep
http://www.youtube.com/watch?feature=player_embedded&v=wIWuEAFlg1Y
20. Howard Brody, M.D., Ph.D. Facts About the Pharmaceutical Industry
http://www.youtube.com/watch?v=OSA1M5vmWTQ&feature=related
21. Big Pharma’s Big Fines
http://projects.propublica.org/graphics/bigpharma
22. Medicines Australia Code of Conduct: breaches (Aust Prescr 2008;31:162-3) http://www.australianprescriber.com/magazine/31/6/162/3
23. Doctors are meant to prescribe, not to promote
http://www.euro2day.gr/ftcom_en/article-ft-en/1166971/doctors-are-meant-to-prescribe-not-to-promote.html
Thank you very much
Yours sincerely,
GAN BER ZIN
Malaysian Pharmacist
On Behalf of “Say No to inducement of medical prescribers Facebook" group:
https://www.facebook.com/groups/147352308715470/
as a layman, do you think the common people like me would go out to buy medications in a pharmacy after getting prescription from a doctor while i am sick?
i have seen people buying medications in pharmacy and that poor fellow developed allergic reaction.
Anon 1.01, 1.28 and 7.22
Get an education first before giving an opinion!!!!!
So in the process of going forward with this pharmacy bill do you doctors and pharmacists just argue with each other or do any of your associations even bother to inform and also ask the common people what do they want?
Or are the common people deemed uneducated and their opinions and wishes worthless and irrelevant?
Maybe the common people should just better seek alternative and complementary medicines instead.
11:49 PM,
Looks like you not only need an education on the right to dissent, but also medication of the psychotic kind.
Pity.
11:49,
You sound like a Red Bean. Blurting out a few words of condemnation without any explanation. No upbringing, eh>
Be civil, man. Learn to argue. Put out your reasoning. Otherwise people will call you stupid. And the High Court has recently ruled that the words stupid and recalcitrant are not defamatory.
2:41 AM,
Seems to me that the arguments on dishonesty, cheating, profit motive etc apply to both - the medical clinic doctors as well as the privately practising pharmacists.
And I'd warn the 11:49 bloke that if he insults me for expressing an opinion, I have a host of insults to throw back at him.
And if this blog allows his comment, it's only fair that the responses be allowed, too.
Ladies & Gentlemen, It is not the pharmacists who want to rob the hard-working doctors of their right to dispense medicine. It is the manipulative Chinese tycoons with chains of shops waiting to open up pharmacies at the expense of the 10,000 doctors. Our beloved Malaysia has the best medical care in the World for decades. Why should the doctors' rights give way to one or two tycoons ? Do not bully the poor doctors using the innocent pharmascists as an excuse. It is the TYCOONS.
Ladies & Gentlemen, It is the greedy Chinese tycoons with chains of shops who want to rob the 10,000 doctors of their rights. Not the pharmacist. This is as clear as daylight.Costs of medicines will increase for the Rakyat if the tycoons succeed.
Appears to me that the problem the doctors side choose to bring up over the pharmacy bill doesn't attack privately practising pharmacists. I think most pharmacists end up employed to somebody else anyway instead of actually owning and practising in their own pharmacies. Is this true or not?I don't know how many people here are doctors, pharmacists or just normal people(like me). There's a pharmacist up there, but his comment only hinted that the current system is unfair to them. They really need to speak up.
Rather there are allegations made that some unscrupulous businessmen are moving towards a monopoly on the pharmacy retail business, buying up small pharmacies and spending money to push the bill. Don't know if it's true or not. Ugly fight and me as ordinary citizen don't get the impression that any side even care to get feedback from ordinary people.
Not surprised, the bill is actually protected under OSA. Heard some doctors were mad they couldn't bring it back home to read or something recently.
Feels refreshing to have an opinion from somebody in the medical field that is neutral.
http://www.mofrust.com/2015/02/what-is-happening-with-us.html
Additional notes for the Rakyat.
We hope to inform the public that we cannot allow 3rd level healthcare to continue when we have these fine pharmacy graduates already trained to provide healthcare delivery which will be safer, more effective and towards a system that will be more cost effective compared to now where the doctors can do what they want without counterchecks on whether they are giving the correct or best medicine at the correct dose for the correct duration and whether multiple medicines they prescribe in on prescription are really necessary or whether these medicines could interact and eventually result in a bad reaction or poor ineffective treatment for the patient. As long as there is no check and balance and one party is doing all the 3 functions :diagnosis, prescription and dispensing, the final outcome of the treatment; whether it is effective or the opposite, no one knows. Is this what the patients want?
For the information of your members please take note that the Government (i.e B.N) had determined the training models of pharmacists and doctors where the curricula were set by the Ministry of Health and the Ministry of Education long time back, where the system of check and balance for the safety of patients and also to promote the optimal outcome of any treatment is the aim.
Our curriculum in medicine trains the doctor for diagnosis and treatment, while that in Pharmacy the curriculum was aimed to trains the graduate to check prescriptions & to look out for errors, to check on drug combinations and contraindications, effective dosing and also on the individual characteristics of patients, their health status, their lifestyle, their concurrent intake of foods/herbs/supplements which can impact on the outcome of the medicines prescribed. All these concerns are questions the pharmacists consider when they screen a prescription and counsel the patient during dispensing.
These roles of the doctor and the pharmacists were planned by the Government when these medical and pharmacy curricula were adopted. Today 19 universities with pharmacy schools are training pharmacists to do these separate roles for the delivery of first world healthcare for Malaysia.
We now have 13,000 registered pharmacists. Much of the problems we are facing today is related to this dichotomy, where training of these professionals are at the level of 1st world and delivery of service in the private sector is still at the 3rd world level, where the doctors still want to diagnose, prescribe and “dispense” (often through an untrained assistants). The original aim of “check and balance” on the medications in the prescriptions for the patients is non-existent. This practice back in 1970s was acceptable because at that period of time we only had 1 pharmacy school graduating pharmacists.
If we are comfortable with 3rd world type of healthcare delivery, then the training of medical doctors should be increased by 2 years, so that they will learn more about medications and dispensing, so that they will be able to do dispensing in the proper manner. At present this is NOT an outcome in the curriculum of the medical doctor; they are not trained in this practice (dispensing) at all. Under such a circumstance, the Ministry of Education should rationalise and close off the pharmacy courses and channel all prospective students to medical schools. This will be maximising the resources of parents and the country, as only those who are trained for a certain career should be doing the job of which they are trained.
With the current arguments going on, doctors are whipping up the concerns of patients by playing on the extra time needed for patients to get prescriptions filled in pharmacies which might be a distance away from the clinic. The current scenario exist as a consequence of no Dispensing Separation, a policy that had been maintained by the government for the past 6 decades. There is no incentive for pharmacists to open a pharmacy next to a doctor’s clinic as no or few prescriptions are coming to them to fill. The work which the pharmacists are trained in, is still being carried out by the medical doctors who NOT trained in this area.
In not having their prescriptions filled by the pharmacists, the patient is also being deprived of all the training of the pharmacists, their counselling on medications, interactions with other drugs, possible /foods/herbs/supplements, possible allergic effects.in other words they might not be given the best medications for their conditions and the treatment outcome are not be optimised.
One other very important benefit that the separation will bring about which has not been given too much prominence is that patients will be prescribed the best option for his medical condition. In the current system, the patient gets prescribed what is in the Doctor's small dispensary including those which are about to expire since the current system is all about business first. What is kept in the Doctor's small dispensary is also influenced greatly by the marketing strategies of the Drug Companies. With Dispensing Separation, this unhealthy aspect of Healthcare Industry in this country can be controlled.
Pharmacist good in giving meds..but can u ensure pts risk,compliance and complications??how do u monitor patient condition or follow-up for a certain chronic disease just an example like diabetes..can u do that??
If u think u can do that..would u take any responsibility if any mortality arise??can u??of course not!! coz u will never have DR in front of ur name..where ur first oath is totally different from us!!! (Do no harm!!)
Plus..if u think pts will come back n forth to the clinic and pharmacy just for the sake of their diabetes follow up and treatment..i don't think they will do that!!it is so ridiculous and definitely such a wasting of time..cost and transport problem furthermore..
Why so eager to do DS..while we already been duin that at private hosp and all gomens hosp and KK..but we call that as dispensary integration..if u r really concern about the patient care..come fight to work for us in private GP..we can hire u..instead of work away from us..
this will definitely make the health systems in GP much more better plus we can reduce the risk of giving wrong meds to the patient if we have pharmacist to work for us(if that is really ur main concern la kann)-yes fight for that..
So..the current system is already good and no patient has any complaint about it..then y bother to change??if u can get at least 20% from the rakyat marhaen to sign ur petition then please proceed. .
if none of them did.. then cont dreaming my frens!!!
Huh? So..the current system is already good? Good for the private prescribing and Dispensing Doctor you mean?
Perhaps you should read the World Health Organisation Paper, "Policy Perspectives on Medicines — Promoting rational use of medicines: core components" available at http://apps.who.int/medicinedocs/pdf/h3011e/h3011e.pdf ,in particular Section 10 of the report as below:
10. Avoidance of perverse financial incentives
Financial incentives may strongly promote rational or
irrational use. Examples include:
• Prescribers who earn money from the sale of medicines (e.g. dispensing doctors), prescribe more medicines, and more expensive medicines, than
prescribers who do not; therefore the health system should be organized so that prescribers do not dispense or sell medicines.
• Flat prescription fees, covering all medicines in
whatever quantities within one prescription, lead to over-prescription; therefore user charges should be made per medicine, not per prescription.
• Dispensing fees, calculated as a percentage of the cost of the medicines, encourage the sale
of more expensive medicines; therefore a flat dispensing fee irrespective of the price of the
medicine is preferable. Although it may lead to price increases for cheaper medicines, it lowers
the price of higher cost medicines.
• Patients prefer medicines that are free or reimbursed.
If only essential medicines are provided free by government or reimbursed through insurance,
patients will pressure prescribers to prescribe only
essential medicines. If medicines are only reimbursed when the prescription conforms to clinical
guidelines, there may be an even stronger pressure on prescribers to prescribe rationally.
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