Monday, March 31, 2008

Gun without bullets

I was brought up to believe, traditionally a doctor is such a noble being. He/she is able to diagnose an illness and prescribe as well as to "dispense" medicine to relieve symptoms or to cure the disease. The Sinseh or Chinese Physicians do also diagnose, prescribe and dispense their own traditional medicine. Where would one find Sinseh diagnose a condition and ask the patient to get the medicine from someone else or herbalist (if ever such profession exist)?

So, what happen if someone owns a gun but doesn't have bullets?

Here are some questions and answers related to my posting:

What is the hottest topic among health care providers these few days until even LKS and Malaysia Today blog about it?
The dispensing rights between the doctors and pharmacists.

What is dispensing (medicine)?
To give out or to distribute (medicine).

Who has the rights to dispense in Malaysia currently?
1) Doctors. 2) Pharmacists.

What has the pharmacists been demanding for the past 20 years and now?
The exclusive rights to dispense medicine, no one else.

Why is the rights so important?
Pharmaceutical industry is an extremely profitable business. There is a huge market out there. One can become rich (like doctors?) with such rights. This can be equate to automobile companies with APs (exclusive rights to import certain cars).

Who are practicing separate dispensing currently?
1) All the government hospitals and clinics in Malaysia (Actually not entirely true as many of the dispensing role are done by "dispensers" because there are shortage of pharmacists in the country).
2) All the private hospitals in Malaysia.

Who are not practicing separate dispensing?
All private General Practitioner clinics and most of the individual Specialist Clinics.

Why are they not practicing it?
1) There are not enough pharmacists.
2) Smaller clinics could not afford to hire pharmacists to dispense.

Why are pharmacists unhappy about it?
They are losing income or business for not been able to get enough prescriptions for them to dispense. That is why they are resorting to selling all sort of stuffs (like supermarket), such as health supplements, milk powder, self-grooming stuffs and even food stuffs like mineral water.

Why are doctors refuse to give away their rights?
Primary care or General Practice in the private sector is very profitable (one can not denied) and very competitive as well. Many GPs resort to lower their consultation fees in order to get the patient volumes and gain from dispensing medicines. Take for example, many GPs lower the cost to charge per patient (in a package of consultation plus medications) in order to get accepted as "panel" for many companies. This lowers the cost of health care.

What happen if doctors loose the rights?
Many will raise the consultation fees and health care is going to cost more with the separate dispensing of drugs.

While John Chang and Dr. Khoo Kah Lin can go and debate who and why pharmacists should be or not given the exclusive rights, I am more concern if implementation would be successful if ever the pharmacists won the rights.

This patient has been buying the above three medications from the pharmacy for the past two years without a doctor's consultation and prescription for frequent joint pains.

My few concerns:
1) Will patients ever understand the danger of not consulting the doctors for their problems and to buy medicine from the pharmacies because they are cheaper?
2) Will enough enforcement be there to make sure pharmacists only dispense medicine with only prescription from doctors?
3) Will patients willing to spend more on separate prescription and dispensing (higher cost of health care)?

Meanwhile, few possibilities I could imagine if doctors and pharmacists want to cooperate to share the pie:
1) Doctors to hire pharmacists and pay them accordingly to dispense in the clinics.
2) Doctors and pharmacists to open joint venture and share the profit accordingly.

Related links:


Chen said...

hi cytusm.

my answer for your concerns:
1) No. People want cheap or free.
2) No. Definitely no. Even now people are buying controlled drugs from pharmacies without needing prescriptions. For the pharmacies, $$$ is the most important concern, not some silly prescription.
3) No. People want cheap and convenient.

No, I don't think most clinics will be willing to hire pharmacies to dispense in clinics. Their high salaries add to the burden of the clinic's overhead.

Yes, group practice are willing to have joint ventures to open pharmacies. However, it is difficult to get the pharmacists.

NST had article on pharmacists getting exclusive rights to dispensing and trial runs going to be held in major towns.

But star paper the next day of said there was no such thing, according to new health minister. There were just in preliminary stages of conducting a study to see if such a thing is feasible.

So what gives? Which news is correct?

A Member of Ex-USMCK Group said...

why you need a pharmacist when you can do the job well? Pharmacist may be at peak of their knowledge during student time but not when serve the people. They do not get details about a new drugs more than a doctor. They cant recognise and confirm symptoms or sign related to drug complication or another disease, but a doctor can. A doctor can identify a drug that works better for a patient than pahrmacist, as no single drug that works for everyone!. For me pharmacist should not dispense drug according to what they know without recommendation from a doctor. They are only useful to work in lab, since their knowledge is mainly on the drug and not patients.

Palmdoc said...

I put up a Poll in the MMR

Anonymous said...

Under current situation, the dispensing rights should be continued for health practitioner and pharmacist.

Can't really understand why the pharmacists r so keen for a exclusive dispensing right.

I'm sure that u as a health practitioner have come across times in which your assistant, nurses, hospital admin staff or fellow colleagues would ask you for advise and to prescribe as well? However, it might be a rarity for a pharmacist in asking u to prescribe a course of antibiotics for him/her in a government hospital.
I think statistically they rarely felt sick and occupationally are the healthiest among all professions?

Chen said...

the pharmacists r so keen for exclusive dispensing rights is because the profit margin from selling medications is very attractive.

mirwan said...

no pharmacist would dispute the physicians role in investigation, diagnosis and choices of treatment to patient who comes to see them. that is their role and no one is going to take it away from you. your role is secure.

however, who dispenses and handles medication vailable in the clinics? if doctors (who are human after all), makes a mistake.who can be relied on to counter check the prescription in the clinic? the staff in the clinic?

the untrained and uncertified young school leaver on lower than minimal wage finding a temporary job working in your dispensary? the retired nurse with knowledge of drugs from 20 years ago? the registration clerk with zero medical and medication handling experience on minimal wage? all afraid to verify the error with the physician in view of the employer?

Is this safer? Is this "more convenient" for the patient?

or a pharmacist with the knowledge of medicines and the training to actually detect all these?

your call. ethics my dear doctor. you know it. we know it.