Having been part of the medical fraternity, I roughly knows how the medical frat thinks. Honestly, ask around your doctors, how many of their friends comprises of people from medical background. It is like more than 50% on their mobile phone call list has a medical background. So most opinions are formed with the help of other medical personnels.
Is there a need for separation of dispensing rights? Whilst almost all developed countries have enacted laws for separation of dispensing rights, Malaysia still lags behind. The malaysian medical association is a powerful lobby body who has in the past used costs of treatment as the main reason for preventing Malaysia to go on to full separation of dispensing rights.
Personally maybe because I have practiced medicine in developed countries, my feeling is that dispensing right is a right in order for patients to have the optimal medical treatment. Since coming back to Malaysia, i find most doctors here practice “self-delusional” ethics. To be fair, medical treatment is way too cheap in Malaysia. Most people have no idea that other countries, the costs of treatment is many times of Malaysia. But Malaysia being Malaysia, where the competition is cut throat, so doctors will have to resort to certain practice to keep their practice afloat. For that I do sympathise with the medical practitioners here.
I knew of one doctor who personally sells sleeping pills on demand without prescription as pharmacists cannot dispense sleeping pills or other dangerous controlled drugs (S8 - dunno what classification they use in Malaysia). To be fair as well, there are many pharmacists in Malaysia that practices “self delusional” ethics as well as they use to dispense coughing syrups even though they knew the customer was abusing it.
But unless doctors and pharmacists work together and create a better medical settings for Malaysia, we will be in a perpetual chicken and egg scenario where we always expect the other party to make a move. In this scenario however, I sympathise the pharmacists more as they have a less powerful lobby group compared with the medical frat.
Doctors have long abuse this dispensing rights by always lowering their consultation fees to like RM20 but making money on drugs by marking up 200% or more on it. They will give you generic brands and then create this scenario that they are using branded drugs. Though personally i feel generic works as well as the original brands, but it is the truth behind the dispensing that matters.
Just like how doctors have said that give patient a choice to decide whether to let doctors dispense, I will rather say, give patient a choice to decide whether to use generic or not and to compare prices. But i know if patient in Malaysia chooses to ask doctors for prescription, they will turn sour face and patients will have a fear embedded in their mind so reluctantly they will let doctors dispense. Come on, this sort fear is embedded in everyone’s mind when they see their doctors and the doctors know about it. So when doctors ask for dispensing right is actually more of a move to protect their rice bowl than their concern over best medical practice. Doctors know this.
But occasionally doctors should dig deep down their hearts and ask themselves if their compatriots in developed countries realised the importance of separation of dispensing rights, surely the Malaysian doctors are not dumb enough to realised the importance for the sake of practicing the best approach for patients.
BTW does your friend have a sister?
he has.. but i doubt you would want for reasons I won’t go into
oops.. i tot u comment on this other post.. damm.. i am getting old.. which friend are you talking about?
The convenience of patients getting their medication from their doctors on the spot is a plus for many. I agree patients should be given the choice whether they want the cheaper generics or the more expensive branded names.
In the case of specialists, certain medication is sold much cheaper than pharmacies(eg glaucoma drops) because of the very nature they’re specialized, specialists can confidently buy certain medication in bulk thus bringing down the price.
The dilemma could be solved if the Govt impose a new ruling all clinic dispensary should never remove the medication label and write down the name of the medication on the envelope. I know many private practices remove the medication label so patients cannot buy from outside.
helen: the basics behind why dispensing rights should be separated is because there need to be a secondary level filter to ensure that the drugs given to patients are safe. Most doctors (I know I don’t get to do as much Pharmacology as I should in medical school) do not have as much knowledge as a pharmacist in drug interactions. Honestly, most of us would know for this disease, we prescribe this. But often we overlook the drug interaction side. This is the basic of why all developed countries have separation of dispensing. Well, it is afterall the patients’ health and for their best interest. Frankly, i cannot see either way in Malaysia would be good. There are too many rotten apples around to see any system working well. Doctors in Malaysia ought to come out and say, “look we are oppose to that because it will break our rice bowl” instead of giving so many bullshit excuses. They think the general public have no brains issit? Sorry if I sound harsh. I can say as much as I want because I have been in the medical frat and have left it.
I agree with you, doctors’ rice bowl may be “one” of the reasons on why doctors are against pharmacists having exclusive rights, but that may not be the sole reason. Do open your thoughts to various factors before you want to make general assumption. Let’s not include government hospitals/clinics and private hospitals, cause they practice separate dispensing. Many private GPs do care about reputation. If they want to prescribe a drug, they want to make sure the drug works on the patients, whether original or generic. Therefore doctors want total control of their dispensing drugs because patients pay for it. Patients today have more ‘brains’ as they go ‘doctor shopping’ (if you don’t know such a thing exists). No doubt about patients having options to choose, that is what we are trying to advocate now. Assuming doctors don’t have enough knowledge on pharmacology, showed your ignorance. Before you want to compare our country to other ‘developed’ countries, try to find out how our health care system works. If the MOH decides to enforce such policy on separate dispensing in future, they must make sure such policy applies to all health care providers, irrespective of government or private setting. If the government can show to us they are practicing such policy 100% without much problem and in the best interest of the patients, I have no more reason to believe such system can not work. I will share with you my experiences if I have the time to write again.
Doctors wants total control of dispensing because of patient pays for it? Yeah duh, they get to earn money therefore they want to have dispensing rights.
If doctors are doing such a good job of providing a one stop diagnostic and therapeutics and what not, then let me tell you the REAL scenario as I am a practicing pharmacist in Malaysia
1) All medicine are suppose to be labeled. Surprise surprise, 80% of patients bringing their medicine to me from their private GP are not labeled the drug active ingredient.
2) Private practice Doctors purposely conceal the identity of the drugs by removing all packaging of the drug as to prevent patients from seeking a second opinion.
The above contravene the Poison Regulation amended 1984.
The above is not a problem if the medicine are obtained from the hospital setting because in the hospital setting Dispensing Separation is already in place long ago.
Can you imagine what is the consequences if the patient is taking an unidentifiable medicine? Should he fall sick in a different place and he does not have access to his/her regular doctor, how will the doctor treat him/her because the new doctor may not know what are the current medication the patient is currently taking.
come on. we are in the pathway to be a developed nation. To become a developed country, certain changes are really needed. This is what happening now in our health care systerm - dispensing separation. If dispensing separation has been proven to be good for physicians, pharmacists and patients in many countries, why and what are we waiting for? Personally, I am very sure dispensing separation not only does bring benefits to the public and pharmacists, it will definitely brings advantages to our dearest doctors. Doctors, put your hand at your heart and tell yourself, you will be more professional by letting go the right that really does not belong to you.
Didn’t anyone also aware that some pharmacists do not label their drugs sold to patients?
If patients happen to develop adverse effect due to drugs, the doctors usually call the clinic to find out the name of the drugs, which are recorded. Not really a big issue.
No point comparing who is more unethical here.
Smalls issues like labeling practice and other stuffs like that can be modified and enforced to make the dispensing practice fairer and more transparent for both doctors and pharmacists without doctors the need to give up such role which they have been practicing right?
We all know for a fact what is it like out there with regards to dispensing of medications. Ask yourself whether your practice is really patient-centered?
1. Do you really follow laws and regulations when it comes to dispensing of medications? Ethically and professionally?
2. Do you abide by code of ethics and guidelines set by your medical associations and council especially use of sample medications and your relationship with pharmaceutical industry?
3. How do you mark-up your medicines? Any formula?
4. Who dispense the medication at your clinic?
5. Do you allow sale of medications without having to see you?
6. How do you select drugs to be kept in your clinic?
7. Amongst the options that you have, then how do you choose which drug to be prescribed and dispensed? Is it patient’s financial status e.g. self paying vs insurance o corporate patients?
Doctors…once for all and for patient’s sake please honestly and openly tell us OBJECTIVELY why the system won’t work here in Malaysia so that we can really focus on the issues and make the system work..STOP go round and round attacking the pharmacists. As you would know, in any profession there tend to be bad apples…pharmacy and medical profession are no exception, so please don’t generalize on issues
i can never agree more with garston. Good comment