Who Is Right, Who Is Wrong?

Doctors and pharmacists, they sure have patients' welfare in their mind ........ not. Its all about $$$$$. Read below (copied from NST).

The separation of duties between doctors and pharmacists is definitely on the cards, even if the two healthcare professions cannot agree on the terms and conditions and when it should take effect. RINA DE SILVA and HEIDI FOO talk to Malaysian Medical Association president Datuk Dr Khoo Kah Lin and Malaysian Pharmaceutical Society immediate past president John Chang.

Q: After 17 years, do you think it is time to separate the functions?

Dr Khoo: I don't think the dispensing should be done exclusively by pharmacists.

Chang: Certainly. It's a good start.

Q: Why?

Dr Khoo: If you are vomiting, suffering from diarrhoea and high fever and the doctor gives you a
medical prescription, you would have to hunt around to get your medication. Pharmacists are not located next door to every clinic.

Chang:When the government makes a firm policy on when it is going to take place, a time frame must be given for pharmacies to be set up.

Q: If not now, when would be a good time?

Dr Khoo: If you have enough 24-hour pharmacies , it would be fine. In the meantime, you must have what is called shared dispensing, which is giving patients the option to obtain their medication from either the doctor who gave them the prescription or a pharmacist.

Chang: The government should realise that setting up pharmacies is not a 100m dash.

Q: Several Asian countries including India, South Korea, Indonesia, Thailand and the Philippines have implemented the separation of functions between clinics and pharmacies, so why not Malaysia?

Dr Khoo: You have to see whether the separation of functions is applied to all parts of those countries. Some places in the Philippines, for instance, are impossible to penetrate. In Malaysia, it can be done in Kuala Lumpur, but what about the rural areas?

Chang: The separation system is also being practised in the Malaysian public hospitals and is working very well because there is check and balance. We see no reason why it should not be applied to the private clinics as well. In fact, doctors should welcome the move because it enables their patients to benefit from the advice of more than one healthcare professional.

Q: This proposed separation, will it be good for the patients?

Dr Khoo: If you are looking at the consumers' point of view, then whether the doctor dispenses the medication or the pharmacist dispenses makes no difference for them.

Chang: This provides patients with the opportunity to get more information about the type of drugs available from the pharmacist. Unlike doctors, this is what pharmacists are trained to do.

Q: Is your stand a bread-and-butter issue or meant to benefit patients?

Dr Khoo: I do not have a problem with pharmacists dispensing medication, but since there is a shortage of pharmacists, they should not be the only ones to dispense medication.

Chang: By relieving the doctor of the role of dispensing, the doctor will focus on the patient's disease and treatment. The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist. This certainly cannot be bad.

Q: Doctors have been accused of dispensing only medicines their clinics carry, or that they carry too limited a range of medicines.

Dr Khoo: A doctor's responsibility is to prescribe what is best for the patient's medical condition. If there is a limited range of medicines, the doctor will give a prescription to the patients to obtain the medication from a pharmacy.

Chang: Firstly, doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more. At the same time, some may argue that it is the pharmacists who will now be the ones who are making a profit. Yes, that's possible, but consumers now have a choice. If you think a pharmacist has overcharged, you can go to another one in future.

Q: There have been many reports of non-doctor healthcare providers who are not doctors doing diagnosis and even offering solutions.

Dr Khoo: Obviously, you should go to a doctor if you have a medical condition. The doctor is the one who has been trained and qualified to diagnose. Pharmacists, for example, are not trained to diagnose a medical condition.

Chang:The pharmacist's role is limited to non-medical advice. Let's say a pharmacist checks a patient's blood pressure and notices that it is high. He should refer the patient to a doctor. However, pharmacists can offer advice such as control of diet and exercise. Pharmacists are not supposed to take the role of doctors in diagnosis.

Q: If non-doctor healthcare providers should not be doing a doctor's job, shouldn't a doctor also not do the job of other healthcare professional such as pharmacists and nutritionists? After all, doctors don't do the work of dentists.

Dr Khoo: It is not a question of who has the right. Doctors are addressing the shortage of pharmacists here.

Chang: Doctors often say pharmacists like to "play doctor". This is where doctors must understand that they are not solely responsible for the healthcare of the public. Doctors should realise that things have changed. Nowadays, patients are beginning to practise home remedies and other alternatives, like traditional medicine. Even our government has realised this.

Q: How well trained are doctors in pharmacology or nutrition?

Dr Khoo: Doctors are trained to ask a patient the right questions, with regards to the medical history, and prescribe and advise accordingly.

Chang: Doctors are required to do four years plus another year in pharmacology while pharmacists specialise in the subject for four years. Doctors cannot say they are experts in the field.

Q: There are bound to be teething problems, such as there not being enough clinics in certain areas and not enough 24-hour pharmacies. How can we solve these problems?

Dr Khoo: In the ideal situation, we should have enough pharmacists. We should also look into ensuring pharmacists are available for residents in urban and rural areas. Even if there are many pharmacies, there is no guarantee there will be a pharmacist there all the time. So that is also a problem to be addressed.

Chang:The current situation is created out of a doctor-dispensing market. How do you expect pharmacies to open near clinics when they don't get customers with doctors' prescriptions? Patients should realise that it is to their advantage to put up with a bit of inconvenience. The two biggest issues doctors would use (to bolster their argument) are the increase in cost and absence of 24-hour service. If a clinic can open 24 hours, so can a pharmacy. It's an administrative issue.

Q: There is concern that doctors are charging extra when they dispense medication.

Dr Khoo: The doctor should charge RM30 for consultation. These days, there is itemised billing which states how much is the consultation fee and how much is the medication.

Chang: It is the duty of pharmacists to explain the difference between a generic and branded drug. This allows the patients to play an active part in the healthcare system. The average person may never question prescriptions given by doctors. It allows doctors to abuse the system without the participation of the patients in decision-making. If the system is implemented, there will not be a situation where the approach is top-down, from doctor to patient.

Q: But should cost be a more serious concern than what's better for patients?

Dr Khoo: The priority is for the patients to get good healthcare, and not let cost be a burden to them.

Chang: That (extra cost) is not always the case. The separation system actually encourages more rational prescribing by doctors.

Q: Who will be held accountable in cases where patients are given wrong medication?

Dr Khoo: If, in the event something happens to the patient as a result of dispensing what the doctor has not prescribed, the pharmacist will be fully responsible.

Chang: The moment the prescription reaches the pharmacist, it is the pharmacist who is accountable. On the other hand, doctors will be responsible for the diagnosis and drugs recommended to the patient. In other words, there are two healthcare professionals taking care of the welfare and interests of the patient.

Q: Brand name or generic?

Dr Khoo: If the doctor decides to write down the brand name, the pharmacists must supply the brand name. For example, if he writes down Panadol, then the pharmacist must dispense Panadol, not paracetamol (generic name). Doctors must have the right to write the brand name.

Chang: There must be a law stating doctors must prescribe generic names instead of brand names so that patients will have a choice.

Health Minister Datuk Liow Tiong Lai will meet doctors and pharmacists to discuss the separation of duties before the implementa-tion of a pilot project in urban areas

Air Putih

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