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©New
Straits Times (Used by permission)
by Annie Freeda Cruez
KUALA LUMPUR: Complement each other, not fight. This is the advice given by
Health Minister Datuk Liow Tiong Lai to doctors and pharmacists who have been
arguing over the right to dispense medicines.
"We are talking about two professional bodies. They should
complement each other and not be competing with each other."
He said it could not be denied that both were specialised in their respective
fields of work.
Right now, Liow said, the system was such that doctors handled all the
functions.
On the issue of separation of duties in the dispensing of medicine, he said: "I
had a meeting with the Malaysian Medical Council last week and I will be meeting
representatives from the Malaysian Medical Association tomorrow. I will meet
representatives from the pharmaceutical industry next week."
Liow said he would decide on the matter after the meetings.
For almost 20 years, pharmacists have been fighting for the return of their
right to dispense medications but have been unsuccessful for various reasons.
The ministry had planned to conduct a pilot project on the separation of
functions between clinics and pharmacies in selected major towns before
implementing it nationwide.
However, even before the pilot project could kick off, there have been protests
by doctors.
'Patients want their pills from clinics'
KUALA LUMPUR: The number of patients who visit private clinics may drop if
doctors are not allowed to dispense medication, said the Dermatological Society
of Malaysia.
Its president, Dr Allan K.C. Yee, said Malaysians usually see
a doctor to get medicines.
"Malaysians generally do not believe in paying consultation fee for nothing, if
they know they are not going to get medicines from the doctor," he said.
This is one of the reasons why the 70-plus member society is against the idea of
separation of functions of doctors and pharmacists which would also apply to
dermatologists, who are medical doctors by profession, said Yee.
He added that dermatologists are more qualified than pharmacists in advising
patients in applying topical medicines which is frequently the common treatment
for skin problems.
"Dermatologists are better qualified to show the patients how
to apply the medicine to the affected skin, how much of the medicine to use and
how to store them," he said.
The patients might also be shy to ask the pharmacists how to use the medicine in
a pharmacy, especially if the problem is around the private parts, he said.
Yee admitted that dermatologists' profits will drop if the separation takes
place but said the consultation rate will not change.
He also said the condition of the topical drugs is compromised when drugs are
sold in bulk packaging and then repacked by pharmacists.
"Customers are the ones who lose out because they would not be able to keep the
medicine for long as it would be either spoilt or become ineffective," he said.
How some Asian nations handled dispensing split
by Rina De Silva
KUALA LUMPUR: Dispensing of medicine by pharmacists and not
doctors is not just a western practice. It is the norm in several Asian
countries, including India, Korea, the Philippines and even Indonesia.
It became legal in Indonesia in 1964, the Philippines in
1969, India in 1988, and in South Korea in 2000.
It is common to find 24-hour pharmacies in these countries.
Besides 24-hour pharmacies, the Philippines' 72 public hospitals also render
24-hour pharmaceutical services, said Romeo L. Manalo, assistant secretary of
the Office of Standard Pacific Affairs at the Philippines' Department of Health.
"The hospital pharmacies run on an eight-hour shift not only for the inpatients
and outpatients but also for the general public," he said.
In Mumbai, India, there are at least twenty 24-hour
pharmacies, said Subodh Priolkar, immediate past president of the Indian
Pharmaceutical Association.
If the pharmacy is closed, the patients can purchase the prescribed medication
from hospital pharmacies which are open 24 hours, he said.
There are about 1,000 government hospitals there, he added.
The only exception to the law is in the rural areas in India where clinics there
would purchase medicines in bulk from pharmacies, he said.
The exception to the law is also allowed in rural areas in Indonesia, said Eka
Suripto, the head of communications at the Indonesian Embassy here.
In big cities, where there are more than one pharmacy, each will take turns to
operate 24 hours, he said.
Although the separation of functions is now a norm, the practice came with its
share of problems initially in Indonesia and South Korea.
As doctors could not dispense their own medicine some started to acquire their
own pharmacy and the pharmacists' role was reduced to merely following the
orders of the owner, said Eka.
He said due to the increasing number of such cases, the government issued an
additional regulation in 1988 which barred doctors and dentists from dispensing
or preparing medicine, except injections.
In South Korea, the separation of functions was strongly opposed by physicians
who were afraid of losing an income source, said Prof Dr Soonman Kwon, chairman
of health policy and management department at the Seoul National University's
School of Public Health.
"Following a wave of strikes, the government was forced to modify the reform
package and to raise the doctor's consultation fees substantially to compensate
for the physicians' income loss," he said.
Prior to the mandated separation of functions, both physicians and pharmacists
were prescribing and dispensing medicine which resulted in the overuse and
misuse of medicine, he added.
"After the separation of functions, pharmacists are not happier because they
cannot prescribe anymore," he said.
In India, the separation of function made no difference to the doctors'
consultation fee, said the spokesperson from the media division of the Indian
High Commission here.
In private practice, the consultation fee of 50 to 200 rupees (about RM4.20 to
RM16.50) remained the same.
Subodh said the separation of functions worked because only pharmacists have the
knowledge and training to dispense medication and counsel patients on how to
take the medication.
"In the event of possible effects of drug combination, pharmacists have the
right to ask for a medical history," he said.
He added that doctors usually prescribe the best medication for the patient
based on the patient's medical history.
There has been an improved therapeutic compliance in the Philippines as a result
of the separation, said Manalo.
"Pharmacist as dispensers serve as the second technical person in contact with
the public by providing the necessary information and counselling on drugs and
other related matters," he said.
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