It was reported that the system of “Doctors diagnose, pharmacists dispense” was proposed to the Ministry of Health to be implemented in April this year. The new system will make it illegal for doctors to dispense medicine and the patients will need to go to a retail pharmacy to purchase the prescribed medicines.
The new system will surely cause inconvenience to the patients. However, the pharmacists argued it will bring down the prices of medicine and give doctors access to many more drugs.
Unfortunately the cheaper prices are by no ways guaranteed. The prices of medicine are not controlled and fixed in this country. It was proven in this country, the prices of medicine can vary greatly from pharmacy to pharmacy. Even if the medicine prices are cheaper in the pharmacies, the patients will likely end up paying more once the charges for the doctor consultations are included. Not to mention the cost of making a separate trip to a pharmacy and the time involved.
The way forwards is to control and fix the prices of the medicine sold in this country. Once the prices are fixed, the doctors and the pharmacies will be selling them at the same price.
At the moment, a doctor can always write a prescription for the patient to buy in a pharmacy if the drug was not available in the clinic. The doctors are not going to compromise on the health and safety of his patients if they did not have the medicines in their clinics. They will lose the goodwill of their patients if they did not give the best treatment available. The more common scenario is the pharmacy concerned does not have the prescribed medicine in stock, so either the patient has to go to another pharmacy or the doctor has to change the prescription.
We all agreed that the pharmacists are trained to dispense medicine. But the doctors are also qualified to do so. Even in the countries that have separation of dispensing rights, it is not an absolute rule that doctors are not allowed to dispense. In 46 out of 50 states America, the doctors are allowed to dispense drugs as long as there is no patient exploitation and patients have the right to a prescription that can be filled elsewhere.
In Australia and United Kingdom, thousands of doctors are allowed to diagnose and dispense medicines to millions of patients in the rural and remote areas. The population was not enough to sustain a separate community pharmacy. So the so called “dispensing doctors” are providing an essential service to the communities there. It is not necessary for the doctors to undergo more training to dispense.
In Malaysia, there are thousands of clinics operating 24 hours a day. It is almost impossible to find a retail pharmacy opening after midnight if you were in need of any prescription medicines. So it will be inconceivable that in Malaysia the pharmacists should have the sole rights to dispense medicine. Our living standard, transportation and infra-structure are surely not up to the task in large parts of our country. Many rural clinics will have to close with loss of dispensing rights.
In fact, in America is that number of dispensing doctors will increase because of several inherent benefits (1). Physician dispensing increases patient compliance. Studies showed 21% to 30% of patients never get their prescription filled at pharmacies. Also, compliance with drug treatment is 60% to 70% better when medications were handed directly to the patients in the clinic rather than just a piece of written prescription. Physician dispensing also ends the risk of errors from illegible handwritings or sound-alike look alike drugs. This can reduce the cost of non-compliance and medication errors by as much as 50%. The delay in getting a prescription filled or not taking the medicine at all may also result in fatal complications including heart attacks, stroke and worsening infections.
We all want to improve the system for the patients. In America, most states allow physicians to dispense drugs under their physicians’ licenses. Nevertheless, the dispensing physician must satisfy various requirements, such as: providing a prescription to the patient; requiring a disclosure to the patient of the right to have the prescription filled elsewhere; requiring the physician to obtain additional permits; requiring that medications be labelled properly and dispensed or directly supervised by the physician; requiring secure storage of drug inventory; limiting controlled substance dispensing; and satisfying various pharmacy record keeping requirements.
In summary, to protect and to empower the patients in this country, we should amend the laws like in America to make doctors’ prescriptions and dispensing transparent and accountable. We should also control the prices of the medicines sold in the private clinics, pharmacies as well as the hospitals. We cannot give in to the interests and demands of the pressure groups. The patients should have the rights to a prescription and choose where to buy their lifesaving medicine.