Comments on Product Of The System: Doctors Prescribe, Pharmacists Dispense, Patients ...

Hate to niggle, but rheumatoid arthritis cannot be...

2008-05-09T23:32:00.000+08:00

Hate to niggle, but rheumatoid arthritis cannot be serologically "proven". And a short coure of steroids is unlikely to cause severe edema. She probably had diabetic nephropathy.

Most GPs have dismal knowledge and there is very little impetus to pursue retraining. Instead of griping about dispensing rights, they should concentrate on updating their knowledge. Pharmacists are essential to good clinical services. That they are poorly distributed and practicing to shoddy standards today only speak of shortsighted MOH policy (poor planning, poor enforcement) and do not in any way detract from that truth. As one of your commenters quite elegantly put it, two wrongs do not make a right.

We have been arguing on who should dispense, appar...

2008-05-09T17:04:00.000+08:00

We have been arguing on who should dispense, apparently whoever gets to dispense will be able to make money until we forgot about the big problem of our health system.

The health system look really good but I just wonder how long the govt can afford to subsidise health cost. At the moment, we pay RM2,bring back big bulk of medicine.
I think the govt must plan to switch to health insurance,compulsory health insurance for everyone. Of course retirees and children exempted. Working folks need to pay a monthly fee for health insurance, then this will solve a lot of problems.
It is true that Malaysian are used to the one stop practise. If there is no price control, the public will never agree to separation of prescribing and dispensing.
Therefore, I suggest MOH must start the health insurance scheme because it can solve a lot of problems including separation of prescribing and dispensing.

We aspire so much to follow the 1st world countrie...

2008-05-09T11:07:00.000+08:00

We aspire so much to follow the 1st world countries in separation of work portfolio between doctors and pharmacists, in other words doing only what we are trained to do (doctors prescribe and pharmacists dispense) - which is precisely the situation in all government facilities. But, to try to impose this on the private practitioners is quite unfair unless the MOH also introduce the compulsory healthcare insurance system (ie. Medicare, etc.) and appointment system based on locality, extant in the 1st world countries. This is to safeguard the interests of the doctors, because it is at their expense that the pharmacists prosper.

At best, if we want to emulate a system, let's emulate everything and not just half-heartedly. At worst, if we can't do that, maybe we should just elect a more far-sighted Health Minister.

Doctors please visit YB Lim Kit Siang's blog n loo...

2008-05-06T12:40:00.000+08:00

Doctors please visit YB Lim Kit Siang's blog n look for the same post. Many don't understand the separation in countries like UK and USA. They just know a pharmacist dispenses drug and that is all. What about the background of the entire system? Some don't even know that pharmacist cannot and should not dispense without prescription,they argued let the patients choose! Further, they don't know that NHS was designed in a way to allow the separation for e.g.doctors don't collect fees fr patients but they r paid according to number of patients assigned under them. An analogy wld be,u can't just grab any graphics card off the shelf n install it just because u think it's good because ur entire pc system may not support it, u must change other parts or find a graphics card which ur pc system wld support.

POTS. When I made the 1st posting, it wasn't being...

2008-05-06T07:05:00.000+08:00

POTS. When I made the 1st posting, it wasn't being published. Only 2 possibilities, either you disallow or there is some technical problem (either I press but not delivered or like one of those mystery emails that takes days to reach recipient). But having read a lot of your posting and you a Christian, I suspect the latter and hence add a clarifier to my post. And it is so I apologize.

Thank you.

This hot off the press. If price is of paramount i...

2008-05-06T07:02:00.000+08:00

This hot off the press. If price is of paramount importance instead of service & safety, may be we should let our local supermarket supply medication instead.

"Wal-Mart Stores Inc., the world's largest retailer, announced Monday it would expand its discounted prescription drug program to offer 90-day supplies for $10 and add several women's medications at a discount. It also said it would lower the price of more than 1,000 over-the-counter drugs. The move marks the third phase of a company program that began in 2006 to provide a 30-day supply of generic prescription drugs for $4. The Bentonville-based company said the program has saved customers more than $1 billion."

Kong,I did not receive any further comments from y...

2008-05-06T02:36:00.000+08:00

Kong,

I did not receive any further comments from you in this post apart from the first one.

I will only prohibit comments that will bring harm and potential harm to my loved ones.

As you can see, i even allow comments that harp on my character and motives with no relevance whatsoever to the post title.

I treasure dissenting views as I too am here to learn.

Please re-post your comments earlier. I'd be interested to hear.

Regards.

I am truly impressed with your writings, and pleas...

2008-05-06T01:18:00.000+08:00

I am truly impressed with your writings, and please keep up the good work.

By the way, i have seen a pharmacist who takes history and performs physical examination, just like any doctor. She even uses a stets to take bp the classical way!

Fully agree to what's happening to the health syst...

2008-05-05T16:11:00.000+08:00

Fully agree to what's happening to the health system of malaysia.

I'm a 5th year med student, and I also have first hand experience how atrocious the system can be..

I have patients who brings in questionable medications from their GPs. Eg, a quinolone for a viral URTI (upper respiratory tract infection)? this is getting way out of hand!

I,myself whom my own relatives, who believe 100% to what her pharmacist tells her.. even selling her a whole crateful of 'vitamins' after dx a long list of ailments from just looking at iris (iridology), despite having follow-up at MOPD in a goverment hospital.

When she had her angiogram done. She showed me her radiographs.
She even scoffed at me, (when I honestly told her, that I am not trained enough to give her a proper explaination on angiograms), saying even her phamacists can read the radiographs! (tsk.. coming from the same pharmacist that 'practise' iridology..tsk..)

It seems not many people understand the legal and ...

2008-05-05T09:58:00.000+08:00

It seems not many people understand the legal and professional duties of a pharmacist. Here are a few:

1. A pharmacist job is to spot any mistake on the prescription eg., wrong dosage, wrong combination of drug etc. And to alert the original doctor prescribing about these mistake. It's his professional and legal responsibility to do so. In Western countries, pharmacists are considered the better expert on drug, not the doctor unlike the misguided perception in 3rd world Malaysia. Don't have to take my word for it, go ask any Western doctor and lawyer.
2. A pharmacist CAN NOT just change the drug without consultation with the original doctor prescribing it.
3. For certain medication, eg. Antibiotic, a pharmacist can not give it without a doctor's prescription. That's an offense.

As can be seen, the whole purpose of separation of prescribing and dispensing is the EXTRA safety of patient. POTS do not emphasis on patient's safety but rather on inconveniences and cost and I find that a bit disappointing. AFAIK safety always comes with a price tag. But I suppose life is cheap in Malaysia.

In conclusion. 2 wrong do not make a right. It's wrong for the doctor not to subject their prescription to be scrutinized by pharmacist for any possible deathly mistakes (unless doctors think they can make NO mistake). And it's equally wrong for pharmacist to give certain medications WITHOUT a doctor's prescription (because they are ONLY trained in drug but not diagnosis except for minor ailments) or change a prescription without the agreement of the doctor.

And it's equally wrong for POTS to disallow my earlier post on BOTH the wrong of doctor and pharmacist. Whether this post is being posted will speaks volume about the character of POTS on his ability to take comments that's very different from his. If my earlier post has been disallowed due to technical issue, then I apologize.

Great article. Keep on writing!One more problem wh...

2008-05-05T06:45:00.000+08:00

Great article. Keep on writing!

One more problem which would arise from this situation is the worsening of antimicrobial resistance. Even at present, qualified doctors are prescribing antibiotics for illness not requiring antibiotics, with the typical example of fever and flu. The situation will only get worse if pharmacists are given the sole right to dispense medicine, enabling everybody to grab antibiotics off the shelves for illness which don't require the use of antibiotics, hence worsening the problem of antimicrobial resistance. If nothing is done to the escalating problem of unscrupulous usage of antibiotics, Malaysia will face severe problems with antimicrobial resistance in the future.

Agreed with you. Ultimately, the main issue is who...

2008-05-04T12:27:00.000+08:00

Agreed with you. Ultimately, the main issue is who got the money? This is a lose-lose situation for the patients. Somebody got to pay either the HMO or the patient.

Dude, this can be made into a paper and be present...

2008-05-03T10:41:00.000+08:00

Dude, this can be made into a paper and be presented to MOH to help it catch up with the better systems in developed countries and come up with one that works in Malaysia.

On lack of 24 hours pharmacies. Well, if there is ...

2008-05-02T20:57:00.000+08:00

On lack of 24 hours pharmacies. Well, if there is a demand, there will be a supply like everything else. Trust me on this. Supply and demand is the name of the game in this world.