Saturday, April 05, 2008

Doctor Vs Pharmacist? Or Ministry causing unbecessary trouble?


These last weekend the New Straits Times carried a front page article that must have upset the doctors. In the good old days, when Malaysia was young and doctors and pharmacist few, there was no question that when a patient sees a doctors, who examines the patients and made a diagnosis, the doctor will then discuss the diagnosis with the patient and prescribe the appropriate treatment, which usually are drugs which will help the condition. For the sake of convenience (at that time, not enough pharmacist), the doctors will dispense and will inform the patients of the drugs usefulness and important potential side effects. The patient will trust that the doctor taking care of him is the best judge of his condition, and will be happy to buy the prescribe drugs from the clinic. Fast forward 30-40 years and now we have some pharmacist (still inadequate for the whole country) who wants a part of the action. They seem content to say that after 4 years of pharmaceutical studies, they are the guardian (alas self appointed) of drug use. They claim now that doctors do not know how to dispense, did not know about side effects and are unable to do a good job, basically. How naive. We have been doing it when the present bunch of pharmacist were in their diapers. I suspect that there is a strong element of "turf protection" and an even stronger element of profits and cash. These ulterior motives, hiding behind the facade of we are better for the patients. That pharmacist knows about drugs per se is correct, but they are in the dark about how they can be use in a particular patient. As I wrote in the NST, a drug like beta blockers (and I can write the same for many other drugs) can have many uses. I can use beta blockers for treatment of hypertension, palpitations, angina, heart failure, thyrotoxicosis, and even migraine. How can a pharmacist, whose clinic is situated one or two blocks from mine, fill in a prescription and know how to advise my patient in a personal way, about the drug for his condition, when he has no knowledge of which condition I am treating ( unless he rings me up for each prescription. And I know that they wont ). Also, we hardly hear of pharmaceutical societies organizing meetings to update their members. So they take the philosophy that once they graduated, they know everything for all time. What about recent medical and drug advances. What about recent evidence that certain drugs has now been found to be harmful? They claim that cost saving generics are the same as patented drugs. How can that be? They are say that cost will be kept low because we can substitute the doctors prescription with generic drugs. Hello pharmaceutical society President, you can't do that. It is against the law. You will need an MBBS to do that. If I write Atorvastatin, you dispense atrovastatin and not some Indian generic. Anyway, there are probably not yet enough pharmacist to work in the rural areas. They are all crowded in the urban areas, and by the way, they are not 24/7. What about filling prescription in the after hours and graveyard shifts? Well, I believe that I have made my point. What I wish to say is that, THE PATIENT MUST HAVE THE CHOICE. We should not use a law to force people to accept, or put differently, to protect some people's turf. Let the patient decide. If the patient likes to buy from the nearby pharmacy, so be it. If he chooses to buy from his favorite GP, so be it. No one should legislate to take away, a patient's right to choose.

1 comment:

Kong said...

Doctors are also human and mistakes are bound to happen. So who should check for possible mistake in doctor's prescription? Surely not the Form 5 school leaver doing the dispensing in the clinic.