well, ^ pretty much covered the essences of it

its not just the safety as well, it could be 1001 things... like say the effective use and optimizing cost effectiveness of the drug ect ect....

for thoes who dont have experience in a clinical setting would not probably understand what ^ is on about.

and most people dont even realize that how much mistake and fatal errors that is caught by pharmacist in a daily basis and is all sorted out behind the 'scene' of course im talking in the uk.

in malaysia however,i think chances are that the pharmacist is told to shut up and just be a dispensing robot (maybe some1 who've done a hospital placement or working in 1 could enlighten us?)

This post has been edited by mr lappy: Dec 3 2008, 11:54 PM

Wrong. Nowadays, doctors tend to consult the pharmacists first before making decision on drug selection, well, at least in Melaka GH and Muar Hospital.

lol, didnt expect an answer the moment i edited my post

cool, nice to know that things are changing. i guess things are moving in right direction since the last time i had contact with a pharmacist in a hospital.

how about interventions? like changing drugs ect, is that still frown upon and taken as an insult?

This post has been edited by mr lappy: Dec 4 2008, 12:09 AM

lol..hopefully more people will understand and make a change....sigh...

inconvenience is little when compare to safety. i rather have a pharmacist to dispense my medicines than a SPM leaver in the so called dispensary in the clinic. to you there was no value added maybe, but to someone with X numbers of medications taken everyday, it does make a difference when someone whom is the expert in their medication have a look at the possible interactions, doses, side-effects etc before dispensing the medications.

in UK, if a patient is put on a drug for long term, patient then can asked for prescription collection service (PCS) from their preferred pharmacy. what she/he has to do is, to call the pharmacy that she/he is about to run of X med in 5 days time, and she can just drop by the pharmacy on day 5 to have their medicine ready to be collected. the rest, all taken care by the pharmacy, from requesting prescription to collection of prescription from the surgery and getting the medicines ready for collection or delivered to the patient. how inconvenient that can be, if you dont have to leave your house to get the medicine. but of course the healthcare system is just too different between countries. this PCS is achievable in uk because of the benefit of free healthcare.

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Added on December 4, 2008, 1:07 am1) please provide evidence for the statement that dispensing right is given to pharmacist because of human rights bla bla bla. dispensing right given to pharmacist in UK in way before msia achieved independence.

2) dispense and prescribe is two totally different things. pharmacist do not have the right in prescribing. and yes pharmacist is lack of disease management if compare to doctor but they are real good in medicine management if compare to doctor as well (talking abt hospital pharmacist in UK).

3) study? like mr. lappy has mentioned, you wouldnt believe it unless you have seen the number of prescribing errors done by GPs which is caught by pharmacist.

btw shud i moved this to RWI?

This post has been edited by youngkies: Dec 4 2008, 01:07 AM

think that would be the appropriate move since this discussion is no longer regarding 'education' anymore. the thread title as it is suggest already dont really belong here already

You must be very confused about the respective role of doctor and pharmacist.

I have written countless time that doctor has sole prescribing right aka diagnosis right. In plain layman term, it means doctors has more in depth knowledge of disease management and therefore in better position to prescribe. And I have never said pharmacist should take over this role except for minor ailment.

Likewise, I have written countless time that pharmacist has more in depth knowledge of medication. And doctor should also recognize that.

I hope you understand the differences between diagnosis, prescription and medication itself. 3 related but different thing. May be hard to believe but there are differences. Medication is merely everything about the drug itself.

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Added on December 4, 2008, 7:01 amIf you do 'google'. You will find many reports of patient suffering from wrong medication. Even resulting in death. In fact, a whole lawsuit industry can be based on this single problem.

Here are the facts:
1. Doctor are mere human so will and can make mistake.
2. Pharmacist are also human so will and can also make mistake.

But if both of them are in charge of medication given to patient, logic dictates that the mistake will be reduced. That is why developed country views life highly but 3rd world people think it's cheap.

http://www.wrongdiagnosis.com/mistakes/medicat.htm
http://student.bmj.com/issues/08/06/paper+/252.php
http://www.youhavealawyer.com/malpractice/...on-mistake.html

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Added on December 4, 2008, 7:03 amGood. For a moment, I thought people treat doctor as god and will make NO mistake.

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Added on December 4, 2008, 7:05 amNow this is an oxymoron.

In hospital, doctor consult pharmacist because they recognized pharmacist are the expert in medication (mind you, not the diagnosis) better.

But in private practice, they will refuse to have the pharmacist check their prescription.

So what does that tell you?

This post has been edited by Optiplex330: Dec 4 2008, 07:10 AM

First of all, i apologise for using the word "prescribing" wrongly. What i meant was "dispensing". Was multi-tasking when replying the post last night.

1. No evidence, but a mere observation. I might be wrong, hence i apologise in advance.

2. Refer to above.

3. Error caught by pharmacists? Evidence pls. My head of department for medicine once told me that pharmacists in private practice tend to change the prescription to newer medications without giving prior notice to the treating doctors. As i have mentioned before, certain diseases require conventional medications. For those pharmacists here, i am sure you guys tend to recommend newer medications belonging to the same group as the conventional ones. However in medical field, newer not necessarily means better.

In a hospital setting, doctors tend to consult pharmacists before prescribing, due to the fact that both doctors and pharmacists are on the same team. In hospital, medications are indeed dispensed by the pharmacists. Therefore, the issue of inconvenience for the patients does not arise.

However in private practice, for example you get prescription from a clinic, and then again have to rush to the nearest pharmacy to get the medication. Isn't it troublesome? Imagine if there's no pharmacy near by. Mind you, our system is totally different than that of UK. So we have the change to whole health care system before making it convenient for the patients if the dispensing right lies with the pharmacists.

In addition, as i have mentioned before, the biggest hindrance for such change is the lack of pharmacists in Malaysia. You can google and see. The number of pharmacists in Msia is much less than that of doctors. When we do not have enough pharmacists in our country, how can we give them the dispensing right?

Following is taken from an article which you have provided:


Link

Even in the US, a country which awards dispensing right to the pharmacists, the problems of wrong prescriptions and medications are rampant. So what's the point of giving the pharmacists such right?

This post has been edited by hypermax: Dec 4 2008, 12:26 PM

I heard of such a case in UK. A patient took the wrong dosage and suffered amputation. The court fined BOTH the doctor (60%) and pharmacist (40%). In other words, BOTH are held accountable for patient's safety.

You could look at it both way.

1st. Doctor felt the pharmacist is taking away his profit (let's admit it, it's all about money). So the doctor is not happy.

2nd. The pharmacist is also liable. So the doctor should be happy that someone else is footing 40% of the bills.

i dont think doctors are making much profit from selling drugs, most of the time the doctors wont keep expensive special drugs, only common medicines that can sell fast. if they were to give the patient something expensive most of the time they will prescribe and ask the patient to get it from the pharmacy.

in UK and US it is diff, people can afford drugs or at least in the UK. in malaysia if we were to complicated matters and push the price up, the effect of that will outweight the danger of doctors prescribing the wrong dosage or drug.

This must be a 3rd world head of department? Because I don't think such thing is supposed to happen in developed world. I think if the pharmacist wanted to change anything, different drug or dosage, they have to called up the doctor. Just like they have to call up the doctor should they spotted any mistake in the prescription. Otherwise, you should report that pharmacist to the pharmacist association's disciplinary board. For not doing so, that head of medicine of yours should be shot.

On the subject of substituting. I think may be it's ok to allow the patient to choose whether he wanted expensive imported medicine or locally produced version (as long as BOTH are of the same ingredient and dosage). With doctor doing the prescribing and dispensing, I don't think you have that choice as a customer. You simply have to take what is given.

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Added on December 4, 2008, 3:23 pmYou still do not get it, do you?

Fact of life:
1. If you wanted better thing in life or extra safety, you have to pay for it.

It does not matter whether you wanted a structurally sounded house or a better car with ABS and airbags or a better service in the hotel or better safety in medication.

And payment can be both in monetary term or inconveniences. That is why they say there is NO free lunch in this world.

BTW, better does not mean 100% safety because there are no such thing and we are all human, even the doctor.

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Added on December 4, 2008, 3:29 pmLimited choice of drugs from doctor.

This could be potentially serious and compromising patient's safety. Because it could also mean the doctor are giving you that particular drug simply because that is the drug that he has in stock. And not particular drug may not necessarily be the best choice for you.

I could also mean the doctor is only keeping that drug because it gives him the most profit.

This post has been edited by Optiplex330: Dec 4 2008, 03:31 PM

i think we should quote which system in which country when posting since 1 person could be talking about the system in uk and then another person in the US ectect and we all get confused which is which, dont you all agree. at the moment im not even sure when some1 replies which system are they referring to unless they specified....

[quote=Optiplex330,Dec 4 2008, 03:19 PM]
This must be a 3rd world head of department? Because I don't think such thing is supposed to happen in developed world. I think if the pharmacist wanted to change anything, different drug or dosage, they have to called up the doctor. Just like they have to call up the doctor should they spotted any mistake in the prescription. Otherwise, you should report that pharmacist to the pharmacist association's disciplinary board. For not doing so, that head of medicine of yours should be shot.

spot on

On the subject of substituting. I think may be it's ok to allow the patient to choose whether he wanted expensive imported medicine or locally produced version (as long as BOTH are of the same ingredient and dosage). With doctor doing the prescribing and dispensing, I don't think you have that choice as a customer. You simply have to take what is given.

not all drugs can be substituted just like that as some drugs are excipient dependant as well, since it can change the profile of it. so critical drugs like drug for epilepsy, once they are stabilised on it, they stick to the same brand and the same maker. but most of the drug can be substituted. and another thing is that some drugs can influence other drugs that a person might be taking as well, so thats where the pharmacist comes in.

3. I worked in UK and I called the doctor numerous times daily to correct their mistakes (from simple error e.g. legality of prescription to less likely but common issues e.g. wrong dose, or used of short term medication for long term, irrrational prescribing etc). that is my evidence. living proof. i dont blame them, i am working with them, not just pointing out their errors, hence they dont just blame me either if i make a mistake, but work out how both can minimise it.

in a well regulated healthcare system, e.g. a country with dispensing right for pharmacist, it is illegal for pharmacist to alter the prescription without doctor concern. so what you mentioned doesnt happened in a country with a well regulated system with dispensing right for pharmacist.

according to your article,

and you are right, wrong prescription and medications could be a rampant if well reported. unlike msia, even something wrong happened in clinic etc, do you think they will be reported and a record is kept by the healthcare system. and no record in msia to show how or to what pattern is wrong medication given to patient doesnt means our healthcare system is perfect/good.

and wrong medication and prescription is not pharmacist mistake alone sometime. wrong thing dispensed by pharmacist from a clinically right prescription is an absolute pharmacist fault. but wrong prescription and error not spotted by pharmacist hold both doctor and pharmacist liable.

and you missed that,



the injury include doctor prescribing the medications incorrectly. so should we also take the prescribing right away from doctor, since they do mistake as well as pharmacist filling the wrong dosage?

by the way, you are a healthcare professional too, but i think you should visit those first world country and work for yourself to see how their healthcare system is like. i have worked in both msia and uk, and i have seen and experience that msia is way lacking behind. you can't just bump in and said, what right do they have to dispense? doctor should do it all. dispensing right in those first world country is not given to pharmacist because the country has higher human right sense, but that is how the professions should work in a healthcare system. leave the right people to do the right thing, and have respect of each other area.

but i strongly agree that msia is not prepared yet. healthcare system is way lacking behind, pharmaceutical profession is poorly regulated too.

no offense, just that i feel plain wrong to see the statement that pharmacist shouldnt have the dispensing right. maybe not in msia yet, but doesnt sounds right if you generalize with your poor evidence that all pharmacist shouldnt have the dispensing right. i dont see the doctors in UK complaining about dispensing right for pharmacist. we know what we good at, and we work together for the best benefit of patient. and the doctor is still making good money despite w/o dispensing right anymore (might not apply to msia due to differences in healthcare structure).

well i dont see money involved in such error. medications are paid by nhs anyway, so make no profit to either party (well to be honest, pharmacy make some money from the difference of buying the medication at slight cheaper price and payment at monthly revised rate from the nhs). the doctor is earning via registration of new patient and professional fees per patient/per prescription/ per consultation meanwhile the pharmacy is earning from professional fee per item dispensed.

just that, like mentioned above. wrong item dispensed by pharmacist from a clinically right prescription written by doctor = 100% pharmacy/pharmacist fault. but if start with a clinically wrong prescription an dis obvious but failed to get noticed by pharmacist and hence dispensed, both parties hold responsibilities. hence the case you mentioned above.

This post has been edited by youngkies: Dec 4 2008, 05:34 PM

Sorry. A wrong choice of word. Instead of doctor paid 60% of the fine and the pharmacist the other 40%, may be it should be "doctor 60% responsible and the pharmacist shoulder the other 40%"

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Added on December 4, 2008, 8:43 pmOn cost.

It's well documented that big drug companies spend a lot of money on doctor, taking them for expensive holiday disguised as oversea medical forum. The reason--so that the doctor will prescribe their expensive drugs and ignoring the cheaper alternatives.

Now I know once these expensive drug reaches their end of their patent, other companies can also make cheap copy of it legally and of similar quality. Just like you can buy RM50 original DVD vs pasar malam RM5 and both are watchable. And recently news I saw actually all says these cheaper clones are just as good, just that many doctor refuses to accept that fact.

Now if doctors are disallowed to dispense drug, it may remove that 'undesirable privileges' and pushing down cost. And it will be up to the patient to decide which they wanted to buy, the expensive original or the cheap clone.

Possible?

http://www.moneyweek.com/investment-advice...ugs-14168.aspx#

This post has been edited by Optiplex330: Dec 4 2008, 08:53 PM

Ya it is always 60% for the doctor if the error started from the doctor prescription but not picked by the pharmacist, or picked up by the pharmacist, but nothing has been done. Both are accounted for professional negligence.

Fine is just a small matter in fact. Because monetary fine is usually already covered by professional and corporate imdenities/insurance. But removal from/suspension of practising usually follows with such case, hence reputation and money down the drain.

And only a small no. of cases make it to the court anyway. Cause most errors, mistakes reported and complaints are dealed within the professional society and taken care of. Those that make it to the public or courts are usually huge case for public interest or involve in large amount of money or the complainants make it to the media hugely before the usual procedure can be done.

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Added on December 4, 2008, 9:05 pmFollow on your addon.

in UK, there are well written guidelines and procedure for most conditions and diseases. It is unlikely that doctor will be influenced by the pharmaceutical companies to prescribe their branded drug via their holiday invitation.

Unless it is proven to be real worth it by extensive studies and the National Institute for health and Clinical Excellence (NICE) has recommended the use of the branded one for certain conditions, these branded one is just a choice based on the doctor justification, e.g. when cheaper Brand A won't work, lets try more expensive Brand B.

They won't just simply put everyone of the same conditions with the expensive one, obviously.

First they dont get profit directly from the use of their medicines. Pharmacist pay to get the drug and get paid by NHS for the med.

Secondly, every GP has the budget of prescribed item. If NHS see a huge difference between the budget given and the amount of actual item prescribed, the doctor will get a phone call and a meeting.

And so yes, it is very possible that having the pharmacist to dispense drug only and doctor to prescribe only will remove the undesirable priviliges.

This post has been edited by youngkies: Dec 4 2008, 09:05 PM

In Penang GH, any changes in prescription will be made only after consulting the doctor, so don't generalized all pharmacist in Malaysia likes to do whatever they like either in public and private setting.

Newer medications never means better to me, again, don't generalized pharmacists as we know how to evaluate with evidence based study whether which drugs is suitable for which conditions.

About pharmacist dispensing right, I am done arguing with greedy doctors. I just want to say, a Volvo can get you from point A to B as also a Kancil. People won't feel any difference (ignore things like comfort, performance, handling) if their sole purpose is just to get to their destination. However when a serious car accident happen only those in Volvo will know the difference because Kancil driver may no longer have the chance to know the difference.

You can find the research from UK and US yourself, or ask any pharmacists did you ever encounter doctor's errors in your life and you will get a definite answer.

A competent pharmacist only lack knowledge in differential diagnosis (a doctor's job), but certainly not lacking knowledge in disease management in common diseases like STEMI, NSTEMI, CHF, DM etc on what drugs should be given in the treatment regime based on guidelines. Some of the more complicated disease like lymphomas, neither a normal Medical Officer or pharmacist can claim they have better disease management knowledge than a consultant oncologist/hematologist.

the 'clones' are pretty much the same and not just as good since all the new drugs now are required to do a BE(bioequivalence study) which has to match the profile of the original. so its pretty much the same.

some doctors (usually the 'younger') are more willing to switch to the generics than the 'older'. talking about m`sia here. but its not just the doctors sometimes, it could be the patients as some of them are more comfy taking something they've been taking for a long time instead of switching to another brand or make.

i personally had this experience (uk)where this guy comes in every week or so and insisted on the branded version of the drug and the pharmacist had to explain to him that he cant give due to guidelines and had to get him to change the prescription to that brand.... it got a little annoying after awhile since he kept coming back with the same problem ( i suspect he didnt get a replacement and was just trying his luck )

as for pharmas 'influencing' the doctors, if i remember correctly there's a limit of an amount that a pharmaceutical companies can 'spend' on docs which includes freebies and it need to be something that the gp's can actually use instead of stuff like decoratives ect.

mr lappy, what are you doing in UK currently?

yes, the pharmacist can actually give the patient the branded one of the same generic if the prescription is written in generic. but the pharmacy will be re-imbursed for the price of the generic rather than the branded one. so unless the branded one is same price of the generic or cheaper, the patient have to go back to the doctor and ask the prescription to be named to branded item instead or pharmacy suffers loss.

im studying atm.

yes thats why due to guidelines within the company, he cant give the branded.
* opps i think i didnt mention that in my previous post.

but i think no pharmacist would willingly give the branded if its prescribed for generic since like you've said about the money issues and if they are working for others would probably get into trouble

think im derailing the topic >_< its supposed to be dispensing rights in m`sia

This post has been edited by mr lappy: Dec 5 2008, 12:14 AM

Wow, looks like i am being bombarded by hordes of pharmacists here. Well, i have nothing more to say atm as i haven't done enough research on this particular topic. However, i once came across an article regarding such issue in MMA magazine, and it stated all the disadvantages for pharmacists to have the dispensing right. Can't recall as it has been a long time.

Anyway, i have to stress on one point: without enough pharmacists in Msia, the situation is unlikely to change. You guys want the dispensing right, you have to pray that more people join pharmacy course. No offense but facts of life.