Hello i am a pharmacy student.And i am curious that is the MOH in Malaysia will let the pharmacist have back their dispensing right back?I heard some thing about pilot trial or something haha....dont know true onot...

hmm, i think not for the next 10 years, as the doctors are not willing to let go the dispensing right. Also, the number of pharmacists in our country is still lacking.

They've been saying this for years. The doctors have too much to lose and like hypermax said, there just aren't enough pharmacists. It's not going to happen anytime soon.

really but i think in KL alone we have anough already right?And if the doctor keep taking the dispensing right the economically wont favour to the pharmacy...then how are they going to expandleh...Those doctor can get medicine way cheaper than pharmacy wanleh....

There are still not enough doctors in our country so does that means doctors should not have sole diagnostic and prescribing right as well? So why the double standard?

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Added on November 30, 2008, 5:58 amThere were indeed supposed to be a pilot run of dispensing by pharmacist in the Klang valley. But DAP complained like hell so was scrapped. All they know is oppose everything, good or bad.


This post has been edited by Optiplex330: Nov 30 2008, 05:58 AM

its all about the revenue really. a big chunk of the doctors income comes from the meds they give out.

provided m`sia adopt something like the NHS system in uk, i dont see how things will change, unless some1 really powerful push it.

something to ponder...
how would the docs justify charging 30 bucks or however much they charge to the patient by just 'consulting' them? do you think the members of public would take it?

If you do not want to pay that 30 bucks, you can always pay nothing and consult the stranger on the street. Or may be the cleaner about your diabetes? Or the taxi driver for your heart condition?

But if you want to consult someone with many years of hard study and money (RM1 million if overseas) in university about human disease/sickness, you will have to pay that 30 bucks. In other word, you should pay for his knowledge. There is no free lunch in this world.

This post has been edited by Optiplex330: Nov 30 2008, 08:48 AM

ermm.. docs losing rights will jack the price of medicine up... however i do support the need to give it over to the pharmacist... just takes time..

how long is the problem....it have been 20 years man...Why the hell doctor wants to take all the duties?i think alot of them worry about their children as most the GREEDY doctor will definitely push their kids to be doctor and continue to earn...some even unethically...
i really hope that malaysia will act liek the UK NHS system which everybody plays their own role...In malaysia the doctor wants take the most profits..then become so rich..then the youngster will lure to become one not for the passion to medicine but for the money more....so dissapointed with the healthcare system.Or as usual we have to wait singapore do it first then we follow like a little puppy...

This post has been edited by taiko88: Nov 30 2008, 10:10 PM

well, as much as i agree with you, the fact is the general public do not. i foresee that there will be a general shift/push to self medication if that happens. which is what the uk is doing as well to reduce the gp's load. but it means the pharmacist will take up more roles.

well, this i was told it has been going on for really donkey years, i think more than 20...
maybe this time round the 'npa' of m`sia is more proactive and aggressive in getting things done...

*no offence to the pharmacist reading*
from what i've experienced+what my friends experienced, pharmacist is just sitting in their shops and running it.... they do virtually nothing on the clinical side on it(even in the hospitals) and just disshing out meds like robots. when asked why this meds by a customer, the automatic answer would be 'the doc say so'. this should not be the way. and if this continues, your jobs could be replaced by a robot that can be programmed to check for interactions!

even the pharmacist in m`sia has some sort of campaingn like the uk's 'ask your pharmacist' its not done properly, i had a friend who had some questions about the medications she's taking, the answer she got was > go ask your doctors! how can this be? pharmacist are the 1 that is experts on meds, why are they giving the jobs to doctors?? did you spend 5 years doing a MPharm(or 4 if you are doing your degree somewhere else) so that you can give your roles to the doctors?

mr lappy are you a pharmacist?The government is made up of doctors...why dont some of the pharmacist go into politics?and fight for us??why dont pharmacist unite together and fight for the right?

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Added on December 1, 2008, 3:32 amAnd since we dont have enough doctor...why dont just give the role of dispensing to the pharmacist?this will definitely reduce the workload of the doctors right?Or all the wordload mentioned is just to make the government increase their salary?which is RM6k.....WTH....

This post has been edited by taiko88: Dec 1 2008, 03:34 AM

yes im a pharmacy student.
quite a few doctors are in politics. thats why you dont see this happening.
btw, shortage of doctors arent just in m`sia. its global.
why pharmacist dont have a centralised organisation to protect the pharmacist interest? that i would have to ask you since you are a student in malaysia you would know better and im not quite in touch on the malaysia side of things.

you are in UK now?are you a student as well?

i must agree, if the pharmacist can't perform it will be up to the doc, although docs are so called greedy.. i think the cost of med will rise even more with dispensing rights given to pharmacist... neway, with the price of medication that they charge... i dont think it is expensive at all...

you mean the doctor or the pharmacist's price?

doc cheaper/pharmacist exp... most of the time docs will dispense generic drugs wherelese pharmacist will dispense the more profitable drug

due to our country mostly doctor dispense therefore they ask cheaper price from the manufacterer...tharefore...they got it at much lower cost compare to pharmacist...but pharmacist still try to sell it cheap...now you know how hard to run a pharmacy business...and also the doctor tend to sell generics which have a high profit margin...not cheap = he earn less de...

while in other countries pharmacists are starting to apply for PRESCRIBING rights, in Malaysia they dun even have DISPENSING rights yet. a total joke..and as long as Datuk and MB's sons and daughters are being sent overseas for medicine program, i dont think it will change in the near future..

i agree....you check their conversations and blogs...all talk about money..cost...pride...all about themselves...will they see the whole picture?are our malaysian doctor think that they are in the third world country?i heard that some organizations had classed malaysia as third world country at first i dont agree...but now...sigh...in economically cost can reduce if we have good ministers...But their eyes is just covered with Money...what a pathetic professions in our country...doctor that only think of money...you go and check how many blogs online malaysian doctor talk about their paycheck...way more than talking about how they help the public?is that the attitude of a doctor?disgusting man...

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Added on December 1, 2008, 11:14 pmpyroboy?are you a pharmacist?which country are you in now?

This post has been edited by taiko88: Dec 1 2008, 11:14 PM

actually pharmacy also have 'squeezing' power as well, but unfortunately its only thoes large foreign chain that has em'... for eg. guardian(yes they arent m`sian own )

doctors taking generics and selling them at branded prices, thats why they have a huge profit margin.

do you know they get their stuff at pennies per tabs and sell them to you at 50sen ect/ tab?

and another thing that i dont understand is people wanting paracetamol tablets, but look at panadol(couple of bucks) and another generic that is say... 1 buck for instance and still willing to pay 2-4 times the price for somethign the same... although its the same...
the general public equate more expensive= better >_>
you are getting ripped off by the large multinationals!!


so true. now the 'in thing' would be specialist pharmacist prescribing rights where they can prescribe a range which is agreed with the nearby gp's and direct intervention on agreed patients in the attemp to off load the pressure...

well, we have to start somewhere, lets see how things goes...

*to the pharm students in m`sia, keep us peeps that are out of m`sia in the loop !

oya and about the service government,what if one that already work in overseas for a number of years and come back to malaysia?do he still need to service government?or he will automatically gain the licence?

im starting to doubt that you are a pharmacy student. are you just using us to do your 'homework'?

haha,what makes you think i am not a pharmacy student?I amlah..i studying in nottingham...

before i say anything else, what year are you in now?

doesnt matter anymore to TS i guess. he has decided to change to medic.

Dude, the number of pharmacists in our country is much much less than doctors. So, if the dispensing right is in the hand of the pharmacists, it will be a chaos scene as pharmacists are just too few in numbers.

Try to grasp what i said before judging.

This post has been edited by hypermax: Dec 3 2008, 11:18 AM

Not having enough as an excuse is just an excuse. Nothing more.

We can always start with the larger town but that wasn't being done. As I said, mere excuses.

i agree...you think KL not enough pharmacist and pharmacy?try go out and drive for like 5KM sure u will encounter 1....but much less compare to cliniclah haha.....

You still dun get it, do you? If there's not enough pharmacists, then how to award them the dispensing right as the workload will be enormous, due to the lacking in number. Therefore, before asking for dispensing right, there must be more number of pharmacists to undertake the task.

There might be enough pharmacists in KL, but if we start to award dispensing right to only pharmacists in KL, then pharmacists from other areas will demand the same thing. Also, the number of pharmacists in KL is much less than that of doctors in KL.

Your solution is do nothing and keeps waiting. Not even want to do a trial run in the Klang valley says it all. So did DAP.

That is why we will forever be a 3rd world country. Never daring to try and make mistake.

This post has been edited by Optiplex330: Dec 3 2008, 05:09 PM

This mistake can cost gov millions of ringgit, let alone putting patients' lives in danger. In addition, we have issues of greater importance to solve, eg, falling standard of doctors, excessive workload for health care personnel, and lack of health care facilities in rural areas. We should address those problems first before we try to change something of least importance.

Ultimately, the goal for pharmacists' demand for dispensing right is just to fill their own pockets.

This post has been edited by hypermax: Dec 3 2008, 08:20 PM

haha...isit?then isnt that the same reason for the doctor?keep talk about money cost...did they mentioned about patient safety?you know how many wrong dosing appear in hospital ma?the doctor just tell the pharmacist to keep quiet everytime they made a mistake then next time come'bang kamu sudah semakin baik sekarang,makan 1 biji cukup'....sound familiar?let me tell you,those doctor wants the dispensing right is for the money and they want the pharmaceutical industrial treat them like king as they will prescribe the drug they manufacture,who give them more benifits they will give the patients the 'correct' brand...

I would just like to ask: what is the advantage of splitting it like overseas where doctors prescribe and the pharmacists dispense? What is the value added by this system?

When I encountered this system in Australia, I thought it was a hassle. After seeing the doctor, must still make another trip to the pharmacist to get the meds. All the pharmacist did was to look at the doctor's prescription and dispense - to me there was no value add. For me, this system loses points due to inconvenience. So what are its plus points?

i agree too, in the US it is worse.. let's say u are on a drug forever but do u know u need to get a prescribtion every once in a while? the pharmacist can give the drug unless a doc writes something. and there goes 50usd for a piece of paper!

So you're saying by giving dispensing rights to the pharmacists it will result in overall less cost to the consumer?

In your example above, who gets the 50usd? The doctor I presume?

You just some of the very reason why separation of dispensing is desirable: safety.

The role of a pharmacist, if he is doing his job properly, is to spot medication mistake. Based on university training, the doctor are expert in diagnosis whereas the pharmacist are expert in medication. They are supposedly to complement each other for the sake of SAFETY. Not unless you think doctor are not human and can make no mistake.

And since there are no free lunch in this world, extra safety procedure do cost money. That is one of the very reason why doctor are given sole privilege of diagnosis. Otherwise, the bomoh cost far less money.

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Added on December 3, 2008, 10:12 pmThe intangible valued added is called patient SAFETY.

What you are paying for from the doctor is his knowledge. Same for the pharmacist. And since knowledge in both cases is intangible and transparent, of course you do not see anything physical value.

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Added on December 3, 2008, 10:15 pmThat is why we remain a 3rd world country with 3rd world mentality.

The purpose you just described are:
1. The doctor has sole right to diagnosis and to see there are no changes in your diseased state. This is a safety issue.
2. The pharmacist make sure you go through Step 1 to make sure safety procedure are being followed.

You have to pay because in developed country, life are precious.

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Added on December 3, 2008, 10:17 pmAFAIK, no profession or tradesman work for free.


This post has been edited by Optiplex330: Dec 3 2008, 10:17 PM

I think malaysian really thinks doctor=god....and money>life.....well...no wonder alot pharmacist rather work in place like UK haha....in UK pharmacist is trusted very much in everythings about drug..doctor is to diagnosis carefully...since there is a shortage of doctor and they keep moaning for their workload....why dont let pharmacist help them in dispensing?you really think they care about patients safety or the money....in UK or Australia i might not sure about the answer...but in malaysia....you and me also know....but there are still exceptional doctors that really do their job well to heal...

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Added on December 3, 2008, 10:28 pmAnd you know why there is shortage of doctor....coz they want to do everyones job....nutricient...pharmacist...they sell medicine,vitamins,some even sell milk powders...the doctor in Malaysia is like want to become a hypermarket edi....

This post has been edited by taiko88: Dec 3 2008, 10:28 PM

You are spot on regarding doctor overwork.

For minor problem, people can go see the pharmacist. And anything serious, the pharmacist in UK should refer them to the doctor.

Win-win-win arrangement.
For the patient, more convenient because it's much easier to see pharmacist.

For the pharmacist, he get to do what he is trained for and extra safety net vetting possible doctor's medication mistake.

For the doctor, he does not have to spend time with minor problem, only those problem serious enough that needed his attention.

But then, only developed nation understand those sort of thing.

LOL developed nation?malaysia?what year now a?2008.....seelah....maybe my grandson generation then malaysia will realise....oh..singapore also want to practice dispensing right now...i must follow too....'Tuan tuan dan puan puan,kami buat ini untuk keselamatan kamu,pergi pharmacy dapatkan ubat'...can we like be the first one?or at least...dont be the last one...

First of all, pls provide evidence to your statement. If doctors can prescribe wrong medicine, so can pharmacists. Also, pls note that in certain diseases, medication has to be withdrawn gradually, so i don't see any wrong in your statement in bold above.
On the other hand, pharmacists will be treated like kings also if the dispensing right lies with them. Isn't this their ultimate motive?

Totally agree. It will only add to patient's inconvenience.

Pls provide evidence that it'll be safer for pharmacists to have dispensing rights. In other first world countries which hold human rights highly, they want everyone to be happy and respected, therefore giving dispensing right to the pharmacists, thus sharing the benefits.

Also, pharmacists lack the knowledge of disease management, so how can they prescribe more suitable drugs than doctors? Most of the pharmacists will use newer drugs, but hey, certain diseases can be cured better with conventional medications.

Unless a concrete study being done on this particular issue which proves that it is safer for pharmacists to dispense drugs, i dun see a point of giving them such right.

i think you are living in the past, or is this so called " 3rd world mentality"? Docs are no longer treated like gods/demi gods. Nowadays, patients or their relatives will question doctors over their decisions and choice of management. People are getting smarter with vast information available on the net.

This post has been edited by hypermax: Dec 3 2008, 11:50 PM

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.

well, its not bombarded, its just a good discussion.

i did say, its like the chicken and egg thing, something has to change before it happens... and btw, if im right, pharmacist is 1 of the highest starting salary as well and i think you are pretty much guaranteed a job imho in any sector you go to.

regarding the report you mentioned, what did you expect from the MMA? of course they'll side their interest, dont you think?

just something crude to ponder before im supposed to stop doodling and get on my work , if pharm dispensing is bad then why so many courtries adopt it? they all cant be making the wrong decisions right?

What i was trying to say was we can go on debating till the end of time, as there are many advantages and as well as disadvantages. Ultimately, it's all about profit.

Btw, just to make it clear that i do not object the idea of pharmacists dispensing drugs, but i prefer for doctors to do so. In addition, the number of pharmacists in Msia is just too few if compared to doctors.

Yup, HOD in Melaka GH, so i guess in your view, it's considered as 3rd world.
Also, this happened not only once, but several times. I have heard similar stories from other consultants. For some pharmacists, as long as it's the same group of drug, why not?

Of course, there are always black sheep around. However, what i was trying to say was it's preferable for the attending physicians to be in charge of the medications to avoid such problems.

Facts of life:
1. Situation in Msia won't change in the near future if the number of pharmacists is still lacking behind.

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Added on December 5, 2008, 3:14 amYes, that's one of the reasons why i am against such issue.
However, my main concern is the lack of pharmacists to do the job. As you can see in my first post, i stated such but was rebuked by another forummer.
Anyway, i haven't had the chance to work overseas, and i hope i do in the near future, so that i can experience the better health care system which you have mentioned.

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Added on December 5, 2008, 3:23 amSorry to quote back old post, but i find your statement hilarious. If doctors can't diagnose and prescribe, who else can? Enlighten me pls.

This post has been edited by hypermax: Dec 5 2008, 03:23 AM

Allow me to use your own answer to answer your question: If pharmacist can't dispense, who else can? Enlighten me pls.

Hence the 'double standard' Lack of doctor has never been used to stop giving doctor sole diagnosis right. So why use that to stop the pharmacist?

In developed country, I think this is called 'specialization". And it must be done for a good reason, either efficiency or safety.

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Added on December 5, 2008, 7:12 amFrom your answer, I can see that you are a open minded person and not afraid to admit 'mistake'. I respect you for that. A lot of people, for the sake of 'saving face', will argue continuously. Anything but to admit possible mistake.

IMO, your views are typical of someone who has not been exposed to superior practice of more advanced countries. Can't blame you because you haven't been in those countries. But if our society wanted to advance, there are a lot of things we can learn from them and separation of prescribing and dispensing is one of them. The evidence for that is all around us. The main thing holding us back are the self interested doctor and lack of public education. The former being money and the later being in possession of 3rd world mentality. And we can't blame the general public because even highly esteemed leader like Lim Kit Siang has that 3rd world mentality when it comes to this issue. All they can think of is inconveniences and money (both true) but totally blinded to safety. That is why they say, in 3rd world, life is cheap.




This post has been edited by Optiplex330: Dec 5 2008, 07:12 AM

actually the main reason is not the mentality...lim kit siang hiself is doctor...and own lots clinics...nothing to do wif mentality lol...

First of all, doctors are trained in both diagnosing diseases and giving medications. Although we might not have extensive knowledge in medications as the pharmacists, nevertheless we know quite a few things, enough to ensure patient's well being.
On the other hand, pharmacists are not trained in diagnosing diseases. Therefore, i would be hazardous for the patients if the pharmacists were to diagnose (or rather misdiagnose) diseases.

As most of us are aware, Msia is still a developing country. Therefore, we can't possibly adopt the health care system of those western countries which are far more developed. I agree that our health care system needs to be changed, but the first step is definitely not to award the dispensing right to the pharmacists, at least not at the moment.

I thought he is a lawyer?

This post has been edited by hypermax: Dec 5 2008, 03:03 PM

So far, I don't think there is any pharmacist here saying they could do diagnosis. I believe the pharmacist themselves acknowledge doctor are the better person to diagnose diseases. Therefore, it's merely in the fantasy mind of doctors to say that.

Now let's look at your so called 'extensive knowledge in medication' issue. Pharmacist spend 4 yrs in university solely on medication.

As for doctor, they spend 5 yrs in university learning from Anatomy to Biochemistry to psychology to whatever. Would it be logical to assume that, out of that 5 yrs, may be not more than 1.5 to 2 yrs worth of time be devoted to study of medication? And assuming doctor are 50% smarter than pharmacist, then the equivalent time for doctor to spend time studying medication increases to 2.25 to 3 yrs worth. That is still short of the 4 yrs pharmacist spend time studying medication.

The point I wanted to make is. No matter how well informed doctor are in medication, logic dictates that pharmacist should be even more informed than doctor when it comes to medication. That is a fact. Just accept that and in specialization, you should let the best person handle whatever he/she is specialized in. And that means, doctor doing diagnosis and pharmacist checking on the prescription written by doctor.

I looked down on those doctor who think they are god and can make no mistake otherwise why don't they allow others to double check their prescription for possible mistakes? Because AFAIK, all human can make mistake. So I believe all they have in their mind is money, not safety of patients.

First of all, you didn't answer my question regarding who should diagnose and treat if doctors can't.

Secondly, you asked me who can dispense medications if pharmacists can't. In my previous statement, i was trying to explain that doctors can do pharmacists' job, while pharmacists can't do doctors' job. Right now in our country, are pharmacists the ones dispensing medications? Therefore, it is safe to say that pharmacists are replaceable to a certain extent in clinical setting, at least at the moment in Msia (no offense, but facts of life).

We study about medications for more than 4 years, including pharmacology (1 year) and clinics (3 years) where we learn about various therapeutic and adverse effects of the drugs. Therefore, i had stated that doctors know adequately, although not extensively.

Mind you, doctors are no smarter than pharmacists. I believe all of us are equal, just that our fields of interest are different. I believe we should work as a team, not "boss-subordinate" relationship.

This post has been edited by hypermax: Dec 5 2008, 05:37 PM

Although a pharmacist may be more specialised in the field of medication, that doesn't mean a doctor cannot do the job (just maybe not as well).

It's the same with going to a doctor or a specialist, or visit your general dentist or an orthodontist. The general practitioner can probably do an adequate job but probably the specialist does it better. Again, usually boils down to cost factor because people know specialist is more expensive.

The main point is that doctor can both diagnose and prescribe/dispense. Pharmacists don't diagnose, they can't even prescribe (maybe in some countries they are pushing for this) so they are able only to dispense. So the scope of the doctor is wider.

This post has been edited by jchong: Dec 5 2008, 09:33 PM

If the doctor can do a pharmacist job why the hell do I still need to go back to the hospital in the middle of the night to conduct theraupeutic drug monitoring and deciding the appropriate amount of antidote to be given for poisoning cases? Mind you it is only one of the things that I want to point out both Dr and pharmacist have their roles to play and Dr should mind their own business on where they can perform best or trained to be good at (diagnosis, surgery).

On the matter of not enough pharmacist, it is just about supply and demand. Similarly when there is pharmacist dispensing right it doesn't mean community pharmacy are going to earn more as there will be competition to keep the price low, especially competition from those large chain like Guardian.

i agree....doctor are just thinking about their pocket...you see how many GP clinic in our country..why dont they all go and specialise....then can help more people ma...my friend told me alot of them which go into medicine for money will set up clinic immediately after the MBBS and earn alot alot...

At the end of the day, it's all about wanting a bigger slice of the money cake and to hell with patient's interest and safety. IMO, just let them be because life is cheap here in Malaysia and even the 3rd world patients agree and go along with that. Willing buyer, willing selling, I called that.

Generally speaking, that is why I prefer not see doctors trained in 3rd world countries because of their 'life is cheap' and their 'can make no mistake" attitude. Not because of their skills.

I used the term "generally speaking" because there are exception and until I know them, I avoided them. Just in case they think they are god.


This post has been edited by Optiplex330: Dec 8 2008, 09:47 AM

but how many western trained doctor u can see?i think even privater also not alot of them....sigh..but who earn more nowadays?clinic or pharmacy?

It does not have to come to this. We could have a win-win-win situation.

1. Doctor diagnose and prescribe and get paid for using his knowledge and wisdom on human disease. Patient should be educated that knowledge is something they have to pay for. I bet many do not know anything about Knowledge Based economy. Not accepting this is like insisting the lawyer should not charge more for the contract than the paper used (10 sen per contract?)

2. Pharmacist also get paid for using his knowledge and wisdom on medication and to check for possible doctor's mistake (anyone who think doctor do not make mistake must have a hole on his skull). They are not just some Form 5 school leaver dishing out pills.

3. Patients get increased safety. And of course, safety comes with a price.

If patient do not wanted safety, I strongly suggest they go consult a bomoh instead (will accept any amount of red packet as payment or may be even a chicken or duck?) or pick some wide herbs on the road side which is free.

well..basically all the doctor in malaysia think they are god lol...but some GP do regret taking medicine in the end wan...they say they dont like to be trap in the consultation room for whole day haha and wait people bring problem in....if compare to GP i think pharmacy will be better instead...they dont have the heart in healing more but just to prescribe more and more antibiotic which they get commisions from the manufacturer...

Seriously this thread is not going anywhere. It has turned into a doctor bashing thread. I am sorry to say this but many here are not capable of intelligent discussion as they are too emotional.

IF you guys say doctors in the 3rd world are bad and think lives are cheap, then can i say pharmacists in the 3rd world are naive and emotional not capable of doing their jobs properly? Come on, grow up pls.

For those of u saying doctors think they are god, pls go and bang ur head against the wall. That kind of mentality has long gone. Pls do not generalise and criticize just because u are being challenged.

To Yeapy,
The case u have mentioned is an exceptional case. What i am talking about is day to day practice.

well..about this matter..doc and pharmacist..both r simbiosis..
if there's no pharmacist..there will be no license for compounding drugs...no drugs..no medicine..no medicine..what should be given to the patients? no matter how smart the doctors r..it wont works.
n vice versa.
both need to lower down their ego.
n about the right of dispensing..it should hand to pharmacists.
coz we learn from A to Z ..sometimes it looks ridiculous to learn something " remeh"..but actually..important.
we know better bout the drugs..everythng..its origin, how to extract it, what does it contains..how to modify, bla n bla...the mechanism towards body.organs..cells..tissues..u name it.
yes it is true that patient is under doctors' responsibility..they know better bout the patients coz it is their job to diagnose and etc.
but it is our responsibility to choose what's the best for patients..
the best medicine is the one that can gives maximal effect with minimal side effects..and it will b good to minimize the amount of dosage especially those potent drugs..our job is not only sitting at the back ,,take the prescription and prepare the medicine ( this is what ppl use to think bout pharmacist)..pharmacist can do a lot better if they have the right to dispense..
money is not everything eventho nowadays everyhtn need money.
but when it comes to health..no matter how rich we r..we should not jeopardize one's life.

since when is lim kit siang a doctor?!!

bottom line is, it's all about money......gp's/private clinic based specialists earn significant percentage of their income from medicine markups.......

pharmacy is a 'new' profession in msia, and hence doctors given the right to dispense from way back, when there were few or NO pharmacists in many towns........

it's a bit like a right/privilege given which benefits a group......now you want the group to give up that privilege.......you think malays will give up bumi rights willingly?..........

It all comes down to respecting each other job. Pharmacist are well train in drug dose/duration/freq/drug-drug interaction. Doctors are well train in diagnosing and coming up with a medical plan to trat patients. So lets not cross the border whereby the doctors or pharmacist wanna do more than they are able and train to do.

Some people would take what you mentioned, i.e., each doing what they do best, as bashing doctors.

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Added on December 9, 2008, 10:08 amSome are saying....let's try out the 1st world model of separation of prescribing and dispensing on a limited basis in Klang valley and see how it goes.....but doctor and DAP are saying....."don't even think of trying".

If you don't try, how do you progress? So now, who is naive and wanted to remain in the 3rd world?



This post has been edited by Optiplex330: Dec 9 2008, 10:10 AM

The trouble is that doctors in Malaysia have been dispensing for so long that they regard the dispensing right within their border. So they are opposed to the idea of pharmacists stepping in. It still boils down to a money issue because the doctor's pockets will suffer.

i dont deny the fact with regards to your statement above.

Then what do you call the statements below? Praising? This is classical generalization and bashing. Seriously, if you wanna discuss, pls discuss in a more intelligent manner.

There's no clear advantage of pharmacists dispensing medicine, on top of that the pharmacists are lacking here. Have you seen any 24 hours pharmacy around? What if patients need medication at night? Are you going to open shop just for them?
You are talking as if patients will die if pharmacists don't dispense medicine.

This post has been edited by hypermax: Dec 9 2008, 02:16 PM

From the various posts above I see that the central reason behind separating the dispensing role is safety. Any idea how much the safety factor is increased by doing this?

This surely is an exaggeration. People do want safety and it's not as if the present system is unsafe. No one is saying they don't want doctors or western medicine and go back to bomoh or traditional herbs alone.

You are just making the point that the system could be made safer if the dispensing right was separated. What I'd like to know is how much safer would it be?

Yup, agree. Pls show us some studies or evidence how much safer will it be if pharmacists gain the dispensing right.

I know you pharmacists want bigger slice of the cake, but without enough evidence and proof that such method is safer, how are you guys going to convince both the authorities concerned and the public?

This post has been edited by hypermax: Dec 9 2008, 02:21 PM

hypermax, you have repeatedly said that Malaysia is not ready to give dispensing right to the pharmacists due to lack of them at the moment. I agree.

However, in principle do you think that one day we should be heading in that direction? Because if we should, then we have to start somehow. Yes, during the transition period it will be difficult or inconvenient and there will be teething problems but it's gotta start somewhere, somehow right? Assuming that enough people support that move that is...

This post has been edited by jchong: Dec 9 2008, 02:23 PM

You think doctor and pharmacist work for free in developed countries? If yes, then there must be something wrong with you. If no, why shouldn't doctor and pharmacist expect the same in Malaysia.

As I said many times, extra safety cost money. For example, if you wanted a car with safety device ABS/VSC, you have to pay. If you wanted safety like melamine free milk, buy more expensive milk form Australia. If you wanted extra safety condom, buy more expensive Durex. If you wanted extra safety medicine (not diagnosis and treatment, in case someone got the wrong idea), buy original and not those at pasar malam. If you wanted someone who knows medicine better than doctor, you have to pay the pharmacist. There is no free lunch in this world. Get use to that fact please and I hope I don't have to repeat that again and again. As for intelligent discussion, how to discuss if one couldn't even agree on that simple fact: THERE IS NO FREE LUNCH.

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Added on December 9, 2008, 3:43 pmIn some rural area, I do not see even a single clinic. What if patient need to see doctor at night? Are doctor going to open clinic just for them? Or should we also let bomoh do the job of treating as well in rural area? If not, the patient can die. So if your answer is yes to bomoh, then doctor should not have sole right to diagnose and treat. Same principle applies to pharmacist.

This post has been edited by Optiplex330: Dec 9 2008, 03:57 PM

it will only happen when the pecuniary advantages of dispensing is removed........and that will only happen when a centralised, gov funded healthcare delivery system is in place.......eg nhs in uk and medicare in oz........ie professionals are rewarded and compensated for their EXTERTISE........not their PRODUCTS........

Doctors are human and will make mistake. Period.

Pharmacist are also human and will also make mistake. Period.

There is no 100% fool proof safety procedure. In fact, there is no 100% of anything in this realistic world.

Going by logic and rationality, an extra layer of safety is better than none. And unless all those developed countries are run by fools, we can only assume the role of pharmacist does has it's place in those countries.

On actual proof. May be there is or may be there isn't any studies. I don't know and may be you can try to search on google?

But 1 thing I do know. There are many actual studies about the numerous amount of mistake occurring due to wrong medication taken. In fact, a army of lawyer makes their living suing against these mistake so you can imagine how wide spread mistakes must be. And this is in developed countries so in 3rd world, multiple that by a couple of folds.

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Added on December 9, 2008, 3:52 pmYup. I also agree. Pls show us some studies and evidence how much safety will it be if doctor can do everything and hence no need for pharmacist. See...it works both way.

As for local Malaysia. How to conduct any safety trial if doctor don't even wanted to try? What are they afraid of? Lost of money? Remember, the Health Department wanted to do a pilot trial in Klang valley and got shot down by doctors! So how to gather evidence and proof when you would not even agree to a trial? Let's have a trial run. If thing don't work out, then we do not have sole dispensing right to the pharmacist. The important thing is we should do a trial run and see how it goes. I have a theory. The doctor are afraid because they may suspect the trial result might be a success so their income will be reduced. Hence they refused to have it done. Called it conspiracy theory or whatever but that is what I suspected.

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Added on December 9, 2008, 3:54 pmI know you doctor wanted to have the WHOLE cake. And nobody else should have even a single slice. So let me guess who is the more greedy ones......

This post has been edited by Optiplex330: Dec 9 2008, 04:36 PM