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

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

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.

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

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

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.

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

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.

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

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

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

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.

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

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.

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

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

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

So here are the facts that some intelligent challenged people just can not accept.

1. Specialization. As society advanced, specialization occurs. Just like there are general surgeon, brain surgeon, orthopedic surgeon, neurosurgeon etc. Likewise in field of medication, there are specialization and the accepted specialist here is the pharmacist (doctor also studied medication but pharmacist simply studied even more - FACTS).

2. Safety. As society become more advanced and benevolent, we starts to value life more. Adding a extra layer of safety to have someone checking on possible doctor prescription mistake is one way of showing we do value life more now.

3. Cost. Specialist and extra safety cost extra money. Otherwise, why not just let the general surgeon do operation on the brain as well? Or the common doctor doing complicated orthopedic surgery? Ask yourself, would you want to be that patient? If no, why wouldn't you want someone to double check for prescription mistakes, of which there are many.

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Added on December 9, 2008, 4:15 pmYour argument has basis. But it does not apply when you reject the separation of prescribing and dispensing even in areas with plenty of pharmacies like in Klang Valley. By doing so, using blanket 'lack of pharmacist' excuse shows the writer to have ulterior and less noble motive. And that is what I really wanted to put across.




This post has been edited by Optiplex330: Dec 9 2008, 04:15 PM

Everybody wanted a free lunch. I wanted it. And I am sure you also wanted it. All consumer wanted it.

Having said that, developed countries consumer are more knowledgeable by the fact that they are willing to pay.

But 3rd world consumer don't. That is why I used the world "3rd world".

On extra safety. How much is it worth. Well, it depends as to whether you are in the 1st world or the 3rd world. In Congo, I am sure life is cheaper than in Malaysia. In Malaysia, I am sure life is cheaper than in UK. So how much do you think your life is worth? Only you can answer that for yourself. As for me, I think my life is worth to pay for someone to have a 2nd look at my prescription because the alternative is some Form 5 school leaver in the clinic. That is why I know some people will take their medicine to the retail pharmacist asking questions. In fact, even with doctors, I like to have a 2nd opinion and yes, it cost extra because I have to pay all over again.

This post has been edited by Optiplex330: Dec 9 2008, 04:26 PM

Yes, we live in an instant world. That is why 3-in-1 coffee and instant noodle are so popular. We all wanted conveniences. No doubt about that and I think the free market force may come in to remedy this situation.

Assuming pharmacist get to have sole dispensing right, I am sure anyone of the with some smart business sense would want to open their pharmacy right next to the doctors. Pure supply and demand scenario and simply good business. So I doubt you have to worry long for situation to remedy itself.

On your 2nd issue of common cold or sore throat. Then I would turn your argument upside down. In UK, for common cold, people 1st port of call is to see the pharmacist, not doctors. So much more convenience and what more, no queuing. And even though they have less knowledge than doctor on diagnosis, the pharmacist do know something. According to professional ethic, if they sense something more serious or something out of their league, the pharmacist has to refer the patient to the doctor.

As I say, people here have 3rd world mentality and refuses to open their mind and see what the developed countries are doing. We do not have to adapt everything Western but believe it or not, there are some worth adapting. And I think this may be one of them. But only a trial run can prove whether whether we are ready for it or not. So lets say to the doctor, let's have a trial run in the Klang Valley and see how it goes. To reject trial run only reflects their 3rd world mentality and selfish attitude. Not very noble, is it?