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 am

There 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.

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.....

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.

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?

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 pm

The 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 pm

That 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 pm

AFAIK, no profession or tradesman work for free.

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....

well, ^ pretty much covered the essences of it

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, chances are that the pharmacist is told to shut up and just be a dispensing robot.

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 am

1) 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?

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 am

If 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 am

Good. 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 am

Now 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?

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Prescription errors are so common and prevalent in hospitals, nursing homes and long-term care facilities that it has been estimated an average of one mistake per patient per day is made.  While the vast majority of these mistakes may not lead to serious injury, some prescription errors can lead to the patient’s death.

The Saiontz, Kirk & Miles prescription error lawyers can investigate claims for medical malpractice or nursing negligence if a medication mistake results in a serious personal injury or death.

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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?

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.

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.

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?

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 am

From 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.

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

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.

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 am

Some 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?

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.

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...

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?

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...

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 pm

In 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.

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 pm

Yup. 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 pm

I 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......

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?

I said we need to have a trial. And also it's about money. And you seems to ridicule those contradiction. Hence the reply that nobody work for free.

We are the people of this country. So it's our social responsibility to change for the better. If we do not want to change, who would do it for us?  And just because it has been done before does not mean it can not be improved. Are you not supposed to be part of this community's intellect?

As for proof. The proof is in the developed countries. And you only have to study their system and do a trial to see whether it suit our society or not.

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Added on December 9, 2008, 5:49 pm

Are you saying there are shortage of pharmacist in the Klang Valley itself? I didn't know that. Let's hear if from people living in Kuala Lumpur to confirm that to be the case.

why keep mention about lacking of pharmacist...you walk in KL you find yourself...mostly around the housing area will have pharmacy...And by doctor selling the medicine..how are pharmacy going to survive?without pharmacy who will employ pharmacist?without employment who will want to become a pharmacist?in the end...all ruch into medicine and dispensing right will forever stop by the phrase'lack of phamacist'...You see those doctor nowadays..all their blogs...all are talking about pay,wordload,MOVING TO RURAL AREA all sorts of SELFISH things...they did not really mention about patients welfare...Is that a doctor suppose to be?And why the hell they want to stop the trial at klang valley?you dont tell me is because they think by doing that will cause patients death.....You see...all doctor nowadays thinking about their own pockets...why dont use that period and treat more patients instead of go and stop the trial...you trust a greedy doctor to prescribe and sell the medicine to you?if pharmacist dispense he might check and tell the patient whether the medication is essential onot and refer to the doctor...By letting doctor to prescribe and dispense...First thing he will do is look at his stocks...which one have left alot...and which 1 with higher margin...I haven seen any good doctor around klang valley for a long period of time...except those that came back from overseas and really willing to help patients....  Malaysia doctor=Bullshit  Only keep talk about the pay with the government...why dont make more helicopters to bring the doctor to the rural areas?or build more hospital near the rural area instead of increase their salary to 6K and cause the govenrment billions of ringgit...Why the tax use for this?if u say dispensing right is small matter...does it smaller than increasing the doctor salary?.....anyone that here as medical student..please change the situation next time...I think alot malaysian are poisoned by antibiotics...you come to klang any clinic and say you flu....they straight give you...

Sufficient vs many. 2 different things.

You can have many pharmacies but still sufficient to serve the population.

You have have few pharmacies but sufficient for the population size.

So lets do a trial. To see what the pros and cons. And to determine the how many pharmacies are sufficient for what size population. Without a trial, everyone is shooting in the dark and we can argue till the cows come home. The only definitive answer is answer from the trial.

As i say, why are doctor so afraid of trial? Logic dictate that they must has something to hide or lost which may or may not be in the interest of the general population. Again, doctor's interest and community's interest can be different. Mankind will still be living in caves without taking risk and trials. Mistake is ok. Not doing anything is not ok.

And the very funny thing is. Doctors loves trial. Often in newspaper and magazine, we read of doctor doing trials to test new drugs or finding new or better ways to use drug etc. But when it comes to trial of this kind to see whether patient will benefit or not, they reject most vigorously. Finding all sorts of excuses. Pharmacist not enough. No proof. Why? Hypocrite? Doing a MCA (Money Conquers All)?

How do you know? You an expert or a oracle?