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

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

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

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

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.

wow plenty of lovely posts i have missed over just few days.

well to hypermax, all other countries have done it in a win-win situation, doctor is doing their prescribing and pharmacist is doing their dispensing, so why bother keep saying, it is not safe, effective etc. does that means all this while, msia is right, has the best healthcare compare to other countries which allow only pharmacist to dispense.

like said, we are not turning the discussion round and round, but it is you that fails to see pharmacist can do their dispensing job as well, and might be better. I agreed that msia is still way lacking in behind, but dont generalize that all pharmacist is not worth to be given dispensing right.

besides, doctor in msia is not dispensing, they have the dispensing right, but what they do is to write a prescription, pass it to a pmr/spm leaver in the dispensary section and let them to dispense it to the patient. did they do a double check on what is dispense, right medication for right patient?, strength, dose, and instruction check, expiry date and advise on administration. the staff at the dispensary is the one that is dispensing. though i have seen some clinics, which require their dispensing staff to bring what is dispense back to the doctor for a quick glance before handling it to the patient, but majority, no.

to hypermax,

exactly what is said by optiplex. all what you have posted before were keep on doubting healthcare system in countries with dispensing right for pharmacy is no better than malaysia or even worst. that is what my post before was about, just that msia is not ready, doesnt mean pharmacist is not competent for dispensing purpose.

how safe is it to have medicines dispensed by a spm leaver in the so called dispensary section of a clinic. i doubt and i worry for my family that stay in msia.

well you did, from your very early post of talking about dispensing right given to pharmacist because of their advance level of human right in those developed countries. and your doubt of how safe and efficient a pharmacist can dispense compare to a doctor. you are more to generalizing pharmacist as whole rather than focused on to the pharmacist in msia or msia healthcare system.

you are sure? i am not to be honest from my observation. and i have seen plenty of dispensers in the dispensary of the clinic have none of any sort of qualification either.

oh i see. no offense, just a heated discussion. hehe!

despite the lack of understanding in and underestimate of pharmacist roles by hypermax, i have to agree that msia is not ready yet. pilot project would be lovely to test the system, but in the end, i think msia might not seems as ready either.

it will also foot too much financial hassle to the public. and also lack of health awareness among the public could be the downfall as well. the reason why pharmacy works so well in other country is because general health knowledge among the public is way better than the typical msia, hence better use of the pharmacy besides GP, and also the pharmacist is as well respected as the doctor.

well, even when we are ready, doctor wont give it up that easy. with typical msian mentality, expect to see real hard time for pharmacist as well if the dispensing right is given to the pharmacist.

those UCSI etc usually offer the certificate in foreign/twinning university. if that foreign uni is listed/recognised by the board, then you are allowed to practice as pharmacist in msia

http://www.pharmacy.gov.my/

go to board tab, under the left pane, click on the ' list of qualifications'

and how will that improve the competence and skills of the local pharmacist. let them always sit inside the coconut shell?

bigger competition, the best way for someone to improve.

i went to UK and work in there, i dont see me or any of the overseas pharmacists negatively affect the professionals in uk. in fact we are appreciated for filling in the shortage in the country. and they are still welcoming more.

how dispensing right will help? like you said in paragraph below, that will attract foreigner to come and work then. plenty of angmoh love the all year round warm weather in msia.

well do not mixed up between dispensing and prescribing again. dispensing is merely giving out medication according to doctor instruction (prescription).

i am more worry of those dispensers in clinics giving out medication independently without a final check from the doctor. at least the pharmacist would know better what medications to be taken before or after food, more than the so called dispensers in the dispensary of a clinic, how much of clinical and pharmacological knowledge they have?

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Added on December 18, 2008, 11:48 amexactly, who would want to stay in msia, for e.g. UK is welcoming pharmacist to go over and fill their gap, and money is way better, have better roles and make use of professionalism, and best of all, the right for dispensing.

this debate is so like UK 60 years ago, when they were nationalizing the healthcare system, taking away private consultation from the gp to one free healthcare for all.

This post has been edited by youngkies: Dec 18 2008, 11:48 AM

if that happens in msia, just like how NHS was established, the doctors in msia will be going berserk, even more and bigger huh-hah than taking their dispensing right away.

and it is not about who is more ethical or houlier, but if doctor only prescribe and pharmacist only dispense, no one will be influenced by the pharmaceutical companies. as pharmacist only dispense what the doctor has written, and with good protocol, a doctor that prescribe a more expensive drug that can be substituted with a cheaper one, irrationally and on large scale can easily be detected and questioned.

This post has been edited by youngkies: Dec 18 2008, 01:59 PM

oh yes, this is a matter that have not seen by the general public or doctors that has never go out from malaysia, how well the medicine is presented to the patient in country like UK, US and Aus. in fact, in uk, there are strict requirements of how the medicines should be packed/labeled etc.

not only that in malaysia, the medicines handed out didn't contain the essential information of the drug, nor a helpful instruction on how to take the medicines, often i see that the medicines were packed into random packet. (e.g. my grandpa recently visited the doctor for his diabetic medication, when i was asked to see the med, i was surprised to see 6 blister packs of gliclazide were packed into a plastic pack which is made for some other drug, for some foot treatment if i recall right).

i believe when the system ask the doctor side to have all stricter requirement in dispensing, even the simple thing such as in packaging and labeling of items dispensed, i have no doubt they will answer with 'that will add more work load etc". so why not take this opportunity to let the pharmacist do their best at work, dispense as prescribed, counting tablets, printing labels, and meanwhile double check the medication is right, for the right patient.

This post has been edited by youngkies: Dec 18 2008, 11:21 PM

well, once more, know what is dispensing and prescribing. pharmacist doesnt have to know how to diagnose, but have to know what the medication is for, and its right dose. so that when he/she got a prescription, he/she would know that medicines is for the right patient, and at the right dose, and doesnt interact with any medication that the patient is having, and make sure the patient is aware of the side-effect that the patient would be best to know.

the pharmacist doesnt have to diagnose the patient if he/she got pneumonia or cancer.

that is the difference of diagnosis follow by prescribing and dispensing what is prescribed.

if the doctor made a wrong input on the dose on the prescription, i really doubt the spm leaver will notice it, but just to dispense it and hand to the patient, unless the dose is ridiculously uncommon or high. but what if for drug with narrow therapeutic index, a little difference in the dose will do the harm.

oh yes dear doctor. my mistake again.

what opti was trying to say is, if doctor can do their job well, diagnose and prescribe despite the profession is at such a shortage, why not pharmacist given their right to do their job well either. fair not? though ratio of pharmacist:patient is even smaller.