Wednesday, July 02, 2014

Doctors' Right to Dispense Medicine

I refer to the Dr Sng Kim Hock's letter to The Star on 27 June 2014 titled "Docs' right to dispense medicine". In the letter, Dr Sng (and Association of Specialists in Private Medical Practice, which he represents) is of the view that dispensing of medication is the sacred right of the physician.

The family practitioner must be appreciated and valued for their contribution to society, as they have for decades been providing primary care to the patients, screening the patients and hence ensuring that the general health of the community remains good.

The foundation of their practice includes the dispensing of medication, thus ensuring prompt symptomatic and curative care.

The presence of pharmacies nearby or next door should complement their service, but should by no means displace their role in early and urgent therapeutic intervention of illnesses as provided by the family doctor.

We cannot copy the practice of the developed western world, where there is a clear distinction and division between the roles of a doctor and a pharmacist.

No pharmacy in the West would continue to provide repeat medications or even offer consultation to the patient, to “save” costs, as is sometimes seen in this country.

For the above reasons, the role of the physician and doctor to provide consultation, care and treatment to the patient as a one-stop centre must be protected and continued for the present.
I am flabbergasted that Dr Sng actually believed that a doctor should dispense drugs because it's the sacred right, rather than because of the logistical limitation of our country. As a couple of academics have pointed out in a well-written response, there are a variety of reasons why the separation of role between doctors and pharmacists are beneficial and is something we should strive towards.

The elephant in the room, in my opinion, is the conflict of interest. When doctor prescribes a medication and derives financial benefits from the dispensing of the said medication, it is vulnerable to monetary incentives. Why would I dispense the generic rosuvastatin which is shown to be equally effective in ischaemic heart disease, when I know the rich patient in front of me can afford the Rolls Royce atorvastatin, which would keep my wallet and my pretty pharmaceutical rep happy?

One could argue that similar financially swayed practice may also be seen if dispensing is to be left to pharmacists. However, when the division of role is implemented, there is an additional chain on which government can regulate. For example, in Australia there is a government sponsored campaign for pharmacist to dispense pharmaceutically equivalent generic version of a drug when a patient is prescribed a branded medication.

I am similarly baffled by the fallacious statement in the penultimate paragraph. Is the author implying that doctors in Malaysia will repeat medication because they know the patient, while in Western countries patients have no access to repeat medications? Has he not heard of a "repeat prescription" which allows patients to a certain number of repeat medication? Besides, what is the reasoning about consultation being offered to save cost? Do Malaysian doctors do repeat consults and give discount simply because the patients are also obtaining their drugs in the same practice?

The logic is beyond me. I hope more pharmacy colleagues would stand up and stand for the division of role between two inter-connected but distinct healthcare specialties. In essence, this is only the fairest and safest option for our patients' welfare.