YOURSAY ‘Consumers wonder why their choices are being taken away.’
'Doc diagnose, phamacist dispense' will hurt
Doc: As a practicing general practitioner, I must say that Malaysian Consumers Movement president Darshan Singh Dhillon's observation is very accurate.
Currently, GPs (including myself) diagnose and prescribe medication. Nearly all GPs reduce their consultation to the minimal (RM10 to RM15) but make up the amount with the medication prescribed.
Most GPs will not charge too much for their medication and consultation bundle as market forces determine their charges. Charge too high, patients go will go elsewhere.
Also most GP clinic charges for consultation and medication have been controlled by third party administrators (TPAs) who have emerged as big players in the private health market which manage company's staff health care benefits.
So, any way you look at it once the separation of dispensing of medication comes into play, the biggest losers are going to be the rakyat.
The GPs will increase their consultation to the maximum of RM35 allowed by law. We diagnose and the write out a prescription as required by law and the patient has the headache of looking for a pharmacy to get medication.
Remember that most pharmacies do not operate past 8pm nor open before 10am. What's more, if you are looking into a rural setting where there are hardly any pharmacies, where are the patients going to get their medication from? Also a lot of pharmacies may have their pharmacists either on leave or on breakfast, lunch or tea break.
Not to mention, that it’s up to the opinion of the pharmacist to what brand of medication to prescribe to the patient. If the pharmacist decides to give an original or innovator medication to the patient, the cost of medication will certainly sky rocket.
For example, if a patient is seen by a GP and is given mediation by the GP for say, viral flu, a common disease - a bottle of cough mixture, paracetemol, flu medications, sore throat medication including consultation may cost RM45 to RM50.
With the separation of dispensing rights the patient will end up paying RM35 just for doctor's consultation and anything between RM35 to RM70 for the medication from the pharmacist thus seeing the patient total medical bill increase by 100 percent to 150 percent for a common ailment.
Just imagine a patient who has chronic illness like diabetes, hypertension or cholesterol having to pay RM35 a month just to get a prescription. Most GPs do not charge consultation for chonic disease medication. They just give out these chronic medications monthly without consultation to loyal patients.
Please do not forget that medications are subjected to Goods and Services Tax (GST) after April that will see significant rise of cost for medication. As for GPs like us, I guess we will have no choice but to either adapt or die.
Most GPs will reduced the losses incurred by losing dispensing rights by reducing their staff as we will not need more staff to dispense staff. We will also reduce accounting cost as we need not keep track of drug purchase and stocking.
Patient waiting time can be slashed too, as the doctor needs to diagnose and give a prescription and its up to the patient to look for a pharmacy in the heat, rain and not to mention in a sickly condition to get medication.
But my question is who is going to profit from the separation of dispensing right? The big chain of pharmacies such as Cosway (owned by legendary Vincent Tan), Guardian, Caring group. etc.
The losers; GPs like me, but the biggest loser will be the rakyat as usual.
The solution is super simple which is the rakyat being given the choice to choose to where they would like to get their medications from; either from the GP clinic or from a pharmacy. But in Malaysia, a simple solution is never taken into consideration. Cronies will always win at the expense of the rakyat.
Fairperson: Saying that pharmacies do not open before 10am and operate past 8pm is preposterous.
Once this new system in in place, pharmacies will be compelled to open, voluntarily or by regulation to serve the patients. Like in Indonesia, pharmacies take turn on Sundays and public holidays to operate to serve the GPs who are opened during those days.
It is a non-issue. Furthermore, pharmacists are also professionals like doctors who are duty bound to serve the public. Therefore, there is no question of going on leave, or closing for lunch, etc.
If GPs insist that only generics are to be dispensed to patients they can do so by indicating in the prescription. Doctors can put a note saying that no substitutes are to be dispensed without prior consultation with the prescriber.
GPs should also note that in the new system, the patients will get educated on the various medications and actually have a choice between generic and patented medicines. Under the present system, patients have to stick with what GPs' dispense without knowing what they are taking.
For chronic illness like diabetes and hypertension, GPs need not see the patient every month. Prescription can be written for three to six months as patient need only see the GP once in three months or so.
Darshan Dhillon Singh too has many flaws in his arguments. He is saying that doctors diagnose and prescribe while pharmacist dispense, and that this is time-tested.
Except in government hospitals, where else can you find doctors prescribing and pharmacist dispensing? This is what exactly pharmacists are asking for. Doctors prescribe, pharmacists dispense.
Let the pharmacists do the job they are trained for. The fear that pharmacists may step out of the line to diagnose is unfounded and out of ignorance. Under the current system, without dispensing separation it may be possible, but once separation is in full force no professional pharmacist will ever dare to do this as they will be busy with counseling and dispensing medicines.
There is also the accusation that the new system may allow individuals to easily obtain sleeping pills. But even under the present system, psychotropic and sleeping pills are very tightly controlled and leaves no room for abuse or manipulation. The dispensing separation can only enhance the rigidity of this control rather than loosen it.
Do you know that under our healthcare system, certain groups of drugs are allowed to be dispensed by pharmacist without doctors seeing the patients? This will further help the consumers to cut cost by not going to doctors for minor ailments which can be detected by pharmacists and only referred to doctors if serious. This first line of screening indeed reduces the burden of doctors.
Dharshan also may not be aware that currently doctors do not carry wide range of medications for prescribing to their patients as it involves cost, but the pharmacist are willing to carry them. Therefore with dispensing separation, the doctors are free to prescribe from the range of drugs pharmacies normally carry without worrying about the availability or cost.
Dispensing separation is time-tested in other advanced countries and also gives the patients opportunity to experience the best healthcare they deserve.
Anticommunalist: As a consumer I now have ample choices. I can go to the pharmacy to get any medicine I want or if I feel the need to see a doctor and get his medications, I can also do so. If I want to just get consultation from a doctor and get his prescription and later go get my medications from a pharmacy, that is yet another option.
All these options make me in total control of my own personal choice as a consumer. Why is the government or certain pharmaceutical lobbyists want to take away this freedom of choice from me?
From our past experiences, every time this freedom is taken away from us, inevitably we end up paying more and most often than not, a crony or a middleman will end up making a huge profit at the expense of the public. Stop this nonsense immediately.
NuckinFuts: Just take a random poll from the rakyat and see how many people will pay more than RM35 for a GP consultation (minus all the medication) and take a poll of how many GPs out there will continue working for RM35 per consultation without being able to dispense medication.
At the end of the day, a lot of GPs will close shop and a lot of pharmacists will play doctor.
Neutral Stance: Separation of dispensing rights will deter more government doctors from quitting and opening GP clinics. These doctors will continue to improve their skills and improve the overall healthcare. In a way, the government healthcare system can be improved.
Well Thats Fantastic: With the new system, doctors would be forced to actually do the procedures they are trained to do instead of being pill dispensers or they wouldn't make enough money. This in turn would greatly reduce the load on day surgeries in hospitals.
It would also put the dispensing in the hands of a pharmacist instead of the person at the counter in the clinic, thus preventing incorrect dispensing as has happen several times to me, almost killing my child on one occasion.
Malaysian54: This procedure will put the low-income group and the rural people at a disadvantage. I was one of them before and I am glad I had a doctor who charged me very little and made it easy for me.
How many pharmacies are open 24 hours? Are there any pharmacies in the rural areas? How many pharmacies are located near the clinics? How many of us can afford to travel from the clinic to the pharmacies, given our poor public transport system?
A few years back my blood pressure shot up to 190 and my doctor was able to dispense my medication immediately. Imagine if I had to go to the pharmacy to get the medicine when my blood pressure was high.
Malaysia is not ready for this arrangement. Please don't give us more headache and more costs. Allow doctors who are serving the low income and rural areas to dispense medicines.
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