DISPENSING MEDICINE: A case for a separation of roles

Description: DR MOHAMED AZMI AHMAD HASSALI, DR ASRUL AKMAL SHAFIE, DR T. JAYABALAN Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Studies, Universiti Sains Malaysia

YET another debate is raging on the issue of the prescribing and dispensing of medicines in Malaysia. This separation will indeed be an enormous task to achieve as it involves various stakeholders and is not only confined to community pharmacists and general practitioners. Traditionally, doctors have held on to the practice of prescribing as well as dispensing and GPs in particular have served as a one-stop centre for patient needs. So why change something that seems to have worked well for many years? In considering the merits or demerits of a separation of roles, three issues need to be addressed:

- Convenience: It is very convenient to go to one centre where you not only receive treatment but also obtain medication. A separation of services will entail going first to see the doctor and then to collect medication from the pharmacist.

While it might appear that going to two places will inconvenience the patient, in fact this might not be so. For example in a government hospital, you can receive your treatment in one room and still have to cross over to another block to collect your medication. By the same token, a pharmacy located close to a clinic will serve just as well.

- Cost: It is well known that clinics cannot have an exhaustive list of medications. There are instances where prescriptions have to be written out by doctors for patients to purchase from pharmacists.

Secondly, the use of generics will mean tremendous savings for patients as well as the country and this can be achieved without compromising quality.

The generic-substitution policy is best carried out by community pharmacists as medicines are the cornerstone of any medical treatment and pharmacists are trained to dispense medicines. Drug therapy and medicine-related illnesses cannot be managed and monitored effectively without a proper understanding of pharmaceutical care, which is a tenet of modern pharmacy practice.

- Safety: Engaging two practitioners will lead to a good check and balance to prevent any medication errors which sometimes could be fatal to patients. This is an important factor that is recognised internationally, and dispensing separation has become a norm in many developed countries.

We believe there is room for the implementation of dispensing separation in Malaysia but it is a question of timing and appropriate policies.

One of the problems in Malaysia is that doctors and pharmacists do not really appreciate each other's professional roles. The perception that pharmacists are merely businessmen who try to act like doctors has to be changed as pharmacists are professionals highly trained in the rational use of medicines.

Furthermore, with the changes in the current curriculum of pharmacy schools across the globe, pharmacist undergraduate training has become more patient-oriented than product-oriented. At most institutions across the world and Malaysia, medical specialists are also intensely involved in teaching clinical aspects of disease management to pharmacy students during their clinical years. Therefore, a mutual insight into each other's professional roles is needed and any personal conflict should be avoided as it will mar the professional images of both.

DISPENSING: The road to better healthcare

Description: DATUK NANCY HO, President, Malaysian Pharmaceutical Society

WE read with concern the letter from Dr Steven Chow of the Federation of Private Medical Practitioners on the role of doctors and pharmacists in dispensing medicine ("Don't tamper with dispensing system"-- NST, July 7).

I feel the esteemed doctor missed the point when he mentioned "tampering" with the patients' right to choose where or from whom they can get their medication.

The discussion thus far has centred on the need to separate the professional functions of doctors and pharmacists and let the two concentrate on putting into practice what they have been trained for.

In a nutshell, doctors can be spared the role of keeping an inventory of medicines, with its attendant complexities, and instead focus on diagnosing ailments and prescribing medicine. In this way, there will be no doubt more quality time for medical care.

Likewise, pharmacists can focus on dispensing, counselling patients on their medication and providing quality pharmaceutical care. This will definitely allow patients to have more choice, as advocated by Dr Chow, if doctors do not both prescribe and dispense.

At present, patients do not have a choice to have their prescriptions filled at the pharmacies. We should seriously consider giving consumers that choice.

We are determined not to get into a mudslinging exercise whereby professionals accuse each other of irregular practice. Instead, we seek to collaborate with all members of the healthcare industry out of mutual respect.

It is heartening to note that Dr Chow suggested a "professional partnership" between pharmacists and their neighbouring private clinics. Nevertheless, all partnerships should be on a level playing ground and therefore, benefit all parties concerned.

We do not have any doubt that all professional doctors and pharmacists have the interest of the patients at heart. Therefore, let us seek new ways of ensuring better-quality healthcare.

source : new strait time

Assalamulaikum w.b.t dan salam sejahtera

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" belajar memberi daripada menerima"

salam ukhwah

muhammad hafizul amin bin khalid

mpp fakulti farmasi

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