THE debate on who should dispense medication in a general practice has been going on for some time and in the recent letter, “Separation of roles vital to prevent mishaps” by Associate Prof Mohamed Azmi Hassali (NST, July 11), has brought attention to many doctors and patients.
The article enumerated the roles of pharmacists in dispensing, and details of the processes were mentioned, to justify his case. However, he failed to address the main end user, the patient. The issue of increase in the cost of primary healthcare and the inconveniences have not been discussed.
Malaysia has one of the best primary healthcare services (public and private) in Asia and maybe in the world. Anyone feeling unwell can walk into any government polyclinic or outpatient clinic, including 1Malaysia clinics, and will be attended to the same day by medical personnel although there may be a bit of wait.
Similarly, patients can see a private practitioner and treatment can be rendered at an affordable fee compared with other parts of the world. The government allows private primary care doctors to charge a maximum of RM125 but it is rarely followed as there is no minimum charge unlike other sectors.
We have enjoyed a good health-care system since independence despite some shortcomings.
The issue of pharmacists having an exclusive role of dispensing medication has caused concern among medical providers and patients. The drawback is that a patient will have to visit two places — the doctor’s clinic and the pharmacy. Patients worry if the exact medication will be available in pharmacies or if pharmacists will dispense alternatives.
These issues need to be thought through in detail:
FIRST, can pharmacists be available throughout the operating hours of retail pharmacy outlets and will there be 24-hour outlets?;
SECOND, the cost of medication and consultation should be separated; and,
THIRD, having patients go from doctor to pharmacist defeats the purpose of a one-stop-centre for healthcare.
Pharmacists now advise patients on selection, dosage, interactions, and side effects of medication, and act as a learned intermediary between prescriber and patient. But, in Malaysia and some Asian countries, this role is done well by doctors as medical studies include a compulsory pharmacology subject.
Doctors in private clinics dispense medications meant to be taken home and today, medical information is easily available. In many western countries, some of our prescribed medications are considered over-the-counter medication.
The role of a pharmacist is probably more important in hospitals, where the prescription is done by specialist doctors and the need for details is more necessary than primary care. We should not increase healthcare cost to provide jobs because of an excess supply of pharmacists.
It is hoped that doctors in primary care will take a greater role in dispensing as they are qualified to do so. The need to separate this service is to avoid unnecessary difficulties to both medical providers and patients.
Datuk Dr Kuljit Singh, Petaling Jaya, Selangor