Letters
by EJB
I refer to the newspaper report “Doctors to be disallowed from dispensing Medicine” NST 29th March where the DG of Health has apparently agreed to a pilot proposal where doctors seeing patients at their clinics only prescribe and patients will then have to locate a pharmacy where they will have to purchase their medications separately. Don’t ask when these negotiations started and who were at the discussions who finally agreed to this proposal. In all likelihood doctors’ representatives were either kept away or presumably threatened with the OSA (Official Secrets Act)
It seems the ruling party has learnt nothing from the last elections. More pertinently one must ask. Is this a dying priority for the Ministry of Health now especially when it reported only these last 48 hours about the lethal outcomes of the dengue scourge which it has repeatedly shown it is unable to control and the rising incidence of resurgent tuberculosis? We will not even discuss about waiting time for patients who queue up to see doctors at 4 am in the morning or of parents begging in the media for financial help to save their sick children.
The DG of Health, one would have thought, would have his hands full trying to pool his resources without digging further holes he cannot cover. But there you are. He appears to have caved in to the pharmacy lobby. This debate is not new. It is ancient in terms of healthcare provisions in Malaysia. The basic contention. Why should General Practitioners or other doctors prescribe when there are pharmacists around? Answer, for the convenience of the patient especially in the rural areas or in locations where pharmaceutical chains open ten stores to show a 30 million ringgit turnover so that they can get into the second board while employing only 5 pharmacists to cut costs. These pharmacists will only be in during shift hours and usually not available after 9pm where the rigors of a 24 hour practice will call upon the dedication and commitment of a medical doctor where treatment and prescription come hand in hand.
Was this proposal also the result of a pow wow discussed quietly and clandestinely in a remote backroom of the Ministry? Or could the flashing of this sudden pilot proposal headlined in the NST’s frontpages an attempt to improve Merican’s rather sagging image recently. However, if Merican and co have proposed this truly in the belief that it is for the benefit of patients, then they cannot even possibly fathom the inconvenience they will now inflict on patients who will have to hop off two different locations for medical treatment especially if they are a distance apart.
It appears that Prime Minister Abdullah Badawi is essentially saying it’s business as usual and may have indeed missed a point what the electorate was trying to point out to him in the last elections. Cost of living has boomeranged out of control for much of the middle and lower income groups in this country. The idea is to reduce costs and keep them down if you can, not increase it. This maneuver by pharmacists with the tacit approval of the DG of Health doesn’t point in that direction. This pilot project appears to be directed to enhance or further secure the business interests of pharmacists rather then a genuine calling to help patients. The Malaysian Pharmaceutical Society president John Chang Chiew Pheng’s statement that this move will not necessarily cost patients more is decidedly less then assuring. Hopefully the new Health Minister, Liow Tiong Lai, doesn’t have a hand in this considering the fact that he denied the statement later the same evening. If he has, then clearly lessons of the past have not been learnt.
The Ministry and Malaysian healthcare in general face some serious problems, especially the lack of doctors, accessibility to specialists, waiting time and rising incidences of some serious illnesses both infective and degenerative. The Minister and his DG with their limited resources must focus on this rather then pander to businesses such as the pharmaceutical and medical equipment industries. It was bad enough during Chua Soi Lek’s time when for some mysterious reasons best known to him; he appeared focused on traditional medicine when the nation was having problems even running its conventional medical services properly. Shouldn’t the MOH be trying to make services more convenient for patients instead of fragmenting them and making patients run all over the place for consultations, tests and now prescriptions? Who runs this Ministry anyway?
EJB
#1 by slashed on Tuesday, 1 April 2008 - 7:23 pm
The problem with Malaysia is that most people think that doctors know absolutely everything when it comes to medicine. They fail to realise that doctors only form a part of the medical processes and industry. Pharmacists do play an important part in this. It’s time that the people realise that we’ve been playing the game with the chess pieces on the wrong squares all along.
Alot of the complaints againsts pharmacists here seem to be about their efficiency or lack of thereof. They don’t show up etc etc. But these are not substantive reasons not to change the system. My goodness, if McDonalds serve their food slow does it make their food of any less quality? These are procedural/structural problems that can be corrected!
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On a minor note: jetaime.f Says:
Today at 09: 05.26 (9 hours ago)
THe Health MInistry should focus on hunting down these “doctors” who have a fiduciary duty to their patients.
I think you mean duty of care. At least in English law, doctors do not owe fiduciary duties to patients. And unfortunately, again at least in English tort law, its hard to prove breach. But I agree with all the issues you noted.
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lakilompat says:
Govt. can help promote good & quality medicines at cheaper cost by building good relationship to these laboraties, they can also set up incentives to attract these drug laboratory to invest in Malaysia.
>
Unfortunately, I don’t think we have the expertise to attract them, nor are we economically attractive to them. But more importantly, it does not follow that having drug companies build and do their research in Malaysia automatically = cheap and high quality drugs. These companies usually only go to places where they can exploit the lax law and cost savings.
Just something I quickly googled up.
The drugs that are produced are not necessarily cheaper for us. Even if it would be, and some how our govt manages to strike a deal, I doubt that these companies would slash the prices off drugs that they have already produced before the agreement and thereby leaves us with most drugs still being expensive; and the cost we pay for that minimal gain is a high one: it probably requires a relaxing of the laws and open the public to exploitation.
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One solution is to increase govt subsidization of medicine. But look at the NHS system in the UK. It’s full of problems and there is never enough money. If the UK govt cannot adequately fund the NHS, what more to say about our Malaysian govt.
#2 by slashed on Tuesday, 1 April 2008 - 7:24 pm
http://www.i-sis.org.uk/FDAinDrugTrial.php – sorry this was the link that did not appear.
#3 by jetaime.f on Tuesday, 1 April 2008 - 7:48 pm
Hi slashed, thanks and I do apologize for the error. Guess I’ve forgotten most of the terms and concepts I’ve learned relating the legal side of the medical world.
I don’t think anyone of us would be stupid enough to reject “safe” healthcare. The government has to assess this diligently.
#4 by Utopia on Tuesday, 1 April 2008 - 8:16 pm
QUOTE:”KKK Says:
Today at 17: 04.33 (2 hours ago)
The best advise I can give you, lakilompat, is this:
When you are sick, you don’t have to spend money going to the doctor or pharmacist because there is no law in this country says you must. There is always the dirt cheap bomoh or some herbs in your garden.
But if you do want to see a doctor or pharmacist or any other professional like accountant or lawyer or engineer, you are expect to pay. But as I say, you don’t have to engage their service if you don’t want to. So calm down.”
I think KKK is making a very good point here. I’m sure you WILL obtain more thorough professional advice by visiting the Doctor+Pharmacist than by just visiting the doctor alone. For that better service, you will have to pay a bit more, nothing is FREE!
REAL LIFE EXPRERIENCE:
I have an aunt who used to visit this personal gynea for many years. Since she had her menopause, this gynea has given her hormone replacement drugs plus other types of drugs as she have high blood pressure etc. She visits the doctor about once every 2 to 3 months for a medical checkup and the drugs. This went on for over 10 years! And yes, she took those hormone replacement pills for over 10 years without being advised on the danger of taking them. And any educated doctor or pharmacist should have known that by taking hormone replacement medication, you are exposing yourself to a greater risk of cancer. And yet, the fcking doctor still give her those pills even after 10 years after her menopause just to be able to charge her more for “THE CHEAP CONSULTATION + MEDICATION FEES THAT YOU GUYS ARE SO WORRIED ABOUT”. There is really no reason for a doctor to prescribe that sort of medicine for so long. Upon realising what the doctor has done, my aunt stopped visiting the doctor and taking the hormone replacements as she was totally fine without them.
However, my aunt ended up with breast cancer, and the amount of agony and pain that she has to go through can’t even summed in any amount of money that you can saved. Thankfully she has recovered and still alive now. Although one can never prove for certain whether the prolonged hormone replacement medication has a direct effect on this, there is certainly a very high possibility.
I know majority of the doctors out there are probably more professional than the one my aunt encountered. But there is also a lot of doctors out there who are only concerned about the amount of profit they make! Else why so many doctors prefer to run private pratices? Why so many people want to do medicine? To save life and to help the ill? Maybe true for some, but for the majority of them is the because of the $$$$$$$$$$$.
I’m just trying to point out there’ll be a better check and balance if the power to dispence medicine is given to the pharmacists. This will reduce the chances of what happened to my aunt occuring. As the famous saying goes, “Power tends to corrupt, absolute power corrupts absolutely!” Noone can tell if the doctors in Malaysia aren’t as corrupt (such as dispencing unnecessary medicine etc.) as those BN goons. After all, if you look at MCA, many of those corrupted leaders are actually doctors! ROFL…
#5 by cemerlang on Tuesday, 1 April 2008 - 10:58 pm
Sad isn’t it for Kementerian Kesihatan Malaysia. Always telling people to be sihat but sendiri not so sihat at all. Mengutamakan duit is not sihat at all. In fact, this sort of thoughts should be referred to a psychiatrist. It does look like KKM is heading the way of privatization because anything to do with medicine is actually very expensive. Then may be jobs and businesses will be created for those with pharmacology expertise. If money is the reason for everything, then there is no need for status, titles and there is no need to talk about what historical heritage . Looks like money is running the MOH. The MOH is imitating the private hospitals. In private hospitals, their pharmacy is kept aside and after seen by a doctor, you bring your prescription to the counter of the pharmacy, buy and pay for the medicine.
#6 by nus on Wednesday, 2 April 2008 - 12:20 am
# walkman Says:
March 31st, 2008 (2 days ago) at 11: 37.33
Greetings,
Why the change? Currently this system is working very well. If we think the drugs sell at clinics are more expensive, we can go to pharmacies to purchase them. As mentioned by many people, why make the patients who are already sick and weak to travel through traffic jams and hunting for parking spaces, just to seek cure and then for medication? What works for other developed countries may not work well here. Just like they allow total freedom of speech and demonstration on the streets are irked at by you, the wakil rakyat. So, don’t again think you know best.
***************
BEWARE
The doctor usually checks the drugs packed by his nurse before issued to patients. This is good.
In medical centres, which charge very high because of high overheads, we can opt to get he drugs ourselves at the corner and friendly drugstore. This is good.
The doctor is not around to guide the patient at the phamarcy on the correct drug and dosage as the same drug could be 20mg or 40mg packings. He may buy a larger dosage risking overdose. This is bad.
Some pharmacies get high commissions from certain manufacturers or local distributors such as oversea trips to push their products. Therefore, how could unsuspecting patients be able to decide to take the many alternative original makes and generic forms? This is bad.
#7 by KKK on Wednesday, 2 April 2008 - 12:38 am
“The doctor is not around to guide the patient at the phamarcy on the correct drug and dosage as the same drug could be 20mg or 40mg packings. He may buy a larger dosage risking overdose. This is bad.”
I think you are very confused and got it wrong the other way around. The JOB of the pharmacist is to check the correct drug and dosage prescribed by the doctor.
BTW, did you know drug companies very often send doctors free trip overseas to attend seminars (or fun) and very seldom the pharmacist? That should give you an idea as to who is getting the fat commission. Again, your information is very wrong. As I say, I am in the pharmaceutical industries and knows a bit more than most people.
#8 by lakilompat on Wednesday, 2 April 2008 - 11:57 am
If the pharmist prescribed wrong medicine, who’s fault is it? or if the doctor wrote wrongly? But if doctor wrote wrong sometimes the nurse will check again with the doctor because he or she is there to be consulted. But the pharmist wouldn’t know he or she just follow the instructions.
#9 by deja vu on Wednesday, 2 April 2008 - 11:59 am
very well said, KKK. as u and I r from the industry we understand much better than the man on the street. many comments here made me want to laugh out loud. basically most equate a pharmacist to a medicine peddlar and not a medical professional. most talked about convenience and r not willing to sacrifice that for improved safety, this is mind boggling, really!
there are much more the pharmacist community need to do to educate the public. surely their asking for making their own choice and this should not be the ministry’s decision is very wrong. we know that decisons made under such circumstances surely can never be a good one.
alternatively, all doctors should be made compulsory to present every patient with a prescription (and also the patient to keep a copy) whether he wants his medicine from the doctor or his choice of pharmacies. this will be able to avoid doctors forcing medication on their patients. this also will let the patient to compare prices. too many a times patients do not knowq what medicine they are taking!
#10 by lakilompat on Wednesday, 2 April 2008 - 12:01 pm
To KKK, u r jus jealous that a 4 years pharmacology was owned by a doctor. Don’t forgot Doctor is a profession (they have to serve the public before obtaining license to open their clinic), well having said that i don’t mean pharmist is not a qualified profession, just very rare profession in Malaysia & not widely recognized it is unlike Western country whereby consultation cost is expensive, normally u will visit pharmist to prescribe some drugs as in overseas you can find pharmacy in every major stores.
#11 by deja vu on Wednesday, 2 April 2008 - 12:15 pm
lakilompat,
there is a thing call telephone.
even at this moment where doctors are doing dispensing, they still write out prescriptions to be filled by pharmacists (for medicine not available at their clinics), we sometimes encounter this – dr wrote wrongly/ prescribed wrong medicine, we CALL the precribing dr to clarify! and pls do not make up your own stories, NURSES (in private clinics, these are school leavers and not state registered nurses) are not trained to ask the dr!!! they are not able to identify these! even if she is a lawyer, engineer, accountant, PM (yes..badawi)… they cannot do it!!!
i have to say too, lakilompat, u r doing a good job by exposing what the public do not know and this gives a chance for pharmacists to educate, thank you…. pls continue.
P/s– it’s pharmacist, not pharmist!
#12 by deja vu on Wednesday, 2 April 2008 - 12:22 pm
lakilompat, drs dont spend 4 yrs studying pharmacology, that’s for pharmacists. and pls know what u r saying first, chk out what pharmacology is, google it.
pharmacists also go thru compulsory attachment with the govt hospitals (ie serving the public) before getting their license to practice!
now u (and the others) know more and u r more informed, yes, pls continue!
#13 by Lim Kah Poh on Wednesday, 2 April 2008 - 12:28 pm
Firstly, let me introduce myself. My name is Lim Kah Poh. I am the Secretary of the Negeri Sembilan Area Committee, Malaysian Pharmaceutical Society. I had read the comments written in this blog and I would just like to offer my clarification on some of the matters of concern.
Firstly, regarding comments that there is nothing wrong with our current culture/system in healthcare, I would say that it is a working system with its pros and cons. I guess the keyword here is development. Just like in the old days, we use typewriters. You can still use a typewriter if you want to. However, it is not going to be very productive compared to a computer. As ranked by the World Health Organisation, the countries with the best healthcare systems are all practicing separation of dispensing and prescribing. If it is such a bad system, why is it that there are so many countries working their way towards it?
Secondly, I think it is disrespectful to say that the guardian of the healthcare of a country are doctors only. It is a show of bitterness to disregard other health professionals. Dentists, Dietitian, Vetenary doctors, Nurses, Medical assistants, Pharmacy assistants, among others (my apology to those that I had left out) each have different roles to play, but each are equally essential in a proper healthcare system of any country. Now, I know a lot of doctors who are very close friends and I have my utmost respect for the profession. However, to have a doctor who claim that they are in only important factor in the healthcare system if pure arrogance.
Thirdly, regarding pateints having to travel from a clinic to a pharmacy to get their medicine, I would say those are superficial assumptions. At this moment, pharmacists who decide to start their own pharmacy or doctors who decide to start their own clinic will more often than not, decide to start in an area reasonably far away from each other as possible. This is because, in a way, we are competitors. It is just like if you want to open a grocery store. How likely is it that you will want to open your grocery store next to a Hypermarket? I think you do not have to have the business sense of the likes of Bill Gates or Donald Trump to see that it is more likely to be a suicidal business decision than not. However, when there is separation of prescribing and dispensing, pharmacists who want to start their pharmacy and doctors who want to start their own clinic will look for a place where it is relatively close to each other. This is because, we understand that if we make it convenient for the patients, then it is more likely for patients to visit our clinics and pharmacies rather than one that is situated a distance away.
Forthly, regarding the misunderstandings on the knowledge of pharmacists and doctors. Remember this, we are different profession, trained to fill different parts of the healthcare system. As a pharmacist, I do not look down on the knowledge and capabilities of a doctor and would not condone such action from any of my peers. However, I would say that there are black sheeps among us, both pharmacists and doctors. I had never claim that I am capable of performing a doctor’s job. As such, I hope doctors do not claim that they are capable of performing our job. I don’t belittle a doctor’s contribution to the health of the nation, so please don’t belittle a pharmacist’s contribution.
Fifth, regarding the profit and cost. Well, this is all about the share of the cake ain’t it? We don’t see doctors in the government hospital coming out and say, “Well, why should you make the patient wait for hours in the pharmacy? I can dispense my medicine straight away after I diagnose and check me patients.” How can anyone possibly say that dispensing separation will cost the patient more? If the price of medicine is the same, then there will not be any difference in the cost. However, when there is separation of dispensing, the patients will have easier access to “pharmaceutical care”. Keep in mind, that when a prescription reaches the hand of a pharmacist, he/she does not just blindly dispense the medicine as written by the doctor. Prescription screening, evaluation of drug-drug or drug-food interaction, screening for polypharmacies, evaluation of prescription vs. diagnosis, evaluating pharmacoeconomy and in selected cases, planning and coming out with alternative treatment plans which the patient can in turn reconsult the doctor and reconsider his treatment plan in order to safe money, have a more efficacious and safe treatment plan and so on.
There is an example given by a fellow contributor regarding the cost, that a patient were to pay RM45.00 for his visit to a clinic. At this moment, doctors are earning their income from both consultation and dispensing. Say his total nett earning is RM30.00 per patient. Is it fair that he charges the same nett earning of RM30.00 per patient if he were only to consult and not dispense and as such point to a pharmacist profiteering when he/she know fully well that the medicine that he had prescribed will have a cost of RM15.00? I don’t think that it takes a Sherlock Holmes to see who the real culprit of profiteering is, right?
Lastly, ultimately dispensing separation has one major benefit that this by itself warrants all countries which are not already practicing it, to seriously consider. Dispensing separation brings about rational prescribing. If you were to compare a country with dispensing separation and a country without and actually study their prescribing pattern, for, lets say, a simple example of a common cough. In a country where there is dispensing separation, most of them will only be given an antitussive(cough suppressant) and asked to take more fluid and rest. In a country without dispensing separation, we see these patients given an antitussive, a course of antibiotics and some vitamins. If you were to look into the WHO website or any other medical website for any guidelines to the treatment of common cough, you will see that in most cases, the cough would be caused by a viral infection and an antibiotic is not necessary. Why then is this being prescribed so often in countries without dispensing separation? Quite simply, it is because antibiotics are prescription only medicine and if patients have the perception that whenever he has a common cough, flu and fever, which make up to the majority of patients who visits a clinic, the patients will need to go to the clinic to consult the doctor as it is illegal for pharmacists to sell them without a prescription.
It is understandable that nobody will be happy when there is a new policy that can affect their income. However, as health professionals, I believe that spreading inaccurate rumours and backstabbing is uncalled for. For my fellow pharmacists, I hope that you refrain from belittling doctors. For the MMA and the doctors, I hope you would give our profession the respect it is due. Rational opinions to the public are most welcome. To Mr. Lim Kit Siang, I am sorry if I sound authorative in your blog. However, having read what I had, I believe I have to put in a few words.
Thank you.
kp
#14 by Papayamilk on Wednesday, 2 April 2008 - 12:40 pm
Are the pharmacies going to dispense these medications at lower prices? Unlikely, as most pharmacies would not dispense generic drug which are cheaper.
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Some pharmacies get high commissions from certain manufacturers or local distributors such as oversea trips to push their products. Therefore, how could unsuspecting patients be able to decide to take the many alternative original makes and generic forms? This is bad.
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I am a pharmacist and I am really surprised that doctors think we pharmacists like to sell expensive drugs. These scenarios refers more to doctors rather than pharmacists. People usually go to pharmacy to save money. Do u think they are so stupid as to take up everything recommended by pharmacists? On the other hand, patient will not know what is being prescribed by doctors untill they are paying at the counter. When they are prescribed expensive drugs, they will only pay the bill and vow not to come again. In a pharmacy they can just refuse to buy or walk straight out of the pharmacies if they think that particular pharmacist is not honest.
Regarding the good incentives (overseas trips) some pharmacists get from selling medicine, I am not at all envious or jealous because in order to get these incentives, they will have to purchase a big lot of one particular brand of medicine before hand, totalling tens of thousands. For your information, this medicine will expire in a short 2 years and if they don’t sell it in time, this will mean loss literally. Furthermore, if they are not selling it cheap, nobody is gonna buy. It’s really surprising to know that doctors think that pharmacies are making huge profit from selling proprietory medicine. We all know generics are more profitable, generics are cheaper and hence more acceptable by the public.
I am really pissed of with my own ‘profession’. While our government recognise pharmacists as ‘professionals’, but there is nothing exclusive about being pharmacists as provided by our health policy. Our role is only a subset to doctors’. For example, what lawyers do, an engineer can’t do. They can do but there is no credibility and is not legal. You don’t see doctors issuing legal letters, or defending someone in the court. This is what I mean of the exclusive rights of one profession. However what u see in Malaysia is quite unique. Everything a pharmacist can do, doctors do them all. Some clinics even have very attractive displays of health supplements in patient waitng area.
I for one will not choose to study pharmacy in the first place had I know that I am going to be in this awkward position. And I suspect, perhaps agreed by most of my counterparts, that our health policy is made this way just because a lot of our policy makers are in favor of doctors. And some of them hold medical degrees, e.g. our ex PM, our ex health minister etc. I hope our new government will be wise enough this time. I they really think pharmacists don’t deserve exclusive right to dispense, just abolish this profession in Malaysia. Then nobody is gonna complain.
#15 by lakilompat on Wednesday, 2 April 2008 - 12:49 pm
Pharmacist off course will get higher commission if they sell better drugs. In Taiwan, when you are having cold or flu, the pharmacist will ask u, give u 3 choices of 3 brands, cheaper (eat more), medium, and strong (expensive). Then it is up to the consumer to pick the one he can afford. I’m not sure in Malaysia whether pharmacist are that honest to give you choices.
One thing good abt. US, they have varieties of choices (economic power) but Malaysia pharmacy normally have limited capital, therefore, they don’t subscribe too much else it will expired and if you order less mean the cost is higher.
The MOH don’t care abt it, they only care to find way to robe and profit from these pharmacy. Perhaps the MOH move is try to rejuvenate profit into pharmacy so that pharmacist will have fairer share of profit at the expense of doctor.
#16 by KKK on Wednesday, 2 April 2008 - 12:51 pm
lakilompat Says:” But if doctor wrote wrong sometimes the nurse will check again with the doctor because he or she is there to be consulted. But the pharmist wouldn’t know he or she just follow the instructions.”.
Now you are making me laugh. Are you saying the nurse know more about medicine than the doctor so able to check on the doctor?
And this is where you are very wrong. All over Western world, the pharmacist is acknowledged to be more knowledgeable than the doctor on medicine. Therefore, the pharmacist check on the doctor on medicine and NOT the other way around.
Good joke. I liked it.
#17 by KKK on Wednesday, 2 April 2008 - 12:57 pm
lakilompat Says: To KKK, u r jus jealous that a 4 years pharmacology was owned by a doctor. Don’t forgot Doctor is a profession.”
Again another statement that is funny and getting it all wrong. Pharmacist studied pharmacology for 3 or 4 years, not doctor. Go ask your doctor how many months he studied pharmacology.
#18 by KKK on Wednesday, 2 April 2008 - 1:08 pm
lakilompat Says:….i don’t mean pharmist is not a qualified profession, just very rare profession in Malaysia & not widely recognized it is unlike Western country”.
It is indeed good that you realize/acknowledge we Malaysian are still backward 3rd world country so not able to recognize the true value of pharmacist. On the other hand, by recognizing the true value of pharmacist, people of the 1st world get to enjoy 1st class treatment and safety when it comes to medicine.
So now the question for fellow Malaysian: Do you want to remain receiving 3rd world treatment or 1st world treatment. If you wanted 1st world treatment, then you must start using the pharmacist for what they are trained for, i.e., get them to double check for possible mistake made by doctors on medicine. And it will cost you money like everything else. Sorry, no free lunch in this world.
On the other hand, if you don’t want to spend the money, we can all reject this new bill and continue to receive 3rd world treatment on medicine. The choice is yours.
#19 by Papayamilk on Wednesday, 2 April 2008 - 1:10 pm
For those of u who are not familiar with pharmaceutical industry, doctors are not dispensing in other countries because their government want to promote rational use of drugs. How? Let say in Malaysia, when a doctor sees one of his expensive medicine is expiring soon, to avoid loss, he can choose to prescribe that particular brand of medicine instead of giving cheaper ones which is equally good. Likewise, pharmacist can also do the same, only if the customer agrees to pay. Dispensing separation is carried out in such a way that doctors may decide which is best for the patient and pharmacists may dispense without conflict of interest on either side, which in turn will only benefit patients.
For your information, some government linked company is already benefiting from manufacturing and supplying of medicines to governemnt hospitals (I won’t mention their name. If you go to investigate u will only find out those companies actually belong to one particular political party). I dun see how they are going to benefit from this move ( to disallow doctors to dispense) unless they can take control of all the indepedent pharmacies in this country. And for independent pharmacies like us, we can still decide to not buying from government-linked companies. But if the drugs are good and cheap, why not?
#20 by Papayamilk on Wednesday, 2 April 2008 - 1:21 pm
KKK, let’s just ignore that clown. That ignorant fool can’t even pronounce ‘pharmacist’ correctly. If this guy thinks he is representing doctors, well, he will only humiliate them. I have nothing against doctors. I am only speaking up against a biased health policy, which discriminates my profession.
#21 by c_mon14 on Wednesday, 2 April 2008 - 1:44 pm
I agree with you KKK.
Consumers like you ‘lakilompat’ must be one of crowd that do not take or even buy medicine before. In addition, most of Malaysian are ignorant and this include the person who write this letter to YB LKS. Why do I say so??
1) Most Malaysians do not even bother to know what kind of drug they are prescribed by the doctor.
2) Do Malaysians know who are the real person dispensing the medication to you all?? I for once never doubt a doctor’s ability to know the drug. However, while the doctors are attending to another patients, someone near the dispensory (i will call someone as ‘this person’) call your name to collect your medication. Do you know that the person is qualified to dispense the medication?? My experience tell me that ‘this person’ can only tell you ‘this tablet is for flu and that for fever’. Do Malaysian ever question what kind of active ingredient(S) is(are) present in that one tablet?? I can assure you ‘this person’ dont even know what is an active ingredient. I wonder why Malaysians can bare this kind of treatment?? And I dont know why Malaysians dont want a professional to dispense this medication when pharmacist didnt even charge one cent for it.
3) regarding cost of medication, ‘lakilompat’ and others, have you ever buy medication from a pharmacy before?? Most Clinics will only write
(Let assume an arbitrary receipt)
Consultation RM30
Medication RM20
DO YOU KNOW HOW MUCH (FOR EXAMPLE) A BLISTER OF PARACETAMOL WILL COST YOU??? The most you can read out from the receipt you received from a clinic is that the total medication cost me 20 ringgit. How sure are you now that the doctor did not overcharge you??
4) Most of you says ‘there is lack of 24h Pharmacy’ or ‘i cant find a pharmacy’. I would like to ask you to use your brain and think. If a pharmacist doesnt has the right to dispense, how do you expect a pharmacist to open a pharmacy?? This is a demand and supply concept. Pharmacist also need to earn to survive. IF Pharmacist were given the right to dispense, i can assure you will find a pharmacy nearby a clinic with given proper time frame.
5) Some of you even says that all self medicate and die of it. I would like to ask, to what extend is there truth about it? I for once would not self medicate if i do not know what disease i am having. Furthermore, self-medication of minor ailments is a common practice by most Malaysians. Dont even dare you tell me you didnt even self-medicate for once! If there is a pharmacist, you can ask a pharmacist’s opinion whether can you self medicate. If you has a minor cough, you wouldnt go to a doctor but to buy a bottle of ‘WOODS’ or ‘PEIPAKOO’ to self medicate 1st. And do you know what kind of active ingredient(S) is(are) present?? Can you confirm that brand ‘X’ can help you with cough or just another marketing gimmick??
Pls think carefully first b4 you all lash out and talk bad about one profession. If Pharmacist isnt good in dispensing drug or not knowing more about drug, why would all hospital want to hire pharmacist to dispense drug to you all but not doctor or even nurse?? You can see this practice all over the world whereby doctor diagnose and pharmacist dispense. Then why would it be bad for community pharmacist to dispense medication to you all??
regards,
c_mon14
#22 by deja vu on Wednesday, 2 April 2008 - 1:48 pm
Papayamilk, pls let lakilompat continue, so that we have a chance to let evryone knows the true picture, and also what to address. we do not know what the public needs to know. he is not the only one reading this.
lakilompat wrote: “The MOH don’t care abt it, they only care to find way to robe and profit from these pharmacy. Perhaps the MOH move is try to rejuvenate profit into pharmacy so that pharmacist will have fairer share of profit at the expense of doctor” – this is not how things are. seriously i dont really understand your system here either!!??
#23 by KKK on Wednesday, 2 April 2008 - 2:41 pm
I agree with deja vu here. Let lakilompat continue. I suspect the majority of Malaysian general public holds his view on pharmacist, including DAP supremo. So it’s good to hear their views out aloud.
Despite his many failing, I believe BN Prime Minister Badawi was absolutely right on one thing: We Malaysian may have 1st class infrastructure but 3rd class mentality. And typical Malaysian mentality on role of pharmacist is indeed 3rd class. Sad but true.
#24 by lakilompat on Wednesday, 2 April 2008 - 3:13 pm
I did a survey last nite at one of the new complex opposit Bukit Jambul, there’s a Maybank there, and some electrical shops, then I find there are so many pharmacies outlet there with various name. I went to one of them at random, managed to bought ointment “Zambuk” at one of the private pharmacy (Not a typical Guardians chain) cost RM 8.50 but is there any place i can get cheaper than this? I observe the pharmacist is not there, although they have a clear Pharmacist counter on the counter, i asked them where is the pharmacist, the owner said he’s not around. My question are we ready to trust them rather than the nurse who dispense the drugs? and will it be more expensive to get them in Pharmacy?
There are many reason why pharmacies tend to charge higher, it can be due to rental.
The person who might be benefiting from this move is Khairy, don’t forget Khairy registered a company name “Puncak-Pharma” with the funds he amassed, he might venture to open Pharmacy chains, doctors will have to sponsor his little projects. Those doctors who reject to dispense from his pharmacy will get their license revoke and can’t practice in Barisan state or Malaysia.
#25 by Papayamilk on Wednesday, 2 April 2008 - 3:30 pm
Now at least it’s something that make sense here. For ur information, u dun need a pharmacist around to buy zambuk ointment. Anybody can sell zambuk. in my shop with a 20% markup it’s 9.50. is it not reasonable with this percentage? it all depends on the cost.
if u got insider’s info regarding what evil kj is going to do, expose them. i’ll be the first one to oppose this plan if it will only benefit evil kj eventually.
#26 by KKK on Wednesday, 2 April 2008 - 3:46 pm
I didn’t know you need special license to buy Zambuk or Panadol or Axe Medicated oil or milk powder or lipstick in Malaysia?
Any way, since the Malaysian general public do not want nor appreciate the skill of a pharmacist, why should he stick around? May be he decided to go to the canteen or have a smoke or go cry in a corner somewhere. Who knows?
#27 by jetaime on Wednesday, 2 April 2008 - 4:07 pm
I don’t believe anyone should be restricted from voicing out their opinions, question or sharing their views and beliefs. Every blogger would want to use this blog site to voice their opinions and views so that the decision-makers/ government can be better informed and take into consideration the views of all re a certain topic. In this instance, the views of the people, the pharmacists, the doctors, being all parties affected by the proposed policy change.
But I think it is impolite and I don’t believe anyone would like to be spoken to in a derogatory and contemptuous manner. This is just my belief and opinion.
#28 by lakilompat on Wednesday, 2 April 2008 - 4:19 pm
I recommend, the Doctor should hired a pharmacist to work for them in running the clinic. Those nurses should work in general hospitals either govt. or private. This just a suggestion to solve husband – wife conflicts.
Rebrand Malaysia clinic become “Pharma-clinic” Doctor can invite Pharmacist to become partner like law firm.
#29 by lakilompat on Wednesday, 2 April 2008 - 4:21 pm
Oh yeah, while waiting for their turn in “Pharma-clinic” they can shop around for latest health supplements. I would be interested to visit such clinic not only the first world country don’t have but not even our neighbor country like Singapore.
#30 by deja vu on Wednesday, 2 April 2008 - 4:21 pm
lakilompat,
one reason why the pharmacist doesnt stay put in his pharmacy – his true function is taken over by doctors. his work load is much less vs if he is given the sole right to dispense. if the pharmacist do not own the outlet himself, chances are his boss would not want him to work through out opening hours (no doubt this should not be the case).
u just dont get the idea. i want to see u renovate your hse. can one guy fix the roof, tiles, the plumbing work, the electricals etc. well, the subcontractor will pool all the ‘specialists’ together to get the job done. surely u wont want someone offering his services telling u he can do everything, because u know he surely will screw up! if u love your house, u wont agree to it and u know in the long run u would not need further renvation, cances are your house will be in better shape. now why dont u treat your body the same. dont tell me u rather have a sick body vs a damaged house. i am putting to u in simple language as i know u dont know much about the medical field.
#31 by KKK on Wednesday, 2 April 2008 - 4:37 pm
I recommend, the Doctor should hired a pharmacist to work for them in running the clinic.
==============================================
I don’t think this is an good idea because the Check & Balance mechanism might be compromised.
Let’s look at a very worst case scenario. Assuming you have a very unethical doctor who wanted to prescribe some unnecessary & expensive drugs and because the pharmacist is under his employment, he will not dare to speak out. So where is the Check & Balance for the benefit of the patient, the rakyat?
#32 by deja vu on Wednesday, 2 April 2008 - 4:40 pm
lawyers in law firm do not take in judges to become their partners.
no doctors will want pharmacists as partners! why pay another professional (it wont cheap) to do something they THOUGHT they can do well?
lakilompat, u dont know how the system works, so quit making foolish suggestions. stick to raising questions regarding your concern with the separation of function here.
#33 by deja vu on Wednesday, 2 April 2008 - 4:47 pm
let’s move on from lakilompat to some more serious ‘concern’.
this is what Dr Milton Lum wrote in to NST, pls comment.
By : DR MILTON LUM, Petaling Jaya
I REFER to the reports on the issue of dispensing medicine (“Doctors to be disallowed from dispensing medicine” – NST, March 29 and “A need for 24-hour pharmacies” – NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).
Among his claims were:
- With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.
- Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.
- The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.
Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate’s training and continues throughout the medical course.
Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.
On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.
There is also confusion between prescribing and dispensing.
Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.
A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.
Dispensing refers to the preparation and supply of drugs prescribed by doctors.
Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.
The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.
Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.
Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.
Many doctors are already prescribing and dispensing generic drugs.
When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.
Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.
The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.
Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.
The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient’s right to make his own choice? The MPS president’s advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.
#34 by KKK on Wednesday, 2 April 2008 - 4:51 pm
jetaime Says:
In this instance, the views of the people, the pharmacists, the doctors, being all parties affected by the proposed policy change.
————————————————————–
That’s the question I would like to ask Lim Kit Siang when he posted all those objection.
If we want to become an advanced developed country, its only logical that we adopt what’s been universally accepted as normal or good 1st world practice of dispensing by pharmacist.
On the other hand, if we think we are not ready to become 1st class in patient care because of the extra cost, then don’t implement this policy.
And it’s not wrong for MOH to do a pilot study of trying to improve patient care. To ridicule MOH for the sake of objection is wrong IMO.
Of the many government departments, although they all have room for improvement, the Immigration and Hospital staff are the better ones and we should encourage & thank them and not put them down. My 2 sen.
#35 by deja vu on Wednesday, 2 April 2008 - 5:14 pm
in responce:
“Depending on the university, pharmacology may or may not be part of the pharmacy course”
a ‘pharmacy’ course that do not include pharmacology cannot produce pharmacy graduates, but only pharmacy dispensers or technicians (which is not quite true since dispensers do learn about basic pharmacology as well)
“doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe”
this is the malaysian senario.
and pharmacists are legally permited to PRESCRIBE medicine (these are knowned as poison C drugs) for certain minor ailments.
“pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals”
Almost all pharmacists have practical attachments with govt hosp before being granted their practising certs.
“Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history”
drug interaction – family history??? dont try to pull a fast one, doc. i do not even want to say u yourself dont even know…. how sad! that’s your doctor, not a normal GP but a respected specialist!!!
“Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown”
perhaps the DCA (drug Control Centre) would like to make a police report, the good doctor suggested DCA failed to protect the public by approving ‘inferior’ products?
“Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible”
who said that? there is a difference between no knowledge vs limited knowledge compairing to a pharmacist.
either Dr Milton asked someone to write this piece or he surely can come out with something much better…. SAD, yes, very SAD!
#36 by lakilompat on Wednesday, 2 April 2008 - 5:23 pm
A partnership of Pharmacy & Clinic “Pharma-Clinic” if both markup the price too high ultimately customer/patients will choose other.
Pertaining to the fixed consultation fees If you have a permanent job ultimately you can ignore this as it is covered by the hiring company. Normally, company have panel clinics, where operator can visit them. The only things the panel clinics don’t cover are elder ppl, jobless ppl, and siblings.
If we combine Clinic with Pharmacy, the elders ppl. will have varieties of choice cheap to expensive depend which type of drugs they can afford.
In Kluang, Johor, there is a tabib china (he’s certified doctor from china) where a chinese medicine shop are combined. He will normally take your pulse then start asking abt the symptoms. Well, it is very good you will get instant herbs after visiting them. The chinese herbs cure the roots. I once have asthma, it is also cured by a chinese tabib.
What i can see here is Pharmacist are accusing Doctors, then Doctors are accusing Pharmacist, why not shake hand and united, reinvent the business. Whether is expensive or cheap, let the market force decide “laissez-faire” theory.
#37 by KKK on Wednesday, 2 April 2008 - 5:35 pm
Dr. Milton said “pharmacology may or may not be part of the pharmacy course.”
————————————————————-
It indeed sad to think that Malaysian doctor are of such low caliber. Yes, Malaysia deserve to be stuck in the 3rd world category when one of the most learned people in her society like doctor & main political figure could be so poorly informed and providing wrong information. I truly fear for the safety of our Malaysian patient.
On pharmacology. EVERY pharmacy student learn pharmacology. Period. If not, it’s like saying a doctor never get to study anatomy in university and a lawyer never studied law. Tell this to 1st world people and they will laugh their heads off. It’s so ridiculous as to defy imagination. For the record, pharmacology is one of the most vital and main subject studied by pharmacist.
And for this incorrect info to come from a doctor, I have to hide my my head in shame in front of people from other countries.
#38 by deja vu on Wednesday, 2 April 2008 - 5:45 pm
Miltun Lum…memalukan!
why do we not hear anything from our Lim Kit Siang?
#39 by Lim Kah Poh on Wednesday, 2 April 2008 - 5:54 pm
For those who have not already read it, you can refer to my post at 12:28:13 for clarification of some of the issue stated here.
“When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.” Quote from Dr. Milton Lum
Since this matter is brought up, I guess I will go deeper into that so that more of you will understand why separation of dispensing and prescribing is so important.
Yes, bonuses is indeed given to pharmacists and doctors. However, there are many pharmaceutical companies are offering doctors compared to pharmacists, a better bonus so that they prescribe that company’s medicine as oppose to those of a competitor. There are companies which give doctors unofficial bonus as well.
Being competitors and so that clinics will have a higher capability of retaining their customers, uncrupulous (not all) doctors will choose to dispense medicine from these companies rather than those of the competitor, even though the competitor’s medicine may be the medicine of choice for that particular problem as recommended by treatment guidelines from the World Health Organisation.
There are also doctors who dispense smuggled medicine (one commonly termed as Parallel Import) or even immitation of counterfeit medicine to patients without labelling it so that patients do not know the content of the medicine. As such they take the medicine without knowing the possible harmful effect that it may have.
As such, we have doctors prescribing a medicine not because they think that that medicine is best suited for your condition but because they are given a trip to South Korea by the pharmaceutical company or because they can sell that medicine at their competitor’s cost price and still make a substantial amount out of it.
Having said that, I would like to remind you that not all doctors do this.
The above is an example of what we term as irrational prescribing.
With dispensing separation, this can be minimised, if not stopped.
#40 by c_mon14 on Wednesday, 2 April 2008 - 6:00 pm
I agree with you KKK.
Consumers like you ‘lakilompat’ must be one of crowd that do not take or even buy medicine before. In addition, most of Malaysian are ignorant and this include the person who write this letter to YB LKS. Why do I say so??
1) Most Malaysians do not even bother to know what kind of drug they are prescribed by the doctor.
2) Do Malaysians know who are the real person dispensing the medication to you all?? I for once never doubt a doctor’s ability to know the drug. However, while the doctors are attending to another patients, someone near the dispensory (i will call someone as ‘this person’) call your name to collect your medication. Do you know that the person is qualified to dispense the medication?? My experience tell me that ‘this person’ can only tell you ‘this tablet is for flu and that for fever’. Do Malaysian ever question what kind of active ingredient(S) is(are) present in that one tablet?? I can assure you ‘this person’ dont even know what is an active ingredient. I wonder why Malaysians can bare this kind of treatment?? And I dont know why Malaysians dont want a professional to dispense this medication when pharmacist didnt even charge one cent for it.
3) regarding cost of medication, ‘lakilompat’ and others, have you ever buy medication from a pharmacy before?? Most Clinics will only write
(Let assume an arbitrary receipt)
Consultation RM30
Medication RM20
DO YOU KNOW HOW MUCH (FOR EXAMPLE) A BLISTER OF PARACETAMOL WILL COST YOU??? The most you can read out from the receipt you received from a clinic is that the total medication cost me 20 ringgit. How sure are you now that the doctor did not overcharge you??
4) Most of you says ‘there is lack of 24h Pharmacy’ or ‘i cant find a pharmacy’. I would like to ask you to use your brain and think. If a pharmacist doesnt has the right to dispense, how do you expect a pharmacist to open a pharmacy?? This is a demand and supply concept. Pharmacist also need to earn to survive. IF Pharmacist were given the right to dispense, i can assure you will find a pharmacy nearby a clinic with given proper time frame.
5) Some of you even says that all self medicate and die of it. I would like to ask, to what extend is there truth about it? I for once would not self medicate if i do not know what disease i am having. Furthermore, self-medication of minor ailments is a common practice by most Malaysians. Dont even dare you tell me you didnt even self-medicate for once! If there is a pharmacist, you can ask a pharmacist’s opinion whether can you self medicate. If you has a minor cough, you wouldnt go to a doctor but to buy a bottle of ‘WOODS’ or ‘PEIPAKOO’ to self medicate 1st. And do you know what kind of active ingredient(S) is(are) present?? Can you confirm that brand ‘X’ can help you with cough or just another marketing gimmick??
Pls think carefully first b4 you all lash out and talk bad about one profession. If Pharmacist is not good in dispensing drug or not knowing more about drug, why would all hospital want to hire pharmacist to dispense drug to you all but not doctor or even nurse?? You can see this practice all over the world whereby doctor diagnose and pharmacist dispense. Then why would it be bad for community pharmacist to dispense medication to you all?? And to say pharmacist did not study pharmacology is absurd. Please, pharmacists even went further than pharmacology; i.e. pharmacotherapy.
regards,
c_mon14
#41 by Lim Kah Poh on Wednesday, 2 April 2008 - 6:12 pm
Having reread what I had written, I believe it is important for me to note that I believe the MMA and the health ministry do not in any way condone irrational prescribing. I believe, they will take all action necessary against doctors who practice this way just the same way as the Malaysian Pharmaceutical Society or the Bahagian Farmasi will take action against unscrupulous pharmacists.
It is just an illustration or what might happen as there are always black sheeps among us, no matter which profession we are in.
If my illustration had in any way offend anybody especially any doctors, I offer you my sincere apology.
Thank you
#42 by Papayamilk on Wednesday, 2 April 2008 - 6:36 pm
Depending on the university, pharmacology may or may not be part of the pharmacy course.
……………………………………………………………………………..
HAHAHAHAHA….People who came out with this claim definitely needs help. I was once told by a doctor (a specialist, mind you) , that I should not initiate any treatment on my own. If what he means include offering painkillers, flu medicine..etc.I dunno what else I can offer to my customers. I do not diagnose.
The law provides us the right to sell Goup C medicine without prescription, I hope he knows that.
Seriously, I think the writer of this letter (EJB) is a doctor. That may explain why he talks so much about the disadvantages of dispensing separation, and totally neglected the advantages. And he even warns that if government is to carry on this plan, the voters will exercise their rughts blah blah blah..If this is so bad why so many first world countries are still keeping this arrangement? YB Lim Kit Siang might think EJB’s letter is important because he talks about the increase of medical cost and of course, of how voters’ opinion should be respected.
I am not putting in much hope though. See what had our ex health minister done. He had been singling out pharmacists as the culprits for illegal drug trade and abuse. When there was a doctor selling sleeping pills illegally, he simply brush aside the news saying that in every profession there are black sheeps.
Therefore, I suggest that the government should just abolish this profession called ‘pharmacy’ in Malaysia, because it is just redundant, because we have doctors who know it all. So that no more naive young one (for my case, is being stupid and naive all together) will step into this field with high hope and being greeted with disappointment, constantly bashed by people from other profession.
#43 by KKK on Wednesday, 2 April 2008 - 10:14 pm
Lim Kit Siang. Dispensing right for pharmacist is not what you should spend your time because you don’t seem to all the pictures. But this is a letter in Malaysiakini deserve the utmost investigation and if found to be of substance, something urgent must be done. And show us what you are made of.
Slab scheme for doctors needs review
Product of the System | Apr 2, 08 4:15pm
I can accept many features of the NEP, albeit swallowing them like a bitter pill. I will never be able to accept the Skim Latihan Akademik Bumiputera (Slab), however.
For those who are unfamiliar with the Slab scam scheme, it is basically a training programme tailored for ‘outstanding’ bumiputeras with professional qualifications to embark on an academic career.
The privileges accorded under this scam scheme are plentiful and far-reaching, available to ‘bumi’ graduates in medicine, law, sciences and IT. I shall only touch on the medical careers, drawing from my own personal experience lest I make wrong generalised statements about other fields.
Under the Ministry of Health (MOH) ruling, all doctors are required to serve at least four years before being eligible to apply for specialty training in the Masters programme in local universities. No one is exempted from this ruling as in this noble profession of medicine; all doctors are equal in this fair nation regardless of the ethnicity.
Some are more equal than others, nonetheless.
These are the supposed outstanding bumiputera doctors. They only need to serve one year of government service before being offered a range of clinical disciplines in which they desire to specialise in and later on, lecture in. While the rest of their non-bumiputera colleagues serve the district folk, these privileged lot are bypassing everyone else to begin a premature training as a clinical specialist.
On the outset, it would appear justified to reward these ‘prodigies’ with a shorter route to specialty and thereafter a career in academic medicine. If one scrutinises the Slab candidates however, the ugly faces of discrimination, cronyism and shortsightedness will become obvious.
Despite its namesake, the Slab programme is almost exclusively reserved for Malay Muslim bumiputeras. There is a reasonable pool of qualified and talented non-Muslim bumiputera doctors in Sabah and Sarawak. They, however, are denied the chance to become academics through this supposedly noble training scheme. It’s bad enough to label Malaysians as bumi and non-bumi. To further differentiate between Malay and non-Malay bumiputeras is an act more despicable that the apartheid NEP itself. It is racial egoism.
In principle, the by-invitation only Slab programme is open to outstanding, phenomenal Malay bumiputera doctors. In practice however, the candidates are far from it. My Malay colleagues who can hardly string a proper sentence of English together are being accepted into the programme. They can’t even present a simple case summary to the consultants during ward rounds and now they are expected to lecture medical students? Pretty preposterous isn’t it? The quality of Slab trainees ranges from those with minimal knowledge in basic pharmacology to those who cannot handle common medical emergencies without descending into a state of panic.
Are we confident to let our children learn and train under these pseudo-lecturers? A great number of my colleagues who failed final year MBBS exams in Universiti Malaya were invited to join the Slab programme! It gives one a general idea of the quality of our future lecturers. The majority of these Slab products have either failed the external Royal Colleges exam or were never confident to attempt these exams in the first place. There were also two Slab trainees in UM who were dropouts from Australian universities. The future of medical education does not look bright indeed.
Like most other NEP privileges, the Slab programme has been hijacked by well-connected Umno loyalists. A great number of trainees are accepted into the programme because they carry a ‘bin Datuk-something’. The truly qualified bumis are denied an opportunity while mediocre, below- average children of Umnoputras are offered a silver platter to quasi-professorship.
More than being another Umno racist policy, the Slab programme is one that is dangerous. Clinical acumen in the profession of medicine comes from years of experience and there is no other way. A pre-university student who enters medical school without battling it out on a level playing field is already a cause for concern. Now, the same person is expected to perform the clinical duties of a lecturer-specialist after serving just one year of housemanship. In our feudalistic healthcare system, the specialist is always regarded as correct and infallible, even when he has less experience than his medical officers who are subordinates merely because they were not born with a privileged skin colour.
The intentions of the Slab programme were never to provide a helping hand to aspiring bumiputera doctors. It was also never the intention of the Slab programme to provide our universities with a steady source of well-trained lecturers.
The way it is carried out, the aims and purposes of the Slab programme is to mass-produce as many Malay bumiputera specialists as possible and in the shortest time, as well as to inhibit the careers of non-Malay doctors. It is already punishing enough that non-bumi students enter university one year later that their bumi counterparts (two years if one is from a national-type school).
Now they even have to wait four years later than their Malay colleagues before being eligible to apply for specialty training. A Slab product will become a full-fledged specialist by the age of 30 with an almost guaranteed pathway to sub-specialty and professorship by 40. His non-Malay colleagues meanwhile, will only be a newbie specialist at 35, assuming the doctor was successful in his application for specialty training at the very first attempt.
#44 by nus on Wednesday, 2 April 2008 - 11:01 pm
KKK Says:
Today at 00: 38.55 (20 hours ago)
The JOB of the pharmacist is to check the correct drug and dosage prescribed by the doctor.
BTW, did you know drug companies very often send doctors free trip overseas to attend seminars (or fun) and very seldom the pharmacist? That should give you an idea as to who is getting the fat commission.
1st Para: Not true: The pharmacist DOES NOT check the prescription. However, he dictates: “Have prescription will sell”. No prescription no sale. But how many times I have gone to a pharmacy to find the pharmacist on leave or gone to another branch. Probably there is time sharing because they have many outlets with a real shortage of qualified pharmacists.
2nd Para: Not true: Both doctors and pharmacists have equal opportunity to travel. See below:
Lim Kah Poh Says:
Today at 17: 54.35 (3 hours ago)
“When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.” Quote from Dr. Milton Lum.
My suggestion is to continue as before that is, doctors are allowed to prescribe but willing to write prescription if the patient opts to buy medicines outside.
In doctors are NOT allowed to “sell” drugs patients would suffer.
1. We must have noticed that pharmacies are not only selling drugs. In fact, the pharmacies contain in volume more vitamins, supplements, toiletries, health foods and nuts. The “dispensary” is a small portion of the shop usually at the back of the shop. The list goes on. AS such, pharmacies may not keep stock of all the drugs that all the doctors in say Klang Valley prescribe.
2. Patients would be flocking to the pharmacies in town. The problem of getting the drug required in just one pharmacy nearby becomes real since the stock would quickly diminish with greater demand.
The pharmacies especially those with almost a hundred branches all over Malaysia with names we are getting familiar with are very rich and influencial. Hence, their voice would be heard. Whereas, the medical doctors do not have a powerful voice to be heard except for their association. As such, I believe despite all of our views, the final decision by the powers that decide is a foregone conclusion.
#45 by Emily Pratt on Wednesday, 2 April 2008 - 11:20 pm
I am all for the check and balance.
In the justice system, the enforcement (police) cannot be the judge and executioner and neither can the judge be the enforcer nor the executioner.
In the business accounting process, you always need an external auditor to verify the books.
In governance, the Parliament needs the Senate to perform check and balance and vice-versa.
In prescribing medicine don’t we need a check and balance as well?
Doctors are after all only human and are just as capable of making mistake.
#46 by deja vu on Thursday, 3 April 2008 - 12:56 am
my, my, my, nus… most of your arguments have already been raised and answered. the diff is u rephrased them! come out with something new…. pleeeeeeeeeeeeease!
i wrote: we check, if doc wrote wronglly… we CALL, we telephone to clarify (to answer lakilompat saying ‘nurses’ will ask doc blah blah blah)
if you’re the pharmaceutical company, tell me what’s the rasionale behind giving better incentives to pharmacists over docs… sorry to say u dont even have a good biz accumen! comeon, doc recomends new drugs and those pharmaceutical guys needs them more! simple as that.
a thriving biz will stick to their main inventory, those struggling will tend to add in more to supplement, to stay afloat, to survive. pharmacy without sole rights to dispense cannot survive solely on medicine. hey, inventory control is no child’s play… overstock, expiry, pilferage, capital tie down etc. r u in biz yourself anyway?
Guardian Pharmacy?… they r not UMNO cronies, for heaven’s sake! u r funny!
#47 by Yeapy on Thursday, 3 April 2008 - 3:45 am
Those doctor who object pharmacist dispensing right are just afraid of losing their means of getting extra income from dispensing drugs. Sounds familiar ? It is just like those UMNO conies who are afraid of losing their contracts when people say want to start open tender system. They will give various excuses like no 24 hours pharmacy, troublesome etc… which is just plain nonsense, but I do agree that some people living in rural area will have difficulty in getting medication, thus I would say it is ok for those doctor serving in rural area to dispense, but not those in urban city!
Things like drugs can be get at a cheaper price in a clinic was due to the fact that doctors do get a better deal/discount on some drugs compared with pharmacist, reasons? Ask those pharmaceutical company. Moreover, a doctor can get earn through consultation fee, but there is no consultation fee for seeing a pharmacist, therefore pharmacist will need to earn through other way.
Doctor do study Pharmacology, but how much do they learn compared with a Pharmacist ? I know how to drive a car and M.Schumacher also know, but the difference is the driving skill he has got is more than me…that is the main point, both Dr and RPh have different specialized skills and they work together for the benefit of patients!
To all Malaysian, medication error can be very minor, but it can also be life-threatening. Pharmacist is your another barrier for preventing this from happening, pharmacist with dispensing right will be a win-win situation for all of us.
#48 by KKK on Thursday, 3 April 2008 - 7:26 am
Why should any of the $4.25 billion Australian taxpayers paid last year to subsidise the cost of prescription drugs be being spent on the free dancing girls, the free food and wine at top restaurants, and the generous free gifts and perks that the pharmaceutical industry is lavishing on our doctors?—- http://sunday.ninemsn.com.au/sunday/cover_stories/article_896.asp
Google and you will come across many such cases being reported all over the world and the same thing is happening in Malaysia. May be there are but I hasn’t come across similar case for pharmacist. While it’s normal for commercial company to reward merchants selling large amount of their product, even my friend selling agricultural product get to go to China free trip, but for doctor to prescribe an expensive product for the sack of prescribing because he is influenced by those free dancing girl and NOT because it’s in the best interest of the patient is poor professional ethic.
So there you have it. A few grandma may be taking some expensive heart medicine not because she needed it but because of some free dancing girl. And the saddest part is, the grandma has no choice in that decision because it’s made by the doctor and given by the doctor. She wasn’t given a second opinion or double checked by some pharmacist. Heck, she probably wouldn’t be told what she is taking anyway because the doctor don’t have time to tell her and the Form 5 girl at the dispensing counter in the clinic hasn’t a clue anyway about side effect and drug-drug interaction. But let me make it very clear…..not all doctors are unethical and the very vast majority are excellent. But like every profession, there are black sheep and there are those with questionable ethic & wisdom including those that give misleading information to mislead the general public in this very forum. And that’s why we must have a Check & Balance mechanism and giving the pharmacist (universally recognized all over the advanced Western countries to be more informed than doctor on medicinal product and anyone saying otherwise is ethically suspect) that checking right. To say pharmacist is only giving out medicine is totally misleading because should anything goes wrong with the medication he gave out; he is professionally and legally responsible. He is not supposed to act as a Form 5 girl in clinic and Malaysian shouldn’t expect pharmacist to earn a Form 5 girl salary either.
Now you may ask, aren’t pharmacists getting to see those free dancing girls too? Yes, they are also given incentive just like my agricultural product selling friend. But there is very important different here and that’s called “CHOICE”. Having and able to exercise your choice is a fundamental human right and Lim Kit Siang know that extremely well and fighting very hard for that. Thank you, Lim Kit Siang. With pharmacy, if he wanted to sell you expensive Panadol because he wanted to see the free dancing girl, the Malaysian patient will always say…..”wow, so expensive, do you have cheaper type of Panadol?” And sure enough, you will be given a choice to either buy the expensive Panadol or the cheap generic equivalent and pay accordingly. I don’t see anything wrong with that, legally and professionally. After all, we are in a democratic country and thank god and people like Lim Kit Siang to keep that flame burning. And also to have all doubts, different opinions etc being freely expressed in this forum and get the truth out.
#49 by lakilompat on Thursday, 3 April 2008 - 9:02 am
Pharmacist are been marginalized. All the Pharmacist should go protest. If they can’t work with Doctor then lay low and enjoy the fight between Pharmacist vs Doctor. So, MOH is a hero to fight on behalf of Pharmacist at the expense of Rakyat.
Pharmacist want that cake, Doctor deny them, Pharmacist seek help from MOH, the end result, Rakyat suffer. All pharmacist get or no get Rakyat still suffer because MOH not doing anything to improve both. To make peace merge the two, “Pharma-clinic” you can choose your drugs, and also seek consultation. A scenario whereby the elder brother is a Doctor, and the younger is a Pharmacist, both can combined the business into “Pharma-Clinic” the Rakyat can benefit. The main purpose not for profit but to serve Rakyat too. The problem is money is root of all evils. Same with the BN coalition govt. these leaders are good but when come to money, you and i know, at the expense of whom?
#50 by Papayamilk on Thursday, 3 April 2008 - 9:39 am
to nus,
you said:
The pharmacist DOES NOT check the prescription. However, he dictates: “Have prescription will sell”. No prescription no sale. But how many times I have gone to a pharmacy to find the pharmacist on leave or gone to another branch. Probably there is time sharing because they have many outlets with a real shortage of qualified pharmacists.
Please note that a pharmacist’s license only enables him to practice in one particular branch only. So u r saying maybe that pharmacist is taking care of other branches, that is not true. That pharmacist might be away, and if they sell poison without the pharmacist’s supervision they are bound to be punished. This is the same with clinics operating on medical assistants alone. Now this reminds me of another discrimination against pharmacy. Our license won’t allow us to practice in other outlets, which means that our health policy makers believe our knowledge is only valid when we are in the outlet where our licenses entitle us to practice. Doctors are allowed to do locum, but pharmacist are not, that’s the reason why sometimes there are no pharmacists in one outlet. Pharmacists also get sick, but they can’t find people to replace because our health policy thinks we are super humans.
U said,
AS such, pharmacies may not keep stock of all the drugs that all the doctors in say Klang Valley prescribe.
If u understand how our market works. When there is a demand, there sure will emerge the supply. We don’t need to argue on issues like pharmacies don’t operate 24hr, don’t have enough staff, not enough pharmacies…Those are all the excuses used by doctors, including Dr. Chua Soi Liap. There is no doubt that he has a lot of doctor friends.
you said,
Not true: Both doctors and pharmacists have equal opportunity to travel.
Can’t u see the difference there? Doctors take no risk to earn a trip, they just earn it by prescribing espensive medicines. My ex boss only earned a trip after buying one particular brand of medicine for RM30,000++, and mind u, the stock will expire in a mere 2 years. I don’t envy him. I even pity him because one box of this medicine costs RM 185, he only sells it at RM200. And it’s a Group C medicine, so there is no ‘selling without prescription’ issue here.
U said,
If doctors are NOT allowed to “sell” drugs patients would suffer.
Ur assumption reminds me of MCA and UMNO. They said if u dun vote us, there will be no development, our country is going to be in dire state, nobody is going to voice up for chinese community and fight for their rights and so on. So do u see any survey in the U.S. that reveals that most Americans attribute their suffering to “dispensing separation”? I nearly suffocate myself from supressing laugh.
YB Lim Kit Siang now you hear us please do not let people like EJB twisting your mind anymore. Pharmacists have every reason to be angry. I have no choice because I am already in this profession.