Doctors Prescribe, Pharmacists Dispense, Patients Suffer
Real Life Scenario
Madam Ong is a 52-year-old lady with a twelve-year-history of hypertension and diabetes. She complained of generalised lethargy, lower limb weakness, swelling and pain. She brought along her cocktail of medications for my scrutiny. Her regular medications included the oral antidiabetics metformin and glicazide and the antihypertensives amlodipine and irbesatan. Madam Ong also had a few episodes of joint pains three months ago for which she had seen two other different doctors. The first doctor suspected rheumatoid arthritis and started her on a short course of the potent steroid prednisolone. Thereafter, she developed increasing lower limb swelling for which a third doctor prescribed the powerful diuretic frusemide.
Madam Ong was not on regular follow-up for hypertension and diabetes. Additionally, she has been re-filling her supply of steroids and diuretics at a pharmacy nearby with the purpose of saving up on the consultation charges.
I took a more complete medical history and performed a thorough physical examination. I concluded that this lady’s health was in a complete mess.
She was under sound management by the family physician until the day she defaulted follow up and was started on prednisolone by a doctor who was unaware she was diabetic. The steroid probably helped in relieving her arthritic pains though the suspicion of rheumatoid arthritis was never proven serologically.
However, it also worsened her sugar and blood pressure control and weakened her immune system.
Her legs swelled up because of the fluid retentive properties of the steroids. In addition, early signs of cellulitis were showing up around her legs due to a weakened immune function. The diuretic prescribed by the third doctor helped a little with the swollen limbs but she became weak from the side effects of diuretics.
Madam Ong’s problems escalated when she decided to forgo her doctors’ opinion altogether and decided to self-medicate simply by collecting all her medications from the pharmacist who supplied them indiscriminately. Unknowingly, the pharmacist had added to the lady’s problems in spite of the wealth of knowledge the pharmacist must have possessed.
The above scenario is a fairly common scene in the Malaysian healthcare. We see here an anthology of errors initiated by doctors, propagated by the patient’s health seeking behavior and perpetuated by a pharmacist.
Noteworthy but Untimely Move
The Ministry of Health is set to draw a dividing line between the physician’s role and the pharmacist’s, restricting physicians to prescribing and according dispensing rights solely to the pharmacists.
Such a move virtually has its effects only upon doctors in the private practice and particularly the general practitioner who relies on prescription sales for much of one’s revenue.
Doctors prescribe and pharmacists dispense. It’s the international role of each profession and very much the standard practice in most developed countries.
The Ministry of Health however, has failed to take into account the local circumstances in mooting this inaugural move in Malaysian healthcare. The logic and motive behind the Ministry of Health’s proposal is in fact laudable, but only if the Malaysian healthcare scenario is more organized and well-planned.
Spiraling Healthcare Costs
In the United Kingdom, all costs are borne by the National Healthcare Services. In the United States, despite all the negativity painted by Michael Moore’s Sicko, most fees are paid for by health insurance without which one cannot seek treatment. In these countries and many European nations, there is hardly any out-of-pocket monetary exchange between patients and their clinicians.
This however is not the case for Malaysia. Most patients who visit a private clinic are self-paying clients. The costs of consultation and medications are real and immediately tangible to patients. A visit to the general clinic for a simple upper respiratory tract infection may set one back by as much as RM 50.00 inclusive of consultation and medication. Most clinics these days are charging reasonable sums between RM 5 to RM 15 for consultation. Some are even omitting consultation charges altogether in view of the rising costs of basic healthcare. The introduction of the MOH’s ‘original seal’ to prevent forgery of drugs contributed much to this.
There is no denial that most clinics rely on the sales of medications in order to remain financially viable. From my personal experience, the charges for medications by private clinics are not necessarily higher than pharmacies. In fact, since each practitioner has a stockpile of one’s own preferred drugs, the cost price of the medications can be much lower than that obtained by the pharmacists who need to stockpile a wide variety of drugs. It is therefore a misconception that pharmacies will provide medications to patients at a much lower cost all the time for all medications.
Retracting dispensing privileges from the private clinics will only force practitioners to charge higher consultation fees in order to sustain viability of their practices. In the end, the patients end up paying a greater cost for the same quality of healthcare and medications. Inevitably, much of the increase in healthcare costs will also be passed on panel companies who will then be paying two professionals for the healthcare of their employees.
In this season of spiraling inflation, this proposal by the Ministry of Health is ill-time and poorly conceived.
Unequal Distribution of Medical and Pharmacy Services
As it already is, private general practice clinics are mushrooming at an uncontrolled rate. A block of shoplots in Kuala Lumpur may house up to five clinics. Does Malaysia have a corresponding number of pharmacists to match the proliferating medical clinics? If and when clinics are disallowed to dispense medications, the market scenario will become one that heavily favors pharmacists. The struggling family physician suddenly loses a significant portion of his revenue while the pharmacist receives a durian runtuh overnight.
The situation is worst in the less affluent areas and rural districts where the humble family physician may be the solitary doctor within a 50km radius and no pharmacy outlets at all. For example, there are no pharmacies in Kota Marudu, Sabah and only one in the town of Kudat. Patients seeking treatment in these places will get a consultation but have no avenue to collect their prescription if doctors lose their dispensing privileges.
The absence and dearth of 24-hour pharmacies is also a pertinent issue. At present, many clinics operate around the clock to provide immediate treatment for patients with minor systemic upset. These clinics play an important role in reducing the crowd size and the long waiting hours at the emergency departments of general hospitals.
Without a corresponding number of 24-hour pharmacies to dispense urgent medications, the role of 24-hour clinics will be obtunded. The MOH’s plans of implementing its doctors-prescribe-pharmacists-dispense policy will merely backfire and result in the denial of services to patients.
A Bigger Problem Is The System Itself
The increasing number of medical centers around the country is not necessarily in the patients’ best interests or an indicator of improved healthcare provision. Most clinics and medical centers serve an overlapping population of patients. A person may be under a few different clinics simultaneously for his chronic multiple medical problems, resulting in a scattered, interrupted medical record. One doctor may not be informed of the interventions and medications undertaken by the patient at another practice. The concept of continuous care and a long term doctor-patient relationship is practically improbable.
This is unlike the system in the United Kingdom where each family physician is allotted a certain cohort of patients for long term care. The doctor remains in full knowledge over his patients’ progress, making general practice one that is rewarding and meaningful.
The trouble-ridden Malaysian healthcare system prevents optimal clinical practice especially for doctors in the private sector.
Until the Ministry of Heath puts in place a more systematic and organized approach to healthcare, patients will still be denied optimal medical services despite a clear division between the roles of doctors and pharmacists. The process of prescribing and dispensing is but one step in the cascade of events that may result in harm being done to the patient. Role separation between the doctor and the pharmacist will not eliminate drug-related malpractice and negligence, as I have illustrated in the real clinical scenario above.
Loss of Clinical Autonomy
Private practitioners in Malaysia are at present enjoying a reasonable sense of autonomy over the health of their patients. In many ways, the freedom of clinicians to make decisions with adequate knowledge of the patient’s needs and circumstances is a plus point in clinical practice.
Involving the pharmacists in the daily management of every patient removes a great part of the doctor’s control over the clinical circumstances of the patient. He may prescribe one drug only to be overruled by the dispensing pharmacist later. The clinician has privy to much information about the patient’s circumstances that are available only in the patient’s medical records. It is based on this information that a clinician makes decisions on the final choices of medications for the patient.
A dispensing pharmacist does not have access to such priceless clinical history and may very well make ill-informed decisions in the patient’s medications. Once again, my introductory scenario demonstrates how pharmacists can help perpetuate a patient’s mismanagement.
Selective Implementation of Rules
Rules in any game should be fair and just and implemented on both parties. If doctors are to be prohibited from dispensing, shouldn’t pharmacists too be forbidden from diagnosing, examining, investigating and prescribing?
Yet this is exactly what takes place everyday in a typical pharmacy.
I have seen with my own eyes (not that I can see with someone else’s eyes anyway) pharmacists giving a medical consultation, performing a physical examination and thereafter recommending medications to walk-in customers. It is also not uncommon to find pharmacies collaborating with biochemical laboratories to conduct blood tests especially those in the form of seemingly value-for money ‘packages’. These would usually include a barrage of unnecessary tests comprising tumor markers, rheumatoid factor and thyroid function tests for an otherwise well and asymptomatic patient.
Pharmacists intrude into the physicians’ territory when they begin to do all this and more.
Doctors may occasionally make mistakes due to their supposedly inferior knowledge of drugs despite the fact that they are trained in clinical pharmacology.
In the same vein, pharmacists may have studied the basic features of disease entities and clinical biochemistry but they are nonetheless not of sufficient competency to diagnose, examine, investigate and treat patients. Pharmacists are not adequately trained to take a complete and thorough medical history or to recognize the subtle clinical signs so imperative in the art of differential diagnosis.
In more ways than one and increasingly so, pharmacists are overtaking the role of a clinical doctor. Patients have reported buying antibiotics and prescription drugs over the pharmacy counter without prior consultation with a physician.
If the MOH is sincere to reduce adverse pharmacological reactions due to supposedly inept medical doctors, then it should also clamp down on pharmacists playing doctor everyday in their pharmaceutical premises. Patients will receive better healthcare services only when each team member abides by and operate within their jurisdiction.
The move to restrict doctors to prescribing only while conveniently ignoring the shortcomings and excesses among the pharmacy profession is biased and favors the pharmacists’ interests.
The Root Problem is Quality
A significant issue in Malaysian healthcare is that of the quality of our medical personnel. This includes doctors, dentists, nurses and pharmacists, therapists, amongst others. A substantial number of our doctors are locally trained and educated. If current trends are extrapolated to the future, the number of local medical graduates is bound to rise exponentially alongside the unrestrained establishment of new medical schools.
The quality and competency of current and future medical graduates produced locally is an imperative point to consider. Competent doctors with a sound knowledge of pharmacology will go a long way in improving patient care and minimizing incidence of adverse drug reactions. The very fact that the MOH resorts to the drastic step in prohibiting doctors from dispensing medications indicates that it must be aware of the high prevalence of drug-related clinical errors.
Much of patient safety revolves around the competency of Malaysian doctors in making the right diagnosis and prescribing the right medications. Retracting dispensing rights from clinicians therefore, will not solve the underlying problem. Our doctors might still be issuing the right medications but for the wrong diagnosis. In the end, a dispensing pharmacists will still end up supplying the patient with a medication of the right dosage, right frequency but for the wrong indication.
Patient safety therefore begins with the production of competent medical graduates. The problem lies in the fact the same universities producing medical doctors are usually the same institutions producing pharmacists. It is really not surprising, since the basic sciences of both disciplines are quite similar. Therefore, if the doctors produced by our local institutions are apparently not up to par, can we expect the pharmacy graduates who learnt under the same teachers to be much better in their own right?
Among other remedial measures, my personal opinion is that the medical syllabus of our local universities is in desperate need for a radical review. There is a pressing need for a greater emphasis on basic and clinical pharmacology. At the same time, the excessive weightage accorded to paraclinical subjects like public health and behavioral medicine need to be trimmed down to its rightful size. Lastly, genuine meritocracy in terms of student intake, as opposed to ‘meritocracy in the Malaysian mould’, will drastically improve the final products of our local institutions.
The MOH’s Own Backyard Needs Cleaning
Healthcare provision in Malaysia has undergone radical waves of change during the Chua Soi Lek era. The most sweeping changes seem to affect the private sector much more than anything else. The Private Healthcare Facilities and Services Act typifies MOH’s obsession with regulating private medical practice as though all doctors are under MOH’s ownership and leash.
An analyst new to Malaysian healthcare might be forgiven for having the impression that the Malaysian Ministry of Health is currently on a witch hunt in order to make private practice unappealing and unfeasible in order to reduce the number of government doctors resigning from the civil service.
Regardless of MOH’s genuine motives, it must be borne in mind that private healthcare facilities only serve an estimated twenty percent of the total patient load in the whole country. The major provider of affordable healthcare is still the Ministry of Health and probably always will be. Targeting private healthcare providers therefore, will only create changes to a small portion of the population. Overhauling the public healthcare services conversely, will improve the lot of the remaining eighty percent of the population.
At present, the healthcare services provided by the Malaysian Ministry of Health is admittedly among the most accessible in the world. The quality of MOH’s services however, leaves much to be desired. Instead of conceiving ways and means to make the private sector increasingly unappealing to the frustrated government doctor, the MOH needs to plug the brain drain by making the ministry a more rewarding organization to work in.
The MOH needs to clean up its own messy backyard before encroaching into the private practitioners’.
An indepth analysis of MOH’s deficiencies I’m afraid, is not possible in this article.
MOH’s “To Do List”
The prescribing-dispensing issue should hardly be MOH’s priorities at the moment.
I can effortlessly think of a list of issues for the MOH to tackle apart from retracting the right of clinicians to dispense drugs.
Private laboratories are conducting endless unnecessary tests upon patients and usually at high financial cost despite their so-called attractive packages. In the process, patients are parting with their hard-earned money for investigations that bring little benefit to their overall well being. Mildly ‘abnormal’ results with little clinical significance result in undue anxiety to patients. More often than not, such tests will result in further unnecessary investigations. The MOH needs to regulate the activities of these increasingly brazen and devious laboratories.
Medical assistants trained and produced by the MOH’s own grounds are running loose and roaming into territories that are far beyond their expertise. It is not uncommon to find patients who were on long term follow up under a medical assistant for supposedly minor ailments like refractory gastritis and chronic sorethroat. A few patients with such symptoms turned up having advanced cancer of the stomach and esophagus instead. The medical assistants who for years were treating them with antacids and multiple courses of antibiotics failed to notice the warning signs and red flags of an occult malignancy. They were not trained in the art of diagnosis and clinical examination but were performing the tasks and duties of a doctor. There is no doubt that the role of the medical assistant is indispensable in the MOH. Just as a surgeon would not interfere with the role of an oncologist, medical assistants too must be aware of the limits of their expertise. MOH will do well to remember the case of the medical assistant caught running a full-fledge surgical clinic in Shah Alam in late 2006.
Adulterated drugs with genuine risks of lethal effects are paddled openly in road side stalls and night markets. They are extremely popular among folks from all strata of society who rarely admit to the use of such toxins to their physicians. It is possible and highly probable that many unexplained deaths taking place each day are in some way related to the rampant use of such preparations.
Non-medical personnel are performing risky and potentially lethal procedures daily without the fear of being nabbed by the authorities. These are mostly aesthetic procedures. Mole removals, botulinum toxin injections and even blepharoplasty are carried out brazenly by unskilled personnel and usually in the least sterile conditions. It makes a mockery of the plastic surgeon’s years of training but above all, proves that the MOH is indeed barking up the wrong tree in its obsession to retract the dispensing privileges of medical practitioners.
Closing Points
In summary, a patient’s health is affected by many factors – a doctor’s aptitude is merely one step in a torrent of events. The health seeking behaviors of patients play an imperative role in the final outcome of one’s own health. Most harm to patients can only occur as a result of unidentified minor errors in the management flowchart of a patient. If allowed to accumulate, such errors converge as a snowball that threatens the long term outcome of an ill person.
There are a multitude of other clinical errors apart from prescribing and dispensing, some of which are not at all committed by trained medical staff. The MOH must get its priorities right by first overhauling an increasingly overloaded public healthcare service.
Lastly, the difference between a drug and a poison is the dose. A toxin used in the right amount for the right condition is an elixir. A medication used in the wrong dosage and for the wrong indication is lethal poison.
May 4th, 2008 at 10: 25.25
YB Lim,
A long time ago, I wrote to you about unethical practice of panel doctors and employers. Many doctors market their clinics to employers so that they get ready supply of patients. This patient suffer in the hands of this doctors as their interest is to ensure to keep the enployers interest and their cashflow rather than the interest of patients.
It is an irony the Medical Association who majority of them also benefit from being a panel clinic depriving the smaller clinics of patients because they just do not get the panel for some company. How could the Medical Association allow the double standard to recognise only certain doctors professional decisions and the other doctors? Did the other doctors failed in their medical examinations?
How could the HRM disallow patients to get the treatments from the doctors of their choice? Free the medical association. Respect the patients right to get treatment based on patients interest first.
This is not a critisim against majority of panels which are ethical.
May 4th, 2008 at 11: 24.38
It is a believe by many to the phrase” if it is not spoil don’t repair it”
If MOH is eager to solve all her problems, please look elsewhere bcos there is no problem here where doctors do the prescription and also dispensing the medicine.
I personally don’t want to go searching for a pharmacy to purchase the medicine after visiting the doctor.
As most may experience waiting your turn to see the doctor at the clinic is already enough agony especially you are really feeling terrible and i don’ t have to say when you are taking your kid or your elderly to the clinic.
If MOH is under directive by their peers to create job for their locally trained pharmacist …huh….forget it before some dies for wrong prescription.
Well , rest assured some of those monkeys has to be the first to set precedent malaysian pharmacist cases.
Bolihland is very predictable, just like when there were lots of news by the papers about crime, they started renting houses in tamans as beat posts….but ,,,ha you all knoe lah.
Later they say it too small, or neighbhout complained noisy becos of in/out traffic…not anymore they would say we built new buildings and big sums be spent…also give employment -what , they would argued….sounds cynical …it is….believ or not.
May 4th, 2008 at 12: 05.20
This write-up is fantastic for layman like me. I think the writer is right. The MOH should seriously reconsider the proposed new drug dispensing system. Not all that’s being practiced in developed world is good for us. There is big difference in educational standard, attitude of the patient, patient-doctor communication, facility of diagnosis, and many other points. Surely these are the differences why our government is scared to death to allow the same open democracy or press freedom like in the States or the West!
Please reconsider seriously without any ’smell’ of racism or group but for the real practical system of enhancing our health care services for the rakyat.
May 4th, 2008 at 12: 12.57
God please don’t allow the authorities to change the present systems. The poor RAKYAT already burden with price hikes everywhere and this will definitely kill him.
May 4th, 2008 at 12: 15.22
If we are going to seggregate the medical treatment and dispensing professions, then are we going to seggregate the legal profession into “barristers” and “solicitors” as in UK and other commonwealth countries? This separation would not only bring incovenience to the general public but it would also cost them more RM!
May 4th, 2008 at 12: 37.32
Frankly are we paying more at doctor office for the same drug when we but it from pharmacy? I want to highlight saying that “The same drug as mean exactly the same kind of drug from the same company and the same dose”
My take is that we pay more in the doctor’s clinic. If you ask the doctor to break down the charge to Consultancy & Treatment and Medicine cost than you will see the cost of the same medicine is about 10-20% higher.
Now if we can get the same for a lot cheaper and easily, why not? I think it boils down to whether we can get the same drug easily or not. Or do we have to drive around to find the pharmacy to sell us the drug.
But I belief with greater demand for pharmacy, more will pop up in the neighborhood.
At the mean time, allow the customer to choose whether to get the drug from the doctor office or get from pharmacy. This will create healthy competition and the winner are the customers.
Shiok Guy
May 4th, 2008 at 12: 45.31
yb LKS, you worte:
.In the United Kingdom, all costs are borne by the National Healthcare Services. >In the United States, despite all the negativity painted by Michael Moore’s >Sicko, most fees are paid for by health insurance without which one cannot >seek treatment. In these countries and many European nations, there is >hardly any out-of-pocket monetary exchange between patients and their >clinicians.
>This however is not the case for Malaysia
The rights of the doctor to prescribe and dispense is the vestigial colonial british conveniece to circumvent the larger population of doctors over the pharmacists at those time and this doctor-pharmacist ratio keeps on enlarging today.
To date, the malaysian population is so used to the “ta pow” service from the doctors that the malaysian pharmaceutical society can argue to epeaker’s throat.
This issue has had been argued between the MPS and MMA for so long that it is a dead horse and the doctors’ coupe de grace is “let the public decide”
Until there is a social health scheme either in the form of UK NHS, or US national health insurance, the malaysian doctors surely win the day. The pharmacists may as well close down together with the pharmaciy schools of malaysia unisversities.
The MOH and the govt cannot afford to offend the doctors to revoke the law forbiding the doctors to prescibe and dispense without incurring the wrath of the malaysian patient population.
On the other hand, to invoke the curses of the malaysian public, the doctors discontinue dispensing dispensing.!. Who knows the doctors may do this and after the “revolts” from the malaysian public, the doctors would move the govt to re-enact doctors shall forever prescribe and dispense !
Malaysian pharmacists historically get crumps from the doctors’ tables.
May 4th, 2008 at 12: 45.45
The rakyat has a role to play too. It takes both hand to clap. The theory of demand and supply apply. To have a better living environment, though having good governance policies are important, cooperation from the rakyat in making those policies a success is equally important. Third world mentalily of Malaysians need to be kicked away.
May 4th, 2008 at 12: 48.33
YB Lim,
Ask a very simple question. How many clinic in Malaysia where the doctor ACTUALLY be seen doing the dispensing?
Just walk in into any clinic, you will the the answer.
I have no qualm to support the non-seggregation, provided the doctor himself dispense medicine to his/her patient. If I am the Minister of Health, I will make sure that each clinic that dispense medicine MUST employ a qualified phamarcist if the doctor cannot dispense medicine to his patient personally. Is this not fair policy???
All these complaints and protest in the seggregation of medical treatment and dispensing is ALL about “making money”
Why on earth in most developed countries are already been adopting the practice whilst Malaysia want to be different.?
Pharmacist are professionally trained to handle and dispensing of medicine, why cant these pharmacist be promoted to take this role. Reason of insufficeint pharmacy is PLAIN RUBBISH to delay and continue to justify with the profitable business of selling medicine by doctors.
The writer states, ” Doctors prescribe and pharmacists dispense. It’s the international role of each profession and very much the standard practice in most developed countries.”
Harping on MOH inadequacies is another “clever” way to sabotage the attempt to moving forward.
Please be true to yourself, professionals.
May 4th, 2008 at 12: 57.16
Shiok Guy: It will be definitely cheaper if you got the same drug from pharmacy than from doctor but you need a doctor to diagnose your illness and prescribe you the correct drug and dosage. Also for the 10% that you want to save, would you take the trouble to spend time to search for another pharmacy, carpark, waiting in the queue again etc. Many patients only see the good of getting’ cheaper drug’ from the pharmacy but this is the short term benefit. You need a doctor to monitor your illness especially the chronic illness and look for complication, change of dosage or consider another diagnosis etc.
May 4th, 2008 at 13: 24.17
YB Lim,
I’m glad you wrote this article. I truly admire your energy to continuously struggle for the betterment of the country.
The healthcare system in the country today can best be described as “No money, don’t fall sick”. Another words, No Money, No talk!
What about government hospital? Well, what is the level of services there?
If you are sick and poor, you will say to yourself “What a cruel society we are in”.
I have my share in that. I’m still quite young, not reaching 40. I have some medical problems that preventing from being productive at work.
In fact, I’m very unproductive due to my medical conditions and they are due to work hazard.
I have three chronic medical conditions, two of them being RSI and chronic sharp backpain.
I spent much money for alternative treatments. One day I went to see a specialist for my backpain in a hospital. Well, of course the bill was high.
I went for several times and I can say that it was a bad experience. The doctor was sarcastic to me when I politely said I prefer not to take
pain-killer. He also didn’t clearly explain the MRI to me. He just said that I was perfect. So I brought the very same MRI to alternative physicians.
Both of them (who has a degree) said there were something wrong with my disc. One of them said I have slipped disc. Another show me the problem and said there definately a problem and went on to show me the problem in MRI. He said I definately have problem, otherwise how could I always felt painful.
Recently, I apply for socso, thinking that I may lose my job. Socso requested me to get the medical report from the specialist.
So I went to the specialist for him to check my condition and the mRI again so that he could produce a proper report. I was hoping he is more
profesional this time. Well, he spent very little time with me and told me that he knew about me. To my dismay, the report contain untrue information.
Besides writing that my lumbar spine was perfectly normal, he wrote that I was sent for physiotherapy and taught extension exercises and erector spinae muscle strenghtening. I don’t agree that my lumbar spine was normal. While I can’t afford to spend more money to seek another specialist second opinion and alternative physician’s opinion is not recognized, the information that I was sent for physiotherapy and been taught exercises were totally untrue.
Subsequently, with the report, I was rejected compensation from Socso. I’m still young and have many more years to live. When I lost my job one day due to my conditions, who will take care of me?
Being a specialist or even a reputable specialist doesn’t give one the license to ill-treat a poor and needy patient like me.
May 4th, 2008 at 14: 01.58
Food Security - Our Basic Rights Molested
Visit http://www.wagthedog-malaysia.blogspot.com for details.
May 4th, 2008 at 15: 02.31
The MOH needs to first take a wholistic view of the whole healthcare system in Malaysia.
Looking at our healthcare system from the eyepoint of a patient, one sees a system that is primarily and solely driven by commercial interests, i.e., the bottomline is profits and money. And who suffers, WE, the patients. No doubt, health care providers need profits to sustain their operations, but there has to be a balance between profits and proper, ETHICAL healthcare.
This is where the MOH has a pivotal role to play. The MOH needs to look beyond the issue of prescription and dispensing rights. The writer had aptly and comprehensively addressed most of the issues that are more paramount than this prescription/dispensing issue.
If the MOH is sincere in tackling the healthcare system, then it needs to take a step back and review the system and have the political will to take the necesary steps to revamp the system if we have to. The MOH should stop addressing ad hoc issues and stop all the talk, talk, talk and talk. It is time for action, action, and action.
What happened to the much talked about national healthcare insurance scheme many many moons ago! Healthcare cost is rising by leaps and bounds.
My neighbour who is a cancer patient opted to give up his cancer treatment years ago because the cancer treatment would caused him a fortune. He chosed death (he died a few months after his diagnosis). Our ministers and politicians do not see and hear all these real life scenarios first hand. Afterall, they and their family have the money to seek treatment overseas.
Medical costs can also be increased these days because most patients had to seek second opinions from other doctors simply because the first doctor’s diagnosis is questionable or his/her conduct did not give patients enough confidence on the treatment/diagnosis. I had a friend who was wrongly diagnosed with breast cancer at a very reputable private hospital only to find out from another 2 specialists doctors (2nd & 3rd opinion) that she was fine!!
I have also seen first hand, pharmacists conducting diagnostic tests, blood pressure monitoring and giving medical advise. In short, they are playing doctor. Some of these “patients” ended up buying loads of supplements and some direct sales products which the pharmacist is a distributor.
So, we can’t trust the doctors, we can’t trust the pharmacists, and our MOH is barking up the wrong tree, who then can we, the patients turn to. God help us!
Fortunately, I have a very reliable and good family doctor with reasonable charges. But what about all the other poor souls out there. In fact, I prefer to get my medications for my chronic health problem from my own doctor instead of from the pharmacists because I am monitored and advised regularly.
We can only hope that the MOH will review the whole healthcare system soon. Hopefully, we will still not be just talking about it come the next General Election. We have the local expertise to devise a national healtcare plan. We just need someone to champion the cause and the political will to move the plan forward.
May 4th, 2008 at 15: 27.32
I tend to believe that the policy makers in the public sector are jealous of the private sector.
Either they are more professional,more efficient and effective, earned more money, or something else that they only know.
These ppl always experimenting and we are the guinea pigs, the taxpayers….just like moe and the water works and the ….aiya what else.
May 4th, 2008 at 18: 18.42
Datuk Liow is only going to prove what his predecessors said i.e it’s the Ministry of Hell
May 4th, 2008 at 18: 40.55
medicolegal cases increasing by the day in public hospitals. and the DG is more interested in private healthcare.
take care of your own back yard first. once you are first class then come teach others how to do their stuff……………
May 4th, 2008 at 18: 44.19
The pharmacists just want to make money. PERIOD Its ridiculous to say that doctors are less qualified in dispensing medication. Pharmacists have a greater understanding of the chemistry of a medicine, not its interraction with the body. If it were the way the pharmacists claimed it to be, it would make more sense for the doctors to diagnose, and the pharmacists to prescribe!!
May 4th, 2008 at 18: 51.49
I am not a doctor and I will be the first one to admit that the current debate over who should dispense medicine puzzles me.
But I expected someone of your stature to protect the interest of rakyat rather than take a political solution by attacking the decision of MOH without doing any through studies.
Very often you claim that we should aim for First World standards in Malaysia but curiously here your view seems to indicate we should maintain a status quo.
Well, as I had stated I have no idea which is a better option but if you want us to support the status quo, then you should supply arguments that are objective and technical that was learned in countries that are practicising the separation of treatment and dispensing. And not highlighting isolated cases of failures.
I have personally have seen many cases where doctors have failed to provide accurate assessment of patients’ conditions resulting in much suffering, pain, expenses and not to mention deaths. But it would be unfair to use that to paint a negative picture of the entire medical profession.
According to my friends living in countries practising such separation, the main objective was to reduce the price of medicine for the ordinary folks. It seems that doctors dispensing medicine took advantage of their position to over prescribe the patients by selling unnecessary and expensive medicines.
Uncle Kit, please do serve the rakyat by highlighting the real problems and help us progress toward the First World standards in all aspects of governance. Don’t let us rakyat be a victim of your political games, just like what had happened during the 1st day of 12 GE parliment.
May 4th, 2008 at 18: 52.02
This is a short sighted article.
The trouble isn’t with the system, it’s with the people in the system. As rightly pointed out, the 2nd and 3rd doctors should have taken a complete medical history before treating her. It’s medical incompetence that almost ruined her life.
Not enough pharmacies? The laws of economics will take care of that. The total count of pharmacies today *must* include clinics that dispense. So, in a block of shophouses with 5 clinics and 1 pharmacy, there are 6 pharmacies. When they are stopped from dispensing, new pharmacies will definitely open up to fill the sudden void.
The oft quoted UK NHS system is riddled with problems as well. You cannot see a doctor when you’re sick, as you need an appointment. By the time you get your appointment, you’re either dead or well. You cannot see another doctor, because each person is tied to only one GP. Even if you go to the hospital emergency, they will take a look, and refer you back to your GP, meaning more appointments.
The problem of not having a centralised patient history, can be circumvented if the government pushes for storing patient medical data in, maybe the MyKad. I thought that this was one of the applications intended for the card. Then, the patient carries around a copy of his/her medical information.
About pharmacists overruling doctors, it’s a question of who is right. It’s presumptious of the doctor to think that a pharmacist may not know as much as a doctor. The two have very different knowledge spheres that overlap. One is knowledgeable about illnesses, the other is knowledgeable about drugs. The overlap is the patient. Let each work in their own areas.
However, I agree that pharmacists should not get into the business of diagnosing. I doubt that any pharmacist carries enough medico-legal insurance, in case of any problems. So, they should always refer sick people to doctors. It’s only the legal thing to do.
In all, I feel that this article, while well written, highlights fears and tries to exploit patients’ miseries but delivers little in terms of actual substance. The only good parts are towards the end, where other problems are highlighted.
May 4th, 2008 at 19: 27.10
if pharmacists can dispense and know more about drugs, radiographers know more about X Rays, Lab technicians are able to infer blood results, nutritionists know best about food a patient shud take, physiotherapists know what exercises is required, and the latest trend where MA’s and Nurses can become Hospital Directors and Deputy Directors………….
so do we actually need doctors anymore ? close all medical schools and open up more schools of allied health sciences………..
May 4th, 2008 at 19: 46.12
WHO SHOULD BE RESPONSIBLE FOR THE TRAIN DERAILED IN SEREMBAN ????? AB sleeping again ???
Look here to see how Chinese Government took responsibility:
Five more officials sacked over China rail accident
Posted: 04 May 2008 1237 hrs
Photos 1 of 1
Rescuers work at the site of where two trains collided in an early morning accident in Zibo
BEIJING : Five more railway officials were sacked for causing a train crash in east China that killed 72 people in the nation’s worst rail accident in over a decade, state press said on Sunday.
http://www.channelnewsasia.com/stories/afp_asiapacific/view/345437/1/.html
May 4th, 2008 at 19: 46.39
The current system of doctors prescribing medicines has been around for many years. And by and large it has served its purpose well.
For the benefit of the patients in terms of convenience,cost and safety, it is best for doctors to dispense medicine at clinics at this moment.
Let’s not be jealous of whoever earns more from dispensing medicines (doctors or pharmacists). Whoever earns more is non of MOH and patient’s business.
Clinics in general enjoy a better discount on drugs from the pharmaceutical companies compared to the pharmacies (this, I’m very sure). Therefore it is baseless to say medicines bought from phamacies will be cheaper. What profits the pharmacist earn is what the doctors earn in general. Drugs somtimes are cheaper if you buy it from clinics because the doctors bought it at a much cheaper price.
Doctors earn from the sale of drugs and charging consultation fees. Sometimes they waive their consultation fees when the price of drugs are too expensive feeling contented with the profits from the sale of drugs alone. Once their dispensing rights is taken away, doctors will have no choice but to charge all patients consultation fees even at a higher rate in order to compensate for the loss of income from the sale of medicines. As a result, patients have to fork out extra money.
When clinics are no longer dispensing medicines, the price war between doctors and pharmacist will cease. Without the stiff competition from doctors, do you think pharmacists will be willing to reduce the price of medicine??? I don’t think so!!
May 4th, 2008 at 19: 52.59
recommended consultation fees for GP’s is btwn RM 20 and 30. recommended consulation fees for specialist is btwn RM 80 and 100.
you walk into a clinic for diarrhoea/vomitting. Hows much you pay for consultaions and medications ?
you walk into a clinic for fever cough and flu. How much you pay for consultations and medications ?
How much do u think you will pay once doctors ONLY prescribe and pharmacists ONLY dispense ?
May 4th, 2008 at 20: 09.12
See doctor and get medicine from the clinic for simple cough and running nose - RM 30
See doctor only but refuse to get medicine from clinic - RM 20
Go to the nearby pharmacy - RM 15
Total spend - RM 35
So judge yourself!
May 4th, 2008 at 20: 35.27
Why groan and complain? Just make sure the newly installed Health Minister lose his seat in the next elections. This will warn his successors against taking the rakyat for fools
May 4th, 2008 at 20: 35.57
YB lim,
I’m thinking that either you are misinformed about this issue or you are politizing for your own political benefit.
If the develop countries can do it why malaysia can’t? Isn’t it your vision to see malaysia have 1st class services?
You are misleading people in general by just publishing doctor’s opinion. thanks.
May 4th, 2008 at 20: 51.03
Malaysia health system is a total mess beginning from the local medical university which favour racism instead of meritrocracy. Result is the low quality graduate doctors we have today which often misdiagnose a patient ailment. A good example was my late father who die of lung cancer but for one year not one doctors was able to diagnose what he was suffering from. He was only prescribe cough medication for his persistent coughing. I had pursue my late father case by reporting this to MCA & to the local reporter. I even sent a letter to the health minister & to the PM but until today no reply was ever given & no improvement was done at all to our pathetic healthcare system. We are totally at their mercy & it was no wonder now that a lot of those pass away now consist a lot of people still at their prime age. Mr. LIm, with 80 seats at parliment I hope that you will continue to pursue the healthcare case where I had left off otherwise more victims will falter at the hands of this so call doctors.
May 4th, 2008 at 20: 54.40
Presently, most doctors waive or subsidize the bulk of their consultation fees because they are making a profit from the medications which they prescribe and dispense.
Under the Fees Schedule of the Regulations 2006, which is part of the Private Health Care and Facilities Act 1998, doctors can charge consultation fees of RM10-RM35. This excludes ANY medicine.
However, if you were to go to most GP clinics presently, most of them charge between RM25-RM45 INCLUDING MEDICINE, depending on locality.
If you remove dispensing from doctors, you can surely expect doctors to charge in the higher range of the allowable fees range as per the Fees Schedule.
Assuming that doctors then charge RM20-RM30 for their consultation fees ALONE, can the patients then buy the medications he would have received from the clinic,
by using the RM5-RM15 “saved” to buy the same medications from a pharmacy?
Do remember that a bottle of cough+cold mixture may cost RM10, 20tabs of Panadol would be RM5, and antibiotics may cost >RM10.
In the end, the PATIENTS FORK OUT MORE!
And that’s not including the extra expenses a patient may have to fork out, in getting to the pharmacy
eg another taxi/bus fare, or parking charges, or petrol charges, or time spent in traffic jams or in hunting for parking spots.
May 4th, 2008 at 21: 05.44
would you prefer to go to a clinic and see the doctor, get a check up, get a scan, X ray, blood test, and medications at the same place - one stop centre
OR
would you prefer to get checked in the clinic. Go to the next Taman for your scan, blood test in the Lab which is a few kilometres away , X Ray some where else and collect your medicines at the Pharmacy down the street ?
we always pride ourselves and say that we have our own culture and our own ways. suddenly now we compare of the health schemes in UK, USA and Australia……..
Aren’t we hippocrites ?
May 4th, 2008 at 21: 08.23
The writer is obviously or doctor and knows specific examples to tell Doctors’ side of the story. I am not saying that the writer does not know what he’s talking about. He does especially on parts relating to the quality of medical personnel & their training and also the fact that the health care infrastructure here is not on all fours as that of developed countries in which this bifurcation between medical prescription and pharmacist’s dispensing is made and now proposed to be adopted without cognition of the difference.
However I am sure the pharmacist lobby will also have its side of the story. Whilst it is true what the writer says - that “pharmacists may have studied the basic features of disease entities and clinical biochemistry but they are nonetheless not of sufficient competency to diagnose, examine, investigate and treat patients” – it may be equally true, according to Pharmacist, that whilst doctors study Pharmacology in medical school, however, doctors may not know as much as pharmacists of drug interactions involved in dispensing. Otherwise why have pharmacy as separate course, wouldn’t it be irrelevant?? Besides Pharmacists lobby does not argue pharmacists are competent as doctors to “diagnose, examine, investigate and treat patients”.
Those who favour the Pharmacists’ lobby will also have their arguments too.
In an increasingly competitive environment, the exclusive dispensing rights hitherto enjoyed by doctors helps. They could lower their consultation fees to like RM10 - RM35 but make money on drugs by marking up 10% to 200% or more on them. In that process they are likely to give drugs of generic brands. (Not saying here generic ones works not as well as original brands) but if the diagnosis/prescription by doctors were separated from dispensing by pharmacists, then patient has more choice to decide whether to use generic or not and to compare prices, in the process educating themselves on these matters whether or not the overall costs will be more or not more….
It is difficult for laymen, even informed laymen neither trained in medicine or pharmacy to take sides in the argument let alone arbiter which side’s arguments are right….We see some truth in onme side’s arguments and some in the others as well.
However it does appear to be a fight over turf – opportunities to make money. The writer more or less admits it when he writes, “Pharmacists intrude into the physicians’ territory when they begin to do all this and more…In more ways than one and increasingly so, pharmacists are overtaking the role of a clinical doctor”. Pharmacists are perceived to be taking away a part of clinical doctor’s existing market share and the bad boy for initiating this is the Ministry of Health & The Malaysian Medical Council in cahoots whose motives and controversial implementation of The Private Healthcare Facilities and Services Act “typifies MOH’s obsession with regulating private medical practice as though all doctors are under MOH’s ownership and leash”. This is resented by doctors because bottom line, doctors – and there are good and not so good ones – will have to survive and keep up with both costs and standard of living as commensurate their long training and important work to society.
At the end of the day, the benefit of patient and public (which is better, more convenient and cheaper service etc) are always used as arguments and justifications to justify their respective positions, as a Devil will cite scripture for his own Cause but basically no matter that these arguments may be true in some cases and not so in others, my sense, as a layman, is that it ultimately has more to do with competition over economic turf couched as always in idealistic public benefit terms. (No offence intended to those in medical or pharmaceutical profession alike). About this I have more to say later. And it is not just between doctors and pharmacists.
May 4th, 2008 at 21: 38.54
“In the United Kingdom, all costs are borne by the National Healthcare Services. In the United States, despite all the negativity painted by Michael Moore’s Sicko, most fees are paid for by health insurance without which one cannot seek treatment.”
I have lived in both the U.K. and the U.S. and I find this to be a sweeping statement.
Seeing an NHS physician is not a problem when you are in the U.K. as a student. But expect the physician to limit themselves to common illnesses and medications which are not exactly the latest. You have no choice over what is dispensed to you by the system. After all you are not paying for them. Physicians complain they are barely surviving. Ask to be referred to a medical specialist and you’ll find that for some reason the specialists are never free to see you. That was the scenario in the 80s. Today the NHS is so starved of funds and is not unlike a patient on life support!
“In the United States, despite all the negativity painted by Michael Moore’s Sicko, most fees are paid for by health insurance without which one cannot seek treatment.”
Michael Moore may have exaggerated the situation. Who is to say he has not but the person without health insurance? I can only speak from my experience – someone with health insurance.
I have health insurance that comes from working – and the premium is not cheap (about USDSL400 a month taken out of your salary) and many Americans cannot afford it even when their employers contribute to such premiums. You can be sure some 4% of Americans are without health insurance simply because they are unemployed. Then there are those working Americans who cannot afford the cost of health insurance. So where do these people go to when they are sick? They could turn to one of those rare charities for the poor if they are not already on the government program referred to as Medicaid for the poor. Sure. But if you are lucky to be found eligible, and get a charity that listens to you or a Medicaid physician, you’ll find that there is a long wait and you’ll still need to pay a portion of the costs. Nothing is free! If you’re really sick and turn up at the ER on a hospital stretcher then that is a different story because the hospital cannot turn you away.
But otherwise who says the U.S. is a socialist country or a capitalist system with socialist leanings – except limkamput!
Though treated by hospitals if it is an emergency and operated on, without health insurance you cannot get post-operative out-patient treatment as readily as those who have and without ready access to a physician you could die sooner than later. And if you die destitute and no relative claims your body, they just dump your body in some unmarked grave. Today they are beginning to cremate them because it would be cheaper and they do that after harvesting your body for organs to donate away!
So to say that fees are paid for by health insurance period, is to ignore the obvious. Health insurance must be paid for and it is expensive – even to those who are working.
To have your teeth extracted you will have to pay some UDLS300 (minimum w/o insurance) and to afford partial dentures be prepared to cough out no less than USDLS3,0000 (minimum w/ insurance). Generally, mouth hygiene among Americans is good because kissing (otherwise known as face sucking – nothing derogatory there) is a national pastime and they cannot afford to go around with rotten teeth, foul breath and toothless! Still some 48 million Americans are walking without health insurance. I guess they are not kissing as much.
In the U.S. you cannot fail to notice the pharmacies at every street corner – almost like 7-11. You get your medications from stores like Rite-Aid and CVS and Walgreens – not to mention the illegal ones who operate in Chinatowns many of whom dispense nothing more than vitamin pills. That way they don’t get sued. Why, you can even get prescription drugs on-line and as far as Canada. Welcome to the USA, the home of the world’s multi billion dollar drug business and home to the world’s drug dealers whose business is made legitimate by the FDA or Federal Drug Administration. These drug dealers do not donate to the campaign funds of presidential candidates for nothing!
Rest assured that medications even with health insurance are still very expensive. What good are non-prescription or over-the-counter drugs when what you need are those prescribed by your physician.
Who says the United States is a socialist state or a capitalist state with socialist leanings except limkamput!
The only comfort perhaps is that doctors or physicians as they are commonly referred to here do not sell drugs to their patients and for illnesses that they themselves diagnose. The danger is obvious! Apart from being saddled with the cost of drugs you do not really need, you may end up with the wrong drugs altogether. Your next-of-kin should then not be surprised if your death certificate reads “died from unknown causes”.
Society here is so litigation oriented, with lawyers offering ‘free’ services to take up medical malpractice suits. Doctors are very careful when prescribing medications and pharmacists when dispensing them. Doctors are reduced to practicing a new brand of medicine called ‘defensive’ medicine – defending themselves against the attorneys.
So to say that “most fees are paid for by health insurance without which one cannot seek treatment” is to be dismissive of the problems facing some 48 million Americans today.
Michael Moore is right.
May 4th, 2008 at 21: 49.44
At the end of the day, nothing matters except money.
The Ministry of Health should educate the public on matters pertaining to health, diseases, conditions, treatment and care. If the public is educated on these, they will know whether they are getting their customized treatment and care. But Malaysian patients are too trusting. Instead of knowing for themselves, they prefer to rely on the doctors. And when things are not going their way, they treat themselves by getting over the counter medicine or seeking some other treatment that may bring more problems.
No two patients are the same even though both have hypertension. There is a difference between a very high blood pressure and just a mild one.
If we wish to be genuinely professional, only the doctors can treat. Doctors here mean western doctors. Or are we going to include eastern doctors too ? Nobody else; no matter what title they carry and what kind of laws that cover them or men made discretion. Doctors should be willing to be transferred to some God forgotten places and serve the people there. Why should medical students conjure up a vision of comfort for themselves ? Why can’t they imagine the many people in some interior parts of Malaysia crying and begging for their help ? Or some unfortunate neglected people on the street. If the doctors have got their focus right, then all this talk about money will be irrelevant.
As for the pharmacists, the word pharmacology means medicine. Nothing else. By right, all medicine should be prescribed. But we all know that some medicine are advertised. This puts us in a very undecided position. What about traditional medicine ? Herbal medicine ? Pharmacists work hand in hand with the doctors. There are so many medicines and it is not like as if one can remember every one of the medicine. Doctors prescribe. Pharmacists dispenses. Nurses make sure the patients swallow or given the medicine. The workflow is there.
May 4th, 2008 at 22: 25.51
Read here the fighting of economic turf between statutory regulator ) (the Board of Valuers representing registered property valuers and agents) on one hand and a lobby group called the VAEA Joint Action Group comprising players from different industries as members, ranging from the Real Estate and Housing Developers Association (Rehda) to apartment management corporations and the Associated Chinese Chamber of Commerce and Industry (ACCCIM) on the other hand in respect of property management of 1.2 million apartments and condominiums with an estimated RM600 million in annual fees at stake… http://www.nst.com.my/Current_News/NST/Sunday/Columns/2230563/Article/index_html
It is not just different professions fighting over economic turf (inter-professional competition) but also sub sections of same profession (intra-professional competition) would fight over economic turf – an example, within same legal profession, the litigation solicitors are vying with the conveyancing solicitors for the latter’s economic turf when the former lobbied for the ruling that in a sale and purchase or other conveyance transaction, one solicitor cannot represent both sides, ostensibly for public interest of preventing conflicts of interest but more to share out the cake…And even amongst those handing conveyance there is competition between big firms fearful of smaller firms getting their market share by undercutting their fees – hence no discount rule justified on basis that it would reduce the noble profession’s image to commercial market practice (though the big firms also give discount on the quiet).
“At the end of the day, nothing matters except money” - cemerlang said which is largely true but it is also self interest posed always as public interests….
The public, consumers, the dispensers of moneys are always to be persuaded to part with their money ostensibly for their benefit with all kinds of clever arguments as if we are fools. May be we are, compared to those who know more and could make clever justifications ostensibly for our benefit….
Public benefit is always used as excuse to justify service of private interests, which is bottom line motivation. Hence the devil can cite Scripture for his purpose is the proverb to describe such hypocrisy. A more neutral description another way is “To thine own self be true.”
But it is not only in self interest fights over economic turf : we have seen enough of it in politics as well, to cite recent examples:
· When Perak MB (Datuk Seri Mohammad Nizar Jamaluddin Mohammad Nizar) was summoned by Perak Royalty for not consulting it on the withdrawal and the transfer order of Jamry as the director of the Perak state Religious Department (also secretary of the Perak Islamic Affairs and Malay Customs Council) he earned a rebuke from the Minister in the Prime Minister’s Department Datuk Seri Nazri Abdul Aziz reminding him and top officials in all state governments that they should be mindful of the status of the Malay Rulers pertaining to Islam and Malay customs – see NST 4th May. The same minister said nothing when on 23rd March 22 Umno assemblymen turned up at the palace, protesting against Terengganu Sultan and present King to protest against HRH’s endorsement of Datuk Ahmad Said’s appointment as MB over UMNO’s preferred choice of Datuk Seri Idris Jusoh. What is Ok for UMNO is not Ok for Pakatan Rakyat’s state govt!
· Another example is TDM under whose administration is widely blamed the 1988 judiciary crisis has now made his first posting under his blog, which has all the appearances of “championing” judiciary independence by questioning whether the PM’s proposal for the Judicial Appointment Commission is really independent – what are details and mechanism of selecting judges appointed members of the Commission, will details be made public, will it conflict with Constitution, if not is there 2/3 majority for constitutional changes etc???
May 4th, 2008 at 22: 26.06
Ismail Merican the DG…has managed to throw everyone off track…even before Liow could move in as the Health Minister he started the turf war between GPs and pharmacies……and now hides behind probably all those ambulance failures, A&E Disasters, Baby loosing arms, long patient waiting lists, leaking hospitals and billion dollar software systems that dont work…….
LKS…don’t be fooled by this guy…..the pharmacy thing is a side issue and doesnt kill as many people as the government system where 80% of the population go to….this a ruse…..a ruse for the culprits to sneak out before all is brought up in parliment…..so PR go after these rascals and please give Malaysians a decent system….this has really got to stop…..
May 4th, 2008 at 23: 34.37
Hi,
May I suggest that Parlimen start the day with : :ANY MATTERS ARISING”.. before and rather tahn jump into the Agenda of the day on Q an A………LIke our meetings held by the rakyat…..
That is the problem with the first parlimen session..
Steven
May 4th, 2008 at 23: 45.38
undergrad2
Great post ! Excellent insight into the US and the UK systems. Good to have people like yourself who know what he/she is talking about rather than unbearable and unobjective rantings that most people here have resorted to.
I am recommending you to the MNS to be included in the “Malaysian Endangered Species List” officially…ha ha ha…
Seriously ,it is people like you and Jeff that keep me coming to this blog. Though we might disagree in certain topics, I enjoy reading both of your posts..
May 5th, 2008 at 00: 35.09
Who says the United States is a socialist state or a capitalist state with socialist leanings except limkamput!
Undergrad2,
You picked one topic on health care and you tried to cover up your pathetic argument that US is a capitalist state. I think others who have read our postings earlier on this topic will know you are just twisting and turning to suit your argument.
Anyway the issue here is whether prescription and dispensation functions should be separated in Malaysia. Admittedly I have no opinion on this because I simply do not know which is the preferred choice. Why talk about US and UK medical care system as if there is nothing good there. I think the only point that you are not happy in your whole argument is that the medical insurance in the US is expensive. My question to you is: is it expensive vis-à-vis the income you are earning? If you have medical insurance, are you generally happy with the service and coverage provided. Please be more holistic when presenting your argument and don’t keep insulting others as if you are the most clever person on earth. You are not.
May 5th, 2008 at 00: 43.09
I think our Health Minister should look into this case.
61 year old MCA man, Mr. Wu Kim Wah (spelling doubted), died from appendicitis lately because the general hospital refused him early admission.
Mr. Wu went to the general hospital on 27 April 2008 for treatment after complained of abdominal ache. Hospital personnel prescribed him medicine and asked him to go home. On 28 April 2008, Mr. Wu’s condition got worse and went back to the general hospital. The nurse gave him intravenous drips and asked him to go home. However, Mr. Wu did not feel any improvement in his condition. On 29 April 2008, Mr. Wu went back to the hospital to request for admission after feeling cold in his body. The doctor refused his request claiming that there was not enough bed. The doctor finally admitted him after much persuasion by Mr. Wu and his family.
Initial X-ray diagnosis revealed that Mr. Wu had kidney stones. However, the doctor later found out Mr. Wu had a burst appendix. Mr. Wu was immediately given operation. He did regain consciousness after that. On 1 May 2008, Mr. Wu’s abdomen swelled up. The doctor said his intestine was not moving and that had caused the swelling. Mr. Wu’s condition deteriorated badly in the afternoon and the doctor continually gave him injections. Mr. Wu’s family asked the nurse what kind of injection the doctor gave him. The nurse cast an unfriendly look at his family and asked them to ask the doctor.
Mr. Wu died finally (probably on 1 May 2008).
What is wrong with our healthcare system? Throughout the tragic event I did not see the professionalism of our doctors and nurses. Are our doctors and nurses qualified? Turning away the patient because there is not enough bed is unacceptable. Are there not standard procedures for admitting a patient to hospital in this country? I don’t blame the rakyat for losing faith in government doctors and nurses after reading Mr. Wu’s case.
I believe Mr. Wu would have been alive if he listened to his wife and went to see a private doctor.
May 5th, 2008 at 00: 51.25
Good to have people like yourself who know what he/she is talking about rather than unbearable and unobjective rantings that most people here have resorted to. - killer
Look, if there is one who rants all the time, it is you. The fact that you could make such as statement is an indication that you are ranting, got it? Now please don’t misconstrue me. I am only defending myself and others who you described as “unbearable and unobjective ranting”. I am indifferent if you want to suck up to some people here.
May 5th, 2008 at 01: 29.10
Uncle Kit, please do serve the rakyat by highlighting the real problems and help us progress toward the First World standards in all aspects of governance. Don’t let us rakyat be a victim of your political games, just like what had happened during the 1st day of 12 GE parliment.
Hello, what are you talking about? You don’t even know this article is not written by Sdr Lim. By the way, what is wrong if there is some biasness? That is the purpose of this blog - to debate and allow different views to be presented, which I hope to you is not ranting.
May 5th, 2008 at 01: 37.02
With the current system, it is not economical to open so many pharmacies within the community as our role as a healthcare provider is only limited to minor ailments and non-prescription drugs. However, in the proposed system, Pharmacists can play a role in the medication process by opening up pharmacies practically everywhere! By then, it will also be viable to make pharmacies 24 hours. A certain law/regulation/code can be done to ensure that there is a pharmacy available within the vicinity of a clinic or such.
Pharmacies are bounded by the Code of Ethics as stipulated by the Pharmacy Board of Malaysia. It states that “The Pharmacist shall not by words or deed or by inference thereof discredit or disparage the professional integrity, or judgement, or skill of another pharmacist or of a member of an allied profession”. This means that if a patient comes to the pharmacy with a prescription for Panadol, pharmacists are not allowed to dispense any other brands of Paracetamol other than Panadol. As such, when pharmacists are in a situation where they are uncertain of the prescription ordered by the doctor, it is only professional of them to consult the doctor without alarming the patient. In the case of the Patient above, her re-filling of prescription is by order of the doctor. The pharmacists have to follow the prescription unless he suspects any non-compliance or medication errors. Whether or not he suspects anything is the onus of his professional conduct. To say that the pharmacist will overrule the doctor’s prescription is not true at all.
In addition to that, private clinics usually lump everything as “consultation and medicine fees” onto the receipt. As some have mentioned, we all don’t know the exact breakdown of the prices. Perhaps the Ministry should enforce such breakdown requirements, and then only we can compare the prices between a clinic and a pharmacy.
Certain medical ailments also do not require a doctor’s attention. The pharmacies role is to counsel the patient on his/her current condition and to recommend a therapy for him/her to follow. If you have seen patients talking to the pharmacist and pharmacist recommending some medication, the pharmacist is not going beyond his roles as all these are minor ailments. Unless the pharmacist suspects further underlying causes, he is obligated to ‘refer him/her to a doctor’. Yes pharmacies can help you measure your BP, measure your body temperature, check for scabies, dandruff or sunburn. Are these what you refer to as physical examination? In economic sense, this definitely reduces the patients’ financial burden to pay for consultation fees. Pharmacists do not charge for consultation.
My point here is, the physician-pharmacist role with regards to proper medication usage and patient safety can be greatly enhanced through such a system. Of course, there are other factors to consider like whether current pharmacists in Malaysia are equip through their professional education to dispense and counsel the patients appropriately? And whether patients are ready to trust pharmacist as much as how they trust the doctors.
FYI, you don’t have to get the medicine from the clinic itself currently. If you request for a prescription, you can always bring a prescription to your friendly neighbourhood pharmacist!
A Pharmacy Student
May 5th, 2008 at 01: 50.15
The problem is not just who prescribe or who dispense. The bottom line is affordability. The price of most imported drugs and medicine in this country are more expensive than developed countries whereas our disposal income is so much less. In the west, most prescription prices are control by the government. The government here should set a ceiling price on all prescriptions. It should also haul up all those big MNC drug companies and control the price of all medicine. I am sure there are plenty of rent seeker in the industry. It should also make more generic drug available to the people.
Otherwise our health service will be ” No money , don’t fall sick ” as posted by rick .
May 5th, 2008 at 03: 02.37
“Anyway the issue here is whether prescription and dispensation functions should be separated in Malaysia. Admittedly I have no opinion on this….” Limkamput
Hoi! How could you not have an opinion on this very important issue??
Doctors diagnose the illnesses their patients suffer from and prescribe the medications their patients need. That’s what doctors do all over the world - except for witchdoctors who got their certificates of practice from other than worldly sources. Pharmacists do what they do i.e. dispensing the medications prescribed by doctors for their patients. To mix the two could result in a volatile mix much like a Molotov cocktail. Never mind what it could do to your purse. This is recognized all over the developed world. Clearly Malaysia is not part of that world – even after some five decades of independence.
Anybody in Malaysia who suffers from bipolar (hint! hint!) would know that a couple of antidepressant pills sold after five minutes spent with your doctor could set you back by more than RM100. I have seen the dazed look on the faces of patients emerging from their doctors’ offices looking as if they are facing a death sentence, that they are sicker than they thought. To these poor souls they must be very sick to need all those drugs their doctors tell them they need. Little do they realize that it is just their doctors making up for the lack of business, making their living at the expense of their patients.
How could you not have an opinion??
“Undergrad2….you are just twisting and turning to suit your
argument”. limkamput
The only people who are turning are those now in their graves today who died needlessly as a result of medical negligence due to misdiagnosis, the prescription of the wrong drugs, over prescription of drugs by doctors or because they could not afford the cost of health care.
In the U.S. both primary physicians and specialists only carry samples of drugs to be distributed to patients free upon request by patients. Oftentimes, these are new (‘new’ as in there are no generics available) in the market and are very expensive even with health insurance. Even here the feeling that there is a conspiracy of sorts involving physicians and drug companies is not without basis. Every time there is a new drug in the market, you see physicians keeping stock of some of these free samples and prescribing them to their patients and keeping a record of their side effects.
May 5th, 2008 at 04: 21.09
I have not read all the arguments but it seems that most of it thus far can be reduced to a cost v quality/safety dispute - the problem being where the balancing point ought to be.
If that is the case, the problem here is that everyone has a different level of tolerance/equilibrium on the balancing scale - it’s gonna be one heck of a task to persuade people of either side to budge… Noone has after all produced substantive, concrete and contextualized empirical evidences to support any argument: and this is of course the task the MOH should be doing; Before any empirical evidence is produced, it’s pretty much useless to get into any heated arguments here - we’ve all got our views (or prejudices) entrenched in our minds and none of the arguments automatically ‘up’ the other since none of them is grounded on anything ‘real’ (read: immediately and directly related to the Malaysian context).
May 5th, 2008 at 04: 57.02
“I have not read all the arguments but it seems that most of it thus far can be reduced to a cost v quality/safety dispute - the problem being where the balancing point ought to be.” Slashed
The balancing point ought to be this, change the government and everything will fall into places.
May 5th, 2008 at 04: 58.15
“Look, if there is one who rants all the time, it is you. The fact that you could make such as statement is an indication that you are ranting, got it? Now please don’t misconstrue me. I am only defending myself and others who you described as “unbearable and unobjective ranting”. I am indifferent if you want to suck up to some people here.” Limkamput
Give me a break!
May 5th, 2008 at 05: 44.16
The article is very convincing but the fact is it has to be separated.The problem started when medical schools were established;a separate body to produce pharmacist did not exist.At the present we have enough schools to produce the number which means that argument can be put aside.The next question is about the rural areas.We should start out at the urban areas before going into rural areas.The question of who is better does not arise.A pharmacist with a doctorate advises a doctor the right medication in the US.Here we will soon reach that stage.If the MOH does not implement it will be a big set back and a laughing stock among the developing nations.One can criticize all aspects of the system but what is followed by the developed countries now is the norm.Any delay will not benefit the public.The doctors have to give up honourably before forcefully taken out.
May 5th, 2008 at 08: 10.00
“We see here an anthology of errors initiated by doctors, propagated by the patient’s health seeking behavior and perpetuated by a pharmacist.”
Why is it that every time there is a problem with the healthcare system the fingerpointing goes automatically to the doctors and the pharmacists ? The example above clearly shows that a large part of the blame should lie with the patient herself. Self medication, failure to inform a new doctor of her diabetic condition, etc are contributory factors to her plight. Putting the blame on a patient’s “health-seeking” behaviour is wrong - all of us are health-seeking in one way or another.
May 5th, 2008 at 08: 12.50
We can’t blame the doctors and the pharmacists for the bizzare behavior of a delusional contributor here. He thinks he has more “hits” than Kit, he thinks he gets more praises than the Lord, and he believes that he is the real expert on everything from religion to economics. He is probably self-medicating on Prozac but we can’t blame the doctors or the pharmacists for this, can we?
May 5th, 2008 at 08: 46.59
Undergrad2,
The context of debate here - bifurcation of physicians’ diagnosis/prescription from pharmacists’ dispensing (prevalent in first world society) relates to the question of choices – for the patient, consumer and public to their interest and benefit. When the question of choices comes in, it implies in a democracy informed choices, right to exercise them in the way best serving of patient/consumer and public interest.
However you have observed that:
· “the drug dealers do not donate to the campaign funds of presidential candidates for nothing”;
· “even here the feeling that there is a conspiracy of sorts involving physicians and drug companies is not without basis”
· “society here is so litigation oriented, doctors are reduced to practicing a new brand of medicine called ‘defensive’ medicine – defending themselves against the attorneys”.
Well in the US, besides drug companies’ lobby, there are the powerful Israeli lobby, the Energy (Oil/Gas) Lobby, Defence lobby, the NRA Gun Lobby, Tobacco lobby, ethnic lobbies, Broadcasters lobby (NAB & NCTA), Workers Unions, Farmers lobbies, Corporate lobby (Business Roundtable) and hundreds of other lobbies, all representing different interests, contributing campaign funds to President and Congressmen alike to serve their interests (money politics) and although no lobby can prevail all the time against all other lobbies, each does have a chance to influence government policies implemented at different times….
Again this backdrop of big government and lobbies, and notwithstanding the Fifth Estate and Bill of Rights, in realistic terms, how meaningfully can Americans participate fully and effectively in their democracy – and what real choices do they have to exercise relatiung to govt policies impacting on their lives??
When money controls politics – lawyers control laws – does an ordinary American have real control over public affairs or for that matter their private affairs including their health amongst other things?
I am sure there is a measure of control as well as lack of control but which is the more prevailing?
Life is simpler here. Politicians’ money politics is confined to just taking a cut/rent seeking from projects/govt contracts dished out or approved by the govt (‘stealing’ according to Godfather) and political power is maintained to indulge in this via playing race and religious card protected a plethora of draconian laws.
As against that, Malaysia post March 8th is pressuring for reforms –more NGOs & Civil Society having a say on public & political issues, more Rule of law, institutional check and balance etc like first world countries..but can money politics be escaped? Or for that matter will there be more real accountability and transparency in governance?
Are we moving to the direction where it becomes not clear as to who controls what, where institutions instead of working for our benefit, control us – where we have no real capability to exercise democratic choices ??? See the beginning of that in Penang where NGOs want to have a say on Penang state Govt policies.
What is your take on these broader issues?
May 5th, 2008 at 08: 54.56
Jeffrey QC,
You are asking me to write a book! I’d rather write a book on the issue of narcisssitic personality and its connection to ‘happy’ drugs like Prosac, Zoloft etc.
May 5th, 2008 at 08: 58.34
All the rich M’sian don’t seek treatment in Malaysia. They either go Singapore Elizabeth Specialist or UK, US.
The late Naza boss also seek treatment overseas. PL late wife.
Well, now they wanted to slaughter & exploit the mid & lower income group.
To all the BN napoleans enjoy the cooking.
May 5th, 2008 at 09: 02.32
Dear Medical Professionals , Please remember your Hippocrates’s Oath and do the right thing!
You have most likely found this website because you are suffering from an adverse drug reaction (”ADR”) to a fluoroquinolone (”FQ”) antibiotic. The fluoroquinolones include the brand names, Cipro, Levaquin, Tequin, Maxaquin, Avelox, Factive, Floxin, Noroxin, Penetrex, Zagam, as well as any other antibiotic that contains the words “flox” or “ox” in the generic name, such as ciprofloxacin, levafloxacin and gatifloxacin.
Some ophthalmic and otic (ear) drops solutions contain FQ’s such as: Chibroxin(norfloxacin), Ocuflox(ofloxacin), Quixin(levofloxacin), Zymar(gatifloxacin), Ciloxan(ciprofloxacin), Floxin Otic (ofloxacin), Cipro Otic (ciprofloxacin), Vigamox(moxifloxacin), CiproHC.
IF YOU ARE CURRENTLY TAKING A FLUOROQUINOLONE ANTIBIOTIC AND ARE SUFFERING FROM ONE OR MORE OF THE ADR’S LISTED BELOW, PLEASE STOP TAKING IT IMMEDIATELY, REPORT YOUR ADR’S TO YOUR DOCTOR AND DEMAND THAT HE/SHE PRESCRIBE A NON-FLUOROQUINOLONE ALTERNATIVE.
If you have finished your course of FQ’S and you are suffering from one or more of the ADR’s listed below, YOU MUST NEVER TAKE ANOTHER FQ ANTIBIOTIC AGAIN.
* Website - http://www.fqvictims.org
May 5th, 2008 at 10: 11.10
Like usual the government is building another fragile stack of cards …
The main fundamental point is this:
The idea or concept is good but the necessary prerequisites and fundamentals are not in place yet making this a harmful and bad move.
The same mistake has been over and over again until I lost hope in the current government especially the BN leaders that have been a majority part of the government until now.
Rome is not built in a day !!!!
The achievements and progress made by developed countries are a result of careful planning and meticulous execution over decades or centuries.
There is no shortcuts in life yet our government thinks it can bypass the hard development process and go straight to the final outcome … It just doesn’t work this way …
We started the National Automotive project (EON) when we don’t have a strong engineering background and highly educated workforce.
We build MSC when we don’t even have the necessary IT professionals.
We build Sepang F1 even when our automotive industry is struggling.
We build more universities and invited foreign universities to setup operations here even when our established local universities are struggling with dropping rankings.
Now we are meddling with the health care system ?
Sigh, when will Malaysians open their eyes and truly learn ?
May 5th, 2008 at 10: 38.31
I think the issue is “which is top priority” in our healthcare system.
Start from the root first.
I guess the standard of doctors is something MOH need to look into first.
1.Criteria for intake?
2.Dubious SLAB scheme where those unqualified guy end up as lecturer in medical school?
etc…
like the author pointed out:
“The MOH needs to clean up its own messy backyard before encroaching into the private practitioners”
I think that is the top priority.
May 5th, 2008 at 12: 56.29
Penang KT Koon wife also seek treatment outside Msia, Msia health standard? depend with which countries U wan to compare with?
But dont think it is improving with times!
May 5th, 2008 at 13: 37.42
Yes, we have learnt something new today. We found out that prolonged use of Prozac is the cause of narcissism.
May 5th, 2008 at 13: 43.25
My parents will normally go Singapore specialist for check up. They don’t really feel safe & confidence on Malaysia specialist, what is the statistic of accidents in Malaysia private hospital, this is not reveal. What abt. those who are poor and average, and those who never knew abt. overseas specialist. These are the group been exploited and slaughtered.
May 5th, 2008 at 13: 56.28
It’s a question of affordability. Specialists in Singapore and Hong Kong charge about 4 times what an equivalent specialist in Bolehland charge. In some cases, it could be up to 10 times. If you feel better at spending that sort of money, then by all means go for it. Accidents happen everywhere - recently there was a case in Hong Kong where a patient undergoing keyhole surgery died when the surgeon accidentally cut a major vein and caused massive internal bleeding. The surgeon was sued for negligence, but the court ruled that it was an accident
May 5th, 2008 at 14: 39.49
cheng on soo Says:
You claimed “Penang KT Koon wife also seek treatment outside Msia “.
Bro, care to cite your source ?
May 5th, 2008 at 14: 51.39
lakilompat Says:
Today at 13: 43.25 (56 minutes ago)
My parents will normally go Singapore specialist for check up. They don’t really feel safe & confidence on Malaysia specialist, what is the statistic of accidents in Malaysia private hospital, this is not reveal. What abt. those who are poor and average, and those who never knew abt. overseas specialist. These are the group been exploited and slaughtered.
Dear lakilompat, your parents must be really rich to do afford to undergo such routine checkups in Singapore. The cost of private medical care so much more expensive in Singapore than here. Only really rich or really foolish people would do such routine check ups in Singapore.
I am preplexed by your claim that the standard of private medical care is Malaysia to be of low standards. This is not a commonly accepted view of both Malaysians and foreigners (see below). Care to back up you claim ?
KUALA LUMPUR: Malaysia is among the world’s top five medical tourism destinations which presents the most attractive opportunities for medical tourists and foreign investors alike, according to an online source for news related to real estate investment and other investment opportunities.
Nuwire Investor said Malaysia ranked third after Panama and Brazil in first and second, respectively, followed by Costa Rica and India in fourth and fifth respectively. In a statement, it said these markets were selected based on quality and affordability of medical care as well as receptiveness to foreign investment.
Nuwire Investor said Malaysia’s medical tourism industry had seen staggering growth over recent years and the number of foreigners seeking healthcare services in Malaysia had grown from 75,210 patients in 2001 to 296,687 patients in 2006.
It said the large volume of patients in 2006 brought about US$59 million or RM203.66 million in revenue. According to Nuwire Investor, the Association of Private Hospitals Malaysia has projected that the number of foreigners seeking medical treatment in Malaysia will continue to grow at a rate of 30% a year until 2010.
http://www.theedgedaily.com/cms/content.jsp?id=com.tms.cms.article.Article_3c0c2eea-cb73c03a-a010ba00-9354bd98
May 5th, 2008 at 15: 02.16
killer, When you rant about, did others ask you for your source? Yes, i can confirm, KTK’ s wife (and son also) sought treatment abroad some times back. I am not complaining about it, i am just trying to tell you please don’t think others know nothing.
May 5th, 2008 at 15: 09.51
Killer,
If you want to talk about medical tourism, let me tell you this, Bangladesh, India, and may be even Myanmar also can perform medical tourism. Medical tourism is about devoting scarce resources to serve foreigners to earn foreign exchange. It has nothing to do with standard of medical care provided for its own citizens.
May 5th, 2008 at 15: 14.01
Killer:
We are dealing with a Mr Know All here, so whatever he says must be right. He is truly a superior being.
May 5th, 2008 at 15: 38.29
lakilompat
Food for thought for you…read the last post too…interesting…
Is Mt Elizabeth hospital’s health services deserve its perceived standard as a private hospital?
My mum was hospitalized recently due to dengue and to our horror, we discover for ourselves the quality of the Mount Elizabeth hospitalization service which would have killed her if we had not been cautious.
http://forum.channelnewsasia.com/viewtopic.php?t=127972
May 5th, 2008 at 15: 56.29
How often when we see a doctor and was given a sample drug and charge for it ? Samples that are suppose to be free and given by drug companies for testing purposes.
Usually a doctor only prescribe drugs that is available in the clinic ?
Doctors should stick to diagnosing a patient than thinking of the millions earn by dispensing drugs in their clinics.
May 5th, 2008 at 16: 02.52
I think that we should remember the words “chup sang” when we consult healthcare professionals.
In Cantonese, these words means “be aware” or “caveat emptor”.
In fact, everything we do in life is a leap of faith. In health matters, the leap of faith can be frightening!
I’m in my mid sixties and I have seen my fair share of doctors, specialists and what not. And I can tell you that there those who are good, those who are bad and those who are downright ugly!
The same applies when one sends a car, TV or other equipment for servising.
With one very important difference. If your
car or TV is messed up, you can always buy a new one. But if your health is messed up, you can be kaput!
But as patients, we can reduce the chances of such things happening by:
1. letting every doctor/specialist we
consult, know all the medication we
are taking as at that date. This is
important because we may be seeing
two or more types of specialists at
close interval.
2. bringing along someone to act as
our “guide” since a patient can be
influenced by the doctor to accept
his opinion because someone who
is sick my not be in a state of mind
to safeguard his own interests
3. I suggest that in the case where an
operation is necessary, a written
statement, listing both the benefits
as well as the detrimental side effects
must be given, by the doctor, to the
patient, signed by both the doctor and
patient AFTER the contents have been
fully explained to the latter. A copy
must be kept by both.
This is similar to the declaration signed
by the patient prior to an operation
that he accepts the risks involved
before an operation
Severe penalties, including
deregistration and heavy fines must be
imposed if there is any deviation from
this aspect.
Hopefully, the PR will keep on tightening the loose ends, not only in healthcare aspects of our life, but also every other aspects as well as we journey towards a brighter future.
May 5th, 2008 at 16: 08.45
“The balancing point ought to be this, change the government and everything will fall into places.” dawsheng
Inadvertently, this is in fact BN’s mentality – they think there is a simple and quick solution to every complex problem. Pathetic again.
May 5th, 2008 at 16: 22.09
may i just know something… should i just give up going back to Malaysia to practice? I’m a pharmacy student btw..
May 5th, 2008 at 16: 51.13
“Antidepressants like Prosac, Paxil and Zoloft must be taken only when prescribed by a doctor – not even a pharmacologist.”
erk pharmacolgists were actually medical doctors who attained their specialty in pharmacology. u mean pharmacist?
and these pharmacologists got many types…paediatrics pharmacologists, hematology pharmacology etc! if in university hospitals, these hot guys who actually control the pharmacy department not the pharmacists…haiya pharmacist does not necessarily has more knowledge than a doctor on pharmacology
May 5th, 2008 at 16: 53.26
my experience ha
even a phd pharmacist ranked below a specialist pharmacologist (erk only second degree level)
and i mean based upon knowledge gap lah
May 5th, 2008 at 17: 05.08
The cost of private medical care so much more expensive in Singapore than here. Only really rich or really foolish people would do such routine check ups in Singapore. [Killer]
Killer, if more expensive medical cost = quality, I would opt for it anytime. Its not the matter of whether you are rich or foolish, its about assurance. I have personally experienced the horror of lousy medical care (TWICE!) at Hospital Tengku Ampuan afzan, Kuantan (HTAA). You may want to read my previous posting if you are truly interested. But to cut it short, its a wrong diagnosis on my mother for final stage cancer in 2000(She’s still very much alive and kicking today!) and another wrong diagnosis of 3rd stage cancer in 2006. The doc even arranged her up for chemo theraphy. Imagine what chemo will do to a healthy person.
May 5th, 2008 at 17: 40.32
First, we must understand that separation of prescribing and dispensing (SPD)is a good system. Many developing countries have already implemented. No country cancel it after the implementation of the SPD , nor did the people because of the SPD and overthrow its government. This shows that the SPD is definitely a good system, the ultimate beneficiaries wii be the general public.
But why the country’s independence 50 years, still can not implement SPD? A doctor can not accept this? May be yes. Insufficient number of pharmacists? May be yes. Doctors are not prepared about it? May be yes.
Why do these problems arise? This is because our medical system as early as the 1980s is just being like our judicial system,ruined by the BN political game.
Just think, if the BN doctors join the MMA, will they ask to promote separation of prescribing and dispensing ? Dare they offend the MMA? In this regard, you can’t blame that very few pharmacists join in politics,it is because in the 1980s to 1995s, less than 100 pharmacists graduated per year. You can see the number of MMA is far more than the MPS. So,if the BN doctors join the MMA, they will protect the MMA rather than MPS. Hence,they will forget about beneficial of SPD.
So I conclude, if the BN to continue to lead this country, the final result is difficult to implement the separation of prescribing and dispensing
May 5th, 2008 at 17: 44.02
haiya just let the people decide lah, if wanna buy meds from doctor buylah, if want buy from pharmacy just let them be…its their money and its their life…a law forbidding drugs being dispensed by either one is totally unnecessary…
weve got problems in both medical and pharmacy community. diagnoses are made by signs and symptoms supported by certain investigations. however not all disease presented typically, some very unconventional u know, medical doctors are not god. so thats why these misdiagnoses happened lah…
an approach toward a patient is based upon team of professionals and of course the medical docs lead while the other allied health professionals each contributed their part lah…
if one poor guy goto see a pharmacist for fever. i bet he only receive panadol for that and nothing else. reminded there are hundreds causes of fever alone. a medical doctor role is to rule out more serious causes of fever. and this is done through certain questions on certain thing that a doctor should know lah. im sure a pharmacist cannot do this…
May 5th, 2008 at 18: 18.41
My take is the system is not in place for such change yet. More specifically, u can’t take one part of a system from other country e.g. pharmacist dispense, n implement it here without studying the background of the healthcare system of both countries thoroughly. As pointed out by undergrad2, in UK doctors or rather clinics under NHS doesn’t collect any fees fr patients but they are assigned a certain number of patients and paid based on that. In Msia, no patient equals no income. In UK the doctor is still paid eventhough the patient assigned under him doesn’t make a visit. With the segregation,do u really expect anyone to spend up to 7yrs or more to qualify as a doctor, the so called coveted n nobel practice, only to charge RM30 or whatever the sum is within the permitted range for the rest of his profession as a GP? GPs unlike lawyers, consultation fees doesn’t increase with years of experience. 30 years of experience doesn’t translate to consultation fee of RM300 per person. It may still only be RM30. I don’t know if any other GPs charge according to years in practice but my family sure don’t, I would have a BMW Mseries for my 18th birthday if they did!
May 5th, 2008 at 18: 40.47
syncbasher83,
The reference to pharmacologists is not a slip. Getting drugs from a pharmacologist, for example, is now standard practice in the U.S. just like getting therapy from a psychologist or counselor is – services paid for at a lower rate.
May 5th, 2008 at 18: 46.24
Lawyers now refer what used to be physicians as pharmacologists.
May 5th, 2008 at 20: 06.04
wah! i really dont want to be in the middle of these lawyers fight…
undergrad,
wah really? if understood by medical profession, thats really wrong knoe…
pharmacists are different from pharmacologists, physicians are very well different from pharmacologists…
pharmacists are those with 1st degree in pharmacy…
the basic root in medical professions are:-
1) physicians who basically are those who specializes in medical treatment…and
2) surgeon…v all knoe well who they are…
pharmacologists are subset of physicians, all pharmacologists are physicians but not all physicians are pharmacologists…
pharmacologists are those who specializes in pharmacology/drugs
not all physicians specializes in pharmacology so not all physicians are pharmacologist…
search in any medical school, medical department which houses physicians are totally separated from pharmacology department…
but erk this is my view as a medical student, but um if lawyers considered all physicians are pharmacologists then the only thing i can say is that, um thats wrong, at least as far as i knoe
May 5th, 2008 at 20: 26.22
synbasher,
There is only one lawyer here and limkamput is the one.
May 5th, 2008 at 20: 27.05
You pseudo lawyer! I said I have no opinion over the choice. I did not say I am not aware of the separation in function in certain countries. If I am a fraud, you are hypocrite - a mega hypocrite.
May 5th, 2008 at 20: 27.47
you are busted, pure and simple, hypocrite.
May 5th, 2008 at 20: 53.29
That’s right how could anyone lived in the U.S. and not have an opinon on the matter?? If you’re aware then you must have an opinion!
May 5th, 2008 at 20: 54.53
now talking on the case of the kid who lost her arm…the case was like this…
she was suspected to have nosocomial infection such as methicilin resistant staph aureus (MRSA). she was given vancomycin which is a very potent antibiotic against such infection as well as its side effect.
now the fault was, the houseman incharge gave her in bolus (one shot injection) whereas the standard should it be diluted in normal saline or given as slow infusion using infusion pump…
and of course the blame should go to the HO for being unaware…
but the fault should go to the whole team…
1) if the pharmacist incharge is competent enough, they should have reviewd every drugs prescribed and advice on doctors prescribing them especially those with serious side effects…but well pharmacists in MOH hosp prefer to be only in the pharmacy behind the counters rather than being in the ward reviewing the drugs…
2) the staffnurses which most of them are senior enough to aware of the mistake done by the 1 year old of medical life houseman…
3) the MOs should have been more concerned on their juniors, they should have less chitchatting in the coffee shop…
May 5th, 2008 at 20: 57.48
“IF YOU ARE CURRENTLY TAKING A FLUOROQUINOLONE ANTIBIOTIC AND ARE SUFFERING FROM ONE OR MORE