very well said, KKK. as u and I r from the industry we understand much better than the man on the street. many comments here made me want to laugh out loud. basically most equate a pharmacist to a medicine peddlar and not a medical professional. most talked about convenience and r not willing to sacrifice that for improved safety, this is mind boggling, really!

there are much more the pharmacist community need to do to educate the public. surely their asking for making their own choice and this should not be the ministry’s decision is very wrong. we know that decisons made under such circumstances surely can never be a good one.

alternatively, all doctors should be made compulsory to present every patient with a prescription (and also the patient to keep a copy) whether he wants his medicine from the doctor or his choice of pharmacies. this will be able to avoid doctors forcing medication on their patients. this also will let the patient to compare prices. too many a times patients do not knowq what medicine they are taking!

lakilompat,
there is a thing call telephone.
even at this moment where doctors are doing dispensing, they still write out prescriptions to be filled by pharmacists (for medicine not available at their clinics), we sometimes encounter this – dr wrote wrongly/ prescribed wrong medicine, we CALL the precribing dr to clarify! and pls do not make up your own stories, NURSES (in private clinics, these are school leavers and not state registered nurses) are not trained to ask the dr!!! they are not able to identify these! even if she is a lawyer, engineer, accountant, PM (yes..badawi)… they cannot do it!!!

i have to say too, lakilompat, u r doing a good job by exposing what the public do not know and this gives a chance for pharmacists to educate, thank you…. pls continue.

P/s– it’s pharmacist, not pharmist!

let’s move on from lakilompat to some more serious ‘concern’.

this is what Dr Milton Lum wrote in to NST, pls comment.

By : DR MILTON LUM, Petaling Jaya
I REFER to the reports on the issue of dispensing medicine (“Doctors to be disallowed from dispensing medicine” – NST, March 29 and “A need for 24-hour pharmacies” – NST, March 31) and the misrepresentations in the statements attributed to John Chang, past president of the Malaysian Pharmaceutical Society (MPS).
Among his claims were:

– With serious risks to health due to improper medication, it made better sense for patients to get their drugs from a pharmacist who would have spent four years acquiring the knowledge rather than from a doctor who had none.

– Doctors stock drugs they prefer to prescribe and, more often than not, these are the ones which give them (more) profit. If the system (separation of functions) is introduced, doctors cannot hold patients to ransom any more.

– The separation of functions is almost like allowing the patient to have a second opinion from a pharmacist.
Pharmacology is not synonymous with pharmacy, although the two are sometimes confused in everyday usage.

Pharmacology, which is the study of the interaction between drugs and humans to produce a change in function, is part of a medical undergraduate’s training and continues throughout the medical course.

Pharmacology encompasses drug composition and properties, drug interactions, toxicology, therapy, and medical applications of drugs.

On the other hand, pharmacy is the study of medicinal substances and drugs, their origin, nature, properties, formulation, production and effects, and their use in humans and animals. Depending on the university, pharmacology may or may not be part of the pharmacy course.

There is also confusion between prescribing and dispensing.

Depending on the illness, a doctor prescribes treatment, which may or may not include drugs, subsequent to making a diagnosis, after taking a history, doing a physical examination and/or carrying out diagnostic investigations.

A prescription is a written instruction authorising a patient to be issued with drugs and/or other treatment.

Dispensing refers to the preparation and supply of drugs prescribed by doctors.

Because of the nature of their training, doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe.

The only healthcare providers who see and treat adverse drug reactions are doctors. Nurses also see adverse drug reactions and they assist doctors in treating them. However, pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals, where they may see and assist doctors.

Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history. Such information is usually provided by patients to their doctors. This information is usually unavailable to pharmacists or, if available, insufficiently detailed.

Drugs are prescribed and dispensed by doctors. Some are branded drugs while others are generics. Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown, unlike the branded drugs.

Many doctors are already prescribing and dispensing generic drugs.

When bulk purchases of drugs are made, bonuses may be given by suppliers to the purchasers, irrespective of whether they are doctors or pharmacists.

Patients seen in private clinics have a choice of having their prescriptions dispensed by the clinic or by a pharmacy. Doctors who dispense incur costs for providing the service, i.e. carrying cost for the drugs and staff salaries.

The claim that doctors prescribe and dispense expensive medicines because of profit and hold patients to ransom is inflammatory.

Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible.

The proposed pilot study by the Health Ministry should answer a fundamental question: Who decides where patients should get their drugs from; doctors or pharmacists? Or is it the patient’s right to make his own choice? The MPS president’s advocacy that patients be deprived of his right of choice in the dispensing of his drugs, needs an answer from the people who are affected, the patients.

in responce:
“Depending on the university, pharmacology may or may not be part of the pharmacy course”
a ‘pharmacy’ course that do not include pharmacology cannot produce pharmacy graduates, but only pharmacy dispensers or technicians (which is not quite true since dispensers do learn about basic pharmacology as well)

“doctors are legally permitted to prescribe and dispense, and pharmacists are legally permitted to dispense but not to prescribe”
this is the malaysian senario.
and pharmacists are legally permited to PRESCRIBE medicine (these are knowned as poison C drugs) for certain minor ailments.

“pharmacists do not usually have practical knowledge about adverse drug reactions unless they are practising in hospitals”
Almost all pharmacists have practical attachments with govt hosp before being granted their practising certs.

“Drug interactions can be minimised when there is knowledge of the patient’s medical, surgical, drug and family history”
drug interaction – family history??? dont try to pull a fast one, doc. i do not even want to say u yourself dont even know…. how sad! that’s your doctor, not a normal GP but a respected specialist!!!

“Many branded drugs do not have generic equivalents. Not all generics have the same efficacy as the branded drugs. It is a fact that the bioequivalence of most generics are unknown”
perhaps the DCA (drug Control Centre) would like to make a police report, the good doctor suggested DCA failed to protect the public by approving ‘inferior’ products?

“Claims that doctors have no knowledge about drugs, adverse drug reactions and drug interaction are mischievous and irresponsible”
who said that? there is a difference between no knowledge vs limited knowledge compairing to a pharmacist.

either Dr Milton asked someone to write this piece or he surely can come out with something much better…. SAD, yes, very SAD!

in NST, a govt hosp MO, D.C.H., Kajang wrote: “pharmacists face no small amount of competition from general physicians. So in order to survive, some pharmacies resort to selling controlled medication (including antibiotics) over the counter to patients regardless of whether they carry a little piece of paper stating the drug name, dosage, and frequency and duration of administration with them”.

confession – MOST retail pharmacists do this!!! yes, i am talking the majority of us! why? yes, for survival!
prescriptions – we dont see much of these, let alone one that is properly written (most doctors either do not bother to write a legally proper script or do not even know what a proper one should be!).
to solve this – make it compulsory for doctors to write proper prescriptions for EVERY case, yes, every case.
then, and only then the choice of either buying from the doctor or their preferred pharmacy is in the patients’ own hands!

hours after i posted the supposed sarcastic piece above… i got the support from BBC (but that’s regarding Uk’s healthcare system of course)!!! i paste here:

Page last updated at 10:34 GMT, Thursday, 3 April 2008 11:34 UK
Chemists ‘to offer GP services’

The government wants chemists to play a greater role in providing care for those with minor ailments, potentially freeing up GPs for more serious ills.

It believes pharmacists are a vastly under-used resource who could easily provide diagnosis for some conditions as well as dispensing treatments.

Primary care trusts – responsible for local health services – already have the power to ask more of chemists.

But the extent to which they do so varies greatly across England.

This is what the government wants to address in a new White Paper, which is designed to encourage PCTs to commission more services from pharmacies by outlining exactly how they could assist.

It is estimated the proposals could save 57 million GP consultations a year.

Health Minister Ben Bradshaw said pharmacists were health professionals capable of dealing with minor ailments, screening for diseases and giving health advice.

“As 99% of the population can get to a pharmacy within 20 minutes, everyone will benefit from more types of treatment available through local pharmacies who can prescribe more, advise more and deal with more.”

Smoking and pregnancy

The kind of services envisaged include vaccinations, help with quitting smoking, and management of long-term conditions like asthma and diabetes.

The “health MoTs” – checks for heart disease, stroke, diabetes and kidney disease for the over-40s announced earlier this week, are also a target.

Many chemists are also already involved in tackling teenage pregnancy, with powers to distribute the morning-after-pill.

The British Medical Association (BMA) broadly supports the move, while the Royal Pharmaceutical Society of Great Britain (RPSGB) also welcomed the news.

“Research has shown that the vast majority of the public has easy access to pharmacies: 99% of the population can reach a community pharmacy by car, by walking or by public transport within 20 minutes,” said Paul Bennet, RPSGB chairman.

Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee said better use of pharmacists could save GPs an hour of consultation time a day.

“We have a tremendous resource in community pharmacists – we’ve got 10,500 in England alone – and they see people with minor ailments every day of the week.

“There is a real opportunity to use the community pharmacy network to take a burden off GPs.”

But David Stout, director of the Primary Care Trust Network, said that while involving pharmacies was a good idea in practice, it was not always easy for PCTs to find the funding.

“Unfortunately everything costs money, and when you commission services from a pharmacy to free up doctors, you’re still paying the same amount to each GP practice – so it doesn’t release any funds.”

“PCTs are working under significant financial constraints, and have to prioritise.”

New contract

The Conservatives also support the idea of using chemists, but said the government had promised in 2005 to do more on this front when it introduced the new community pharmacy contract.

This gave pharmacists the ability to operate as “supplementary prescribers” – handing out repeat prescriptions to prevent patients having to go back to their doctors.

But according to the Tories, figures show that in England just 101 pharmacies provided supplementary prescribing services in 2006/07 out of more than 10,000 community pharmacies.

“All the evidence shows that, three years later, the government has failed to use the contract to deliver the new services it promised,” the party said in a statement.

The Confederation of British Industry (CBI) says involving pharmacies could in the long term save money.

“Seeing a pharmacist costs far less than a GP appointment, and as people are generally seen when they are relatively healthy, problems can be identified before they become a significant long-term risk,” its director of public services, Dr Neil Bentley, said.

But Professor Steve Field, chairman of the Royal College of GPs, said although he welcomed extending the role of pharmacists it may not save GP time.

“By involving pharmacists in preventative healthcare and screening, GPs will actually be busier as we will be identifying more patients who might otherwise slip through the net.

“We believe that there are opportunities for pharmacists to work much more closely with patients – but this needs to be done in partnership with GPs and primary healthcare teams, not instead of.”

thanks for your kind words, KKK. i am not angry, not even a single bit.
FYI, i am already into my twilight yrs in my community pharmacy career, contemplating what i should do next. i have actually started in retailing, then to pharma sales, and moved on to pharma biz management; back to retailing until today.

i am writing all these more for the benefit of the younger generation pharmacists in this country. and i do not deny that it would be a nice sending off for this old man if we do see this ‘right’ returned to the rightful owner before i march out.

i do not think dispensing separation will be very rewarding monetary to the pharmacists in the first place. but it is more for the dignity and due recognition.

at this moment i am still waiting eagerly for lakilompat’s reply.

KKK,
i believe your advice should be more suitable for papayamilk, too bad he said that he’d planned to leave this thread.

lakilompat, what i mean is, what do u think about this report:

The government wants chemists to play a greater role in providing care for those with minor ailments, potentially freeing up GPs for more serious ills.

It believes pharmacists are a vastly under-used resource who could easily provide diagnosis for some conditions as well as dispensing treatments.

Primary care trusts – responsible for local health services – already have the power to ask more of chemists.

But the extent to which they do so varies greatly across England.

This is what the government wants to address in a new White Paper, which is designed to encourage PCTs to commission more services from pharmacies by outlining exactly how they could assist.

It is estimated the proposals could save 57 million GP consultations a year.

Health Minister Ben Bradshaw said pharmacists were health professionals capable of dealing with minor ailments, screening for diseases and giving health advice.

“As 99% of the population can get to a pharmacy within 20 minutes, everyone will benefit from more types of treatment available through local pharmacies who can prescribe more, advise more and deal with more.”

Smoking and pregnancy

The kind of services envisaged include vaccinations, help with quitting smoking, and management of long-term conditions like asthma and diabetes.

The “health MoTs” – checks for heart disease, stroke, diabetes and kidney disease for the over-40s announced earlier this week, are also a target.

Many chemists are also already involved in tackling teenage pregnancy, with powers to distribute the morning-after-pill.

The British Medical Association (BMA) broadly supports the move, while the Royal Pharmaceutical Society of Great Britain (RPSGB) also welcomed the news.

“Research has shown that the vast majority of the public has easy access to pharmacies: 99% of the population can reach a community pharmacy by car, by walking or by public transport within 20 minutes,” said Paul Bennet, RPSGB chairman.

Sue Sharpe, chief executive of the Pharmaceutical Services Negotiating Committee said better use of pharmacists could save GPs an hour of consultation time a day.

“We have a tremendous resource in community pharmacists – we’ve got 10,500 in England alone – and they see people with minor ailments every day of the week.

“There is a real opportunity to use the community pharmacy network to take a burden off GPs.”

But David Stout, director of the Primary Care Trust Network, said that while involving pharmacies was a good idea in practice, it was not always easy for PCTs to find the funding.

“Unfortunately everything costs money, and when you commission services from a pharmacy to free up doctors, you’re still paying the same amount to each GP practice – so it doesn’t release any funds.”

“PCTs are working under significant financial constraints, and have to prioritise.”

New contract

The Conservatives also support the idea of using chemists, but said the government had promised in 2005 to do more on this front when it introduced the new community pharmacy contract.

This gave pharmacists the ability to operate as “supplementary prescribers” – handing out repeat prescriptions to prevent patients having to go back to their doctors.

But according to the Tories, figures show that in England just 101 pharmacies provided supplementary prescribing services in 2006/07 out of more than 10,000 community pharmacies.

“All the evidence shows that, three years later, the government has failed to use the contract to deliver the new services it promised,” the party said in a statement.

The Confederation of British Industry (CBI) says involving pharmacies could in the long term save money.

“Seeing a pharmacist costs far less than a GP appointment, and as people are generally seen when they are relatively healthy, problems can be identified before they become a significant long-term risk,” its director of public services, Dr Neil Bentley, said.

But Professor Steve Field, chairman of the Royal College of GPs, said although he welcomed extending the role of pharmacists it may not save GP time.

“By involving pharmacists in preventative healthcare and screening, GPs will actually be busier as we will be identifying more patients who might otherwise slip through the net.

“We believe that there are opportunities for pharmacists to work much more closely with patients – but this needs to be done in partnership with GPs and primary healthcare teams, not instead of.”

thankyou in advance lakilompat.