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.
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.
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.
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.
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.
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!
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
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.
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.
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.
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.
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.
Food Security – Our Basic Rights Molested
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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.
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.
Datuk Liow is only going to prove what his predecessors said i.e it’s the Ministry of Hell
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……………
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!!
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.
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.
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………..
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
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!!
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 ?
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!
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
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.
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.
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.
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 ?
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.
“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.
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.
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??? :)
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…..
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
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..
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.
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.
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.
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.
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
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 .
“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.
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).
“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.
“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!
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.
“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.
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?
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?
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.
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.
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
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 ?
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.
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!
Yes, we have learnt something new today. We found out that prolonged use of Prozac is the cause of narcissism.
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.
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
cheng on soo Says:
You claimed “Penang KT Koon wife also seek treatment outside Msia “.
Bro, care to cite your source ?
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
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.
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.
Killer:
We are dealing with a Mr Know All here, so whatever he says must be right. He is truly a superior being.
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
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.
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.
“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 i just know something… should i just give up going back to Malaysia to practice? I’m a pharmacy student btw..
“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
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
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.
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
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…
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!
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.
Lawyers now refer what used to be physicians as pharmacologists.
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 :-)
synbasher,
There is only one lawyer here and limkamput is the one.
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.
you are busted, pure and simple, hypocrite.
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!
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…
“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.” – Corporate.Scandals
Corporate.Scandals, you’re spot on!!
There are many so-called doctors/specialists who do not give a damn that the medicines, especially antibiotics, that they give to their patients are causing them very serious side effects.
What’s worse is that they don’t bother to ask their patients what other medicines that they are taking that may cause serious interactions!
In the same vein, they don’t bother to inform their patients how the antibiotics should be taken!
Some antibiotics should be taken on a really full stomach and the patient should take it with an adequate amount of water. Failure to do so can cause stomach ulcers. It’s a fact the many of our doctors are dispensing antibiotics like candies – even those that cause serious side effects!
I have asked some doctors about why patients are not told of the serious side effects of some antibiotics and the reply was: “There is no law requiring them to do so”. NO LAW, NO TELL!! This shows just how callous our doctors are about something that can cause very serious side effects!
I think that Uncle Lim must take immediate action to remedy the situation before more damage and suffering are done to the patients.
this is another typical case here in malaysia…
one malay girl admitted for epigastric pain diagnosed as having gastritis on Oesophagogastroduodenoscopy. She was discharged well with oral omeprazole…
then she had fever with Upper respiratory tract infection symptoms, she went to a pharmacist and was given aspirin. the fever was not subsided and she continued taking aspirin for months…
that prolonged aspirin caused more irritation to her stomach wall. her stomach wall with prev gastritis had developed malignant changes into stomach cancer which causes the prolong fever….
the URTI symptoms were only superimposed…
well when the condition worsen, she was admitted and of course the blame goes to the doctor for not diagnosing her of having stomach cancer…
problem wise, the prolong aspirin causes the malignant changes, it was just gastritis in the first place…
“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.” Procol
Yes, procol. I have mostly fond memories of the years I spent in the U.K. Whenever I visited my doctor, I never had to pay anything. With dentists it was slightly different. I had to pay a small sum. Imagine I paid a mere 10 Br. Pounds for a root canal which gave me no problem for 20 years! In Malaysia the same root canal costs several hundred ringgits. In the U.S. today I would have to pay no less than USDLS3,000 and that comes with insurance. Don’t even begin to think how much it would cost without insurance!
.
You rightly pointed out that if the lucrative part of the business of GPs in Malaysia (primary care physicians or PCPs as they are called here) which includes the dispensing and sale of drugs to their patients, is parceled out to pharmacists, many would not even consider medicine as their profession.
However, I’m sure you’ll agree that as patients our primary concern is getting the right drugs we need and not how doctors would do in their business as GPs if they are precluded from dispensing drugs to their patients.
I dread to think what could happen when a doctor has run out of supply say of Paxil (an antidepressant popular with school kids at least in the U.S. today) and dispensed the more powerful Zoloft to his or her patients! The more controversial use of Zoloft and Prozac as you know has been linked by many to murders and suicides.
It is important that we separate the issues.
a pharmacist’s job is to give meds based on ur symptoms…
but a doc is required to treat the cause…
now lets choose…
I think that certain dangerous antibiotics should be banned if there are more “benign” alternatives.
The earlier this is done the better.
certain dangerous antibiotics should not be banned, it should be prescribed more carefully lah…
if in MRSA, giving another ‘benign’ alternative may cause the bug to be even more resistant adding to its multidrug resistant aledi…
it should be treated aggressively…
when the risk of dying from MRSA outweigh the risk of vancomycin’s side effects, its the doc role to act fast and decisive…that is when these dangerous antibiotics come into view…
syncbasher83 Says:
a pharmacist’s job is to give meds based on ur symptoms…
but a doc is required to treat the cause…
now lets choose…
If you can, please explain to me. If a doctor examines a patient, I suppose the doctor will also know the cause. He then prescribes the medicine. Once the medicine is prescribed, even under separate functions system, can a pharmacist change the prescription? I suppose the pharmacist must dispense the medicine according to the prescription. So where is the advantage of separate function? Please I know nothing much about this, so if you can please explain to me and the rest.
In more advance countries, it is always the case of Doctors prescribing the medicines and the patients have to buy the drug from pharmacy, and in some cases the pharmacist also recommend the patients different type of medicines then the prescription, this is because the pharmacists know about drug much better than a Doctor. In order for this model to work in Malaysia, we need to have Pharmacy in every corner of our Towns and is available to the public 24 hours a day, we also need many trained pharmacists, are we ready for that?
well, im trying to be fair here…these pharmacist say that when it comes to separate functions, the pt ought to get more info on the drug they r prescribed…
ie when to take, enough water onot, before meal or after meal…
and oso got certain 1/2hour after meal…
contraindications, side effects etc…
-actually its basically a mini counseling on the drug
But the point is, Y not we give that right to choose to the patients? those who want more info can buy the drug from pharmacy and those who comfortable to getting it from GPs, so let them alone…
This question arise…these pharmacist wana their ricepot become bigger izit? jealousy?
now this is typical malaysian patient…
70 year old chinese man, very poor living only on selling pau. Hes diabetic for the past 20 years, very easy to forget things…
hes living with his wife, so when his wife is out to sell pau, he usually forget to take his pills…
so we came up with the idea of this antidiabetic drug well packaged into a very well arranged instructions and tablets according to daily doses…so we just asked his wife to put that meds together with his meals so that he wont forget…
luckily they can cope with that routine and he become much better now but of course it was not taken half an hour later after meal like our pharmacists guys told so…
hecks most diabetics in malaysia r in this age range…its good enough they can their doses accordingly, want them to take half an hour later somemore? common man be realistic…would they even remember to even think of their meds half an hour after meal? i bet most of them sleep aledilah man…
“! suppose the pharmacist must dispense the medicine according to the prescription.” Limkamput
You suppose??
Pharmacist are required by law to dispense drugs only as prescribed by physicians – no more and no less. The pharmacist does not and cannot overrule the physician and recommend the use of alternative drugs! The reason is simple. They are not doctors!
The pharmacist is under duty though to inform you if generics are available. Originals are still patented and are expensive. There is no generic for Benicar, for example, since it is new in the market. Vytorin, on the other hand, has a generic – simvastatin which is a lot cheaper. Doctors do the diagnoses and prescribe the medications for his or her patients’ need from the medical point of view. They do not look into the affordability of the drugs they prescribe. That need would be better dealt with by pharmacists since they have a duty to inform patients whenever generics are available.
What he meant to say was “I KNOW the pharmacist must dispense….” or “Nobody KNOWs better than me that the pharmacist must dispense….”. It was just a small lapse of judgement from Mr Know All.
hm GPs are trained to prescribed drugs based on their efficacy compatible to the severity of the disease…most GPs chose patented drugs due to its proven efficacy…
of course generic drugs r alot cheaper but alot of clinical trials done proved that these drugs has poor efficacy compared to their patented sibs….
if one patient got shooting BP like firecracker, prescribing generic antihypertensive has been proven to cause poor BP control…u knoe BP going up and down like hell, its messy and ended up haywired….
well then we can guesslah…hemorrhagic stroke then 8 feet under earth lah…
Anyone going to any GP being given this Uphamol 350? None rite?
this Uphamol 350 only can see in 7 eleven n pharmacy of course…im sad to see our pharmacy nowadays 7 eleven standard!
Haha got one story, last time i got fever so sajelah pegi pharmacy asking for panadol, u knoe the old white one, the one being used by all GPs…then this pharmacy asked me to buy this Uphamol 350, its more expensive, he said can cure better ma…then i refused, know Y?
this uphamol 350 has only 350mg of paracetamol or acetaminophen as compared to 500mg old panadol…more expensive for lower dose? standard dose is 500mg lah dats y u never see this uphamol 350 in GP clinics! except uguys can get those from pharmacylah, lagipun kan they all very well educated on drugs…
im seeing that pharmacist as the same as the 7 eleven casher trying to sell me those uphamol 350…and they wanted all to buy drugs from them only…what a heck!
Ok, I capitulate. You are the best. You know everything – law, philosophy, politics, sociology, economics, government, USA and now medicine, especially antidepressants, and henhouse. You are the Renaissance man (from now on this will be your new title). The other one of course will remain as your sidekick.
“They do not look into the affordability of the drugs they prescribe. That need would be better dealt with by pharmacists since they have a duty to inform patients whenever generics are available.”-undergrad
hmm, in any patient, he/she is being managed by any GP through 3 important steps- history, physical examinations and necessary investigations- all being well documented into one folder, or ticket we called it…
now this folder include one part in the history we called social history- standard info of the patient is required that r–>
1) their occupation
2) their monthly income
so i would like to clarify here lah, most docs will lookup on this when prescribing drugs comes especially when long term medication is needed…
the Q is–do pharmacist has the same system?
syncbasher83,
Doctors don’t mind not dispensing generic meds so long as the patients cld afford it n r willing to pay. The situation is not that ideal in reality. Doctors r sometimes forced to use generic drugs simply because “patented drugs” r too costly for patients. Lower income group will find it hard to cope if they didn’t use generic drugs, for eg hypertension is common even in lower income group. Imagine the strain on them if they hv to fork out over 100 per month just on meds.
“now this folder include one part in the history we called social history- standard info of the patient is required that r–>
1) their occupation
2) their monthly income
so i would like to clarify here lah, most docs will lookup on this when prescribing drugs comes especially when long term medication is needed…
the Q is–do pharmacist has the same system?” syncbasher83
LOL. I think if there is any specific data kept on patients regarding how much they earn, it is merely to help the physician decide how much to charge them!
Am I not right that the primary concern of physicians is with the health of his patient and not the size of his wallet? So when prescribing medication he is motivated by what drugs best meet the patient’s needs based on his diagnosis?
The pharmacist on the other hand dispenses medication as prescribed by the physician. The pharmacist deviates from the physician’s instruction only at his own peril! Here in the U.S. both physicians and pharmacists practice defensive medicine. They work hard to avoid getting sued by their patients especially those with deep pockets who could afford the best attorneys in town. Despite that medical malpractice suits are on the increase. Medical negligence is hard to prove, is a specialized field for attorneys but a very lucrative one. In many cases it involves judgment calls rather than negligence.
When I find the drug prescribed by my physician too expensive or is not covered by my health insurance or is covered inadequately, I’d tell him so on my next visit. He would then prescribe a cheaper drug or he would look to see if there is a generic available. Sometimes the physician does not know if there are generics available but the pharmacist would. If the pharmacist does not know nobody knows!
There is this fallacy about ‘original’ and ‘generic’ drugs. There is no real difference between the two. Original drugs are under patents for twenty years from the time it first came into the market. Generics will make their way into the market once the patent expires. The chemical composition is the same.
Haha got one story, last time i got fever so sajelah pegi pharmacy asking for panadol, u knoe the old white one, the one being used by all GPs…then this pharmacy asked me to buy this Uphamol 350, its more expensive, he said can cure better ma…then i refused, know Y?
this uphamol 350 has only 350mg of paracetamol or acetaminophen as compared to 500mg old panadol…more expensive for lower dose? standard dose is 500mg lah dats y u never see this uphamol 350 in GP clinics! except uguys can get those from pharmacylah, lagipun kan they all very well educated on drugs…
–> Perhaps you should listen to what the pharmacist has to say? A headache requires not more than 350 mg per dose if I’m not mistaken. Of course, chain pharmacies are also trying to make a sale so no rebut there! Are you living in a well-to-do community?
.
hecks most diabetics in malaysia r in this age range…its good enough they can their doses accordingly, want them to take half an hour later somemore? common man be realistic…would they even remember to even think of their meds half an hour after meal? i bet most of them sleep aledilah man…
–> I’m sure pharmacists won’t be the only one who would advise them on this. Some drugs are not effective, or ‘under-effective’ when you take it DIRECTLY after a meal. Some drugs need to be staggered between meals to ensure that it meets its efficacy. No doubt, the pharmacist is at fault here also for not coming up with a medication plan that will ensure complete compliance. However, this should go both ways – if they think they won’t be able to comply, they SHOULD talk to their healthcare providers about it.
im seeing that pharmacist as the same as the 7 eleven casher trying to sell me those uphamol 350…and they wanted all to buy drugs from them only…what a heck!
This question arise…these pharmacist wana their ricepot become bigger izit? jealousy?
–> No we’re not jealous. This is a profession, our profession defines us as a drug dispenser, patient counselor, drug management etc. This IS our primary role to society.
so i would like to clarify here lah, most docs will lookup on this when prescribing drugs comes especially when long term medication is needed…
the Q is–do pharmacist has the same system?
–> Pharmacist DO NOT dispense long term medication without a prescription. What they do is help keep track of their progress and if possible keep the prescriber up to date e.g. whether the patient has been complying, dosage reduction due to side effects etc.
I think what the Ministry should do, if they really want to implement such a system, is to EDUCATE the public on WHAT a PHARMACIST really DOES. So far all the comments here seem to suggest that only those living overseas know EXACTLY what it truly means when it comes to ‘separation of roles’
What do you have to say about limkamput who is self-medicating himself with Zoloft and Prozac and other psychotropic drugs??
Prolonged use (read: abuse) results in unusual aggressive behavior when these are designed to induce the “feel good” factor in patients.
thephunkypharmacy,
didnt i say i got fever? standard dose for that is 500mg, and the pharmacist like the 7 eleven casher trying to sell me the uphamol 350?
the main concern here is that, our pharmacist here competent enough ke? meaning not trying to play doctor?
1) can they make sure that when somebody coming with fever, all the other serious causes of fever r ruled out before giving panadol?
loss of weight or appetite? dysuria? frothy urine? neck stiffness? blood stained sputum? diarrhea or constipation?
2) can they make sure that when an antidiabetic come to buy metformin, that he really need that monotherapy metformin? even after 1 year of metformin, the blood glucose still spike high? would he ask this question and consider sending him to GP for combine therapy change or even insulin?
3) can they make sure that when a guy with BMI of 31 really does not need an antifilarials when he asked for one? he had 2 week history of typhoid fever, and how sure r these pharmacist that the salmonella typhi is not residing the worms?
Don’t look down on lawyers too much, limkamput! Because you gonna need the best of the best to defend you. Read this:
—————————–
Learn if you have a claim against Paxil, Prozac, Zoloft, Lexapro, Celexa, Effexor, Wellbutrin anti-depressant manufacturers.
Commonly-prescribed antidepressants are extremely dangerous.
Attorneys and class action lawsuits are investigating possible legal actions against the makers of Paxil, Prozac, Zoloft, Lexapro, Celexa, Effexor, and Wellbutrin, respectively, to recover for suicides or homicides–some completed, some only attempted–by patients in the first few days or weeks after they were prescribed one of these drugs.
—————————-
Didn’t Godfather and I advise you against the abuse of such psychotropic drugs?? Your narcissistic personality is a drag for readers here. It is time you admit yourself to hospital and do us all a favor.
Report the pharmacist that is supplying you with these drugs without the prescription of your psychiatrist.
i will shoot lawyers like you and your sidekick and if you live, i will shoot again. Talking about health care and medical insurance problem in America (yes America, what is your problem, you think you have the final say again?), you don’t even know the problem is caused by scumbag lawyers.
You see that’s what Prozac does to you! You should seek immediate treatment before you harm yourself.
This post has brought forward some very spirited repartee.
I hope that Uncle Lim can post a thread on euthanasia.
I personally feel that it is a necessary “evil” in our society, not only for those who cannot afford medical treatment (there are many such people in this country), but also for those who can afford it but feel that it is better to terminate the battle than to fight on.
syncbasher83,
1) Perhaps I should ask all my customers who come with fever to see doctors eh? and beware of symptoms that could represent very serious illness– loss of weight or appetite? dysuria? frothy urine? neck stiffness? blood stained sputum? diarrhea or constipation? @#$%^%$# Come on la, not even all the doctors look for this ok!!Go ask kedai runcit owner to do the same when they are selling panadol….look for frothy urine…hmmm…
2)I do advise my customers to go for regular check up and have their medications reviewed by the prescribers, so what? U think we are dispensing machines and can’t give appropriate advice?
3)can they make sure that when a guy with BMI of 31 really does not need an antifilarials when he asked for one? he had 2 week history of typhoid fever, and how sure r these pharmacist that the salmonella typhi is not residing the worms? blah blah blah…………
My question is : What are you talking about?
YAWN…..endless debates…ZZzzzzz
syncbasher83
You’re right. You need a minimum of 600 mg per dose to be effective for fever. 2 X 350 mg is effective.
1) can they make sure that when somebody coming with fever, all the other serious causes of fever r ruled out before giving panadol?
loss of weight or appetite? dysuria? frothy urine? neck stiffness? blood stained sputum? diarrhea or constipation?
–> The pharmacist’s role for non-prescription setting is to aid in the treatment of minor ailments. We have the knowledge to ascertain when to say ‘May I recomment you XXX’ and ‘I would suggest that you see a doctor immediately’. The Code of Ethics for Pharmacists states that “In conformity with his own sense of responsibility, a pharmacist shall refer a patient or client to members of other allied pharmacists when, in the opinion of the pharmacist, the interest of the patient or client, is better served by members of that profession”. We don’t give you Panadol just because you said you have fever e.g. when fever comes with infection, or has persisted for more than 3 days.
2) can they make sure that when an antidiabetic come to buy metformin, that he really need that monotherapy metformin? even after 1 year of metformin, the blood glucose still spike high? would he ask this question and consider sending him to GP for combine therapy change or even insulin?
–> I cannot give you the answer, but like I said, are we ready to trust the pharmacists as much as the doctors? We spend 4 years learning about HOW DRUGS WORK while a GP learns 5 years on HOW TO TREAT A PATIENT. If it was me, yes I would consider that question.
3) can they make sure that when a guy with BMI of 31 really does not need an antifilarials when he asked for one? he had 2 week history of typhoid fever, and how sure r these pharmacist that the salmonella typhi is not residing the worms?
–> Like I said, when patients come to pharmacist, there is a border in our mind between ‘when can we safely allow a sale’ and ‘when symptoms could have a deeper underlying cause’. If it’s the latter, we’ll refuse a sale and ask them to consult a doctor.
This is a profession, our profession defines us as a drug dispenser, patient counselor, drug management etc. This IS our primary role to society.-phunkypharmacist
now man, we do have pharmacists in hospitals and why dont we see whether these pharmacists fullfill their job’s prescription before granting them the ONLY rights to dispense drugs…not to mention those pharmacies out there…
Other than chitchatting behind counters in hospital pharmacy, do they:
1) fully responsible for dispensing drugs? although most of the time the pharmacist is not there in a pharmacy so most work done by their salesgirl lah…
2) giving full counseling on dispensed drugs? – meaning the patients understand if not each, most. contraindications, side effects, drug interactions etc- most will say ” hah suma dh tulis kat depan botol tu, encik baca je arahan ye”…do they even clarify back with each patient whether they understand?
3) drug management? do we see pharmacist in hospital wards nowadays? where r they? as far as i know its the staff nurses who handles the drugs in wards although they r very well not educated on that field- staff nurses r who measure the doses, dilute the drugs, preparing the drugs and the doctors r who did the calculations…
and of course the pharmacists r who very well educated on drugs!
what use of education if they donot practices? dont say that they were not given the chance to practice…
syncbasher83,
now this folder include one part in the history we called social history- standard info of the patient is required that r–>
1) their occupation
2) their monthly income
so i would like to clarify here lah, most docs will lookup on this when prescribing drugs comes especially when long term medication is needed…
the Q is–do pharmacist has the same system
—————————————————————-
If u are talking about incompetency, let me tell u my story.
I used to work in a private hospital. There was once a specialist who wrote 7.5mg of Dormicum as 75mg just because the doctor forgot to write down the dot, and the nurse was pretty convinced that 75mg is the right dosage. I guess u know what is the consequences if the patient were to swallow this regimen.
If u think doctors can do it all, no problem for me. If u think humans do make mistakes, then so do pharmacists. There is no point highlighting one particular case and then singling out pharmacist as the culprit. As I can see, u are disparaging pharmacists in order to raise ur image as a doctor who know it all. Give me a break.
papayamilk,
so its the staffnurse who realize that its suppose to be 7.5mg. is she a drug dispenser? where goes the pharmacist? why theres no pharmacist to review? wah that private hospital really pay the pharmacist for nothing…
pharmacists are:-
1) drug dispenser
2) drug counsellor
3) drug manager
im not seeing any of these being fulfilled by the pharmacist in ur case above lah man…but of course ur salaries were paid…
papayamilk,
i bet u r in the pharmacy that time? chitchatting behind counter?
papayamilk,
i oso bet that 7.5mg dormicum was diluted by the staff nurse rite?
u knoe the staff nurse who do the drug dispensing?
isnt a pharmacist a drug dispenser? where goes the pharmacist?
have u guys been in any hospital?
who gives the drug to the patients?
who tell the patients to take the drugs?
who gives counseling on the drug?
the staff nurses of course!
dont we have pharmacist in hospitals?
YES WE DO. where are they?
simple answer lah…chitchatting behind counter lah, what else…
syncbasher83:
It’s a different setting in hospitals. The sad truth is, however that I agree with you on this. In government hospitals, those you see at the counters are “Dispensers” – they get the orders from the Pharmacists. The pharmacy technicians are the one filling in the prescription. The Pharmacists are managing the hospital pharmacy. Should there be questions dispensers cannot answer, they will refer you to the Pharmacists-in-charge.
Some hospitals are involving pharmacists in the medication usage process. They advise the doctors on the right dosage regimen aka they work behind doors. Some hospitals also have pharmacists doing their rounds with doctors already. I’m not sure about Msia, but in Singapore, we even have clinics ran by pharmacists e.g. diabetic management and smoking cessation clinics. Nowadays pharmacists also have specialized fields esp in oncology.
Again, something should be done to educate the public on the true roles of a pharmacist.
thephunkypharmacist,
im not questioning the roles of pharmacist here…
but when these pharmacists here in malaysia demanded that they are given the rights to play the role of themselves, there are a few questions…
are they competent?
is the present condition conducive enough for the separation of role?
u knoe trust is gained not only by educating the public…
show us uguys can fully function as a defined pharmacist, then we can give u the trust…as defined of course
the problem now is even most pharmacists here in malaysia themselves do not fully function as they were defined…
wanna demand for something else is ridiculous…
now the basic job of a pharmacist is to dispense drugs rite?
in pharmacy, its dispenser who dispenses drugs not the pharmacist
in wards, its the staff nurse who dispenses drugs, not pharmacist
how can we give out trust to you?
syncbasher83 ,
I’m going to rebuff ur claims one by one.
1) I worked in a government hospital. I was always asked by our pharmacy assistant to query doctors who wrote funny prescriptions. That is what we do. I guess u have the experience of being called up by a pharmacist who questioned ur prescriptions. And I believe u will always end up cursing pharmacists right? When someone challenged ur knowledge that is how u react right?
2)Seriously, have u ever seen any pharmacist that ask patient to read from bottles for instructions? Even if there is, I don’t think it represents all the pharmacists ok?
3)From my experience I know pharmacists are generally not welcome in wards because a lot of doctors (u are one of them definitely) will think that pharmacists are going to challenge their authority as prescribers because pharmacists are deemed less knowledgeable and doctors should not be questioned. Is that how u feel? How many times we see doctors initiating treatment without following proper prescribing guidelines? If their treatment is based on how they feel, it won’t be fair to the patient and it will be a waste of money. We are talking about rational use of drugs!
If u really want to debate u are gonna lose. So stop ur baseless claims. That will only make u more childish than u already are.
the phunkypharmacist,
thank u very much for ur honesty…
how well u have proven that
how far our pharmacists nowadays from their defined jobs which are
1) drug dispenser
2) drug counselor
3) drug management
instead pharmacists nowadays are pharmacy manager
great then forbid all GPs from prescribing drugs, then we ll see where its going…
syncbasher83 ,
U are really childish.
The medicine is dispensed by nurse of course. As an employee, I should not question what my bosses (doctors) ordered me to do. I was made storekeeper ok!
But for ur information, the medicine is issued by pharmacy staff and then brought to ward for nurses to administer. I think u mean I should go personally to the patient and then watch him gobble up everything ordered by doctors? I thought my role is to make sure the correct dosage was administered?
In short, u are jealous of what pharmacist know. And u are irritated by the fact that if pharmacists were to dispense, u will sure receive a lot of phone calls questioning ur prescription and most importantly, ur knowledge…I understand how u fee.l
papayamilk,
haha
1) nope im gonna say. “sorry my mistake, u knoe i oncall last night in the labour room, all 10 rooms are fulled from 8am yesterday till bout 7.30am this morning and got 3 ladies with cervix os openings of 8cm at the same time…im in hell retarded today. so thats why we need pharmacists in the wards
2) im seeing it all the time
3)im sure if u ask like this from the staff nurses. “erk akak boleh saya tolong dilutekan ubat tu?”, she will be more than happy to lend u the job. plus she got 2 patients who wet their bed with urine, another 2 wana go to toilet coz cannot walk and got another 1 hot ass shouting out loud like hell becoz her iv line dislodged.
in my entire life from 1st yr med student till now, ive never seen even 1 single pharmacist in the ward really…takkan seorang kena marah habis semua cabut kot…
and another thing, uguys work becoz of your work or just work becoz of the doctors?
Who Is This Towering Malaysian RPK – Background
http://www.wagthedog-malaysia.blogspot.com
papayamilk,
wah now storekeeper and drug issuer lah? not drug dispenser?
of course u have to make sure correct doses were given.
why let the staff nurses dilute the drugs?
of course u gave her correct amount? will she dilute correctly? betulke banyak tu normal saline nye? betulke bagi bolus atau kene slow infusion?
nak bagi im ke iv ke sc?
syncbasher83 ,
Use proper English if u will. I think u are the reason Tun Dr Mahathir wanted our students to learn science and maths in english. U are a doctor ok! With bad command of english how well can u communicate with ur patient? U are living in ur clinic and can’t solialize well with the world outside. The fact that u are an asshole has already proven that u can’t work well with ur counterparts also. U tend to belittle other doctors, pharmacists and so on.
Let me give u a piece of advice here: Don’t humuliate other doctors ok!
With bad command of english how well can u communicate with ur patient?-papayamilk
huh ive talking english to my patients?
u knoe most of them orang kampong, 50% aged more than 30 with 20% only SPM educated. talking english to them?
syncbasher83 ,
U keep on asking pharmacists to dilute drugs as if it is our jobs….Yes we do sometimes, it is only when we reconstitute cytotoxic drugs . U are really ignorant. How about u come to pharmacy doing some cream packing? If u can’t then u are incompetent ( see i am just imitating ur style of argument).
U lil bastard better be off working. I have plenty of things to do later. Oh yeah, I have another advice for u : Please subscribe to some good magazines like Readers Digest. It helps to improve ur english.
CIAO
syncbasher83 ,
Hahahaha u really keep me coming back with ur childish comments…Tell me is ur ‘Lancet’ journal written in english or malay? Is it written in a kampong style so that orang kampong like u can understand? Can u understand what is written inside or u just simply ask around for information? Laughing my ass off! Eeeeeek! Are u a doctor or merely an imposter?
Ok! My conclusion is u are NOT a doctor. U lil kid better dun be fooling around, otherwise i’ll tell ur mamma and she’ll do some spanking for ur own good.
bye bye kiddie
huhu atuk papaya,
im proud being org kampong, i can can serve the community well
pity la atuk papaya aiyoh kesiannye
pharmacist graduated with degree later become storekeeper…
kesian yek erk guna english cakap dengan kotak, penyapu dan bakul sampah ke?
bye bye atuk papaya, good luck with your storekeeping…
Ok this argument is going no where between syncbasher83 and papayamilk.
Syncbasher 83:
are they competent?
is the present condition conducive enough for the separation of role?
–> There will never be a conducive condition if the doctors are not willing too
–> Our professional education are as competent as it is. There may be blacksheeps, but heck don’t all professions have them.
Syncbasher83: instead pharmacists nowadays are pharmacy manager
–>Oh yeah, we dispense, counsel, manage the drugs, and also manage the pharmacy. I don’t see anything wrong with that. The nurses administer the drugs for you, not the doctor. The nurses give you your meals, not the nutritionist.
–> Being a pharmacy manager, a clinical pharmacist are what people call it as ‘career advancement’. This is how far they can go. So you doctors in the hospital don’t have to worry about us becoming the CEO. Maybe the head of Ethic Committee but that’s it.
and another thing, uguys work becoz of your work or just work becoz of the doctors?
–> In the present system where the doctor rules, isn’t that how it is?
Anyway, the Ministry is going to do a trial now. Let’s just see how it goes, then we can give the feedback on whether it’s feasible or not. Geez not like they’re going to implement it irreversibly for now.
Bahasa, English, Cantonese. You can’t speak all three of these, you can’t survive clinical.
All professionals here: doctors pharmacists nurses. Remember your Code of Ethics: respect your allied health profession colleagues. Be constructive in your comments. Don’t reply JUST BECAUSE.
Many years ago, a pharmacist in the OPD(out patient department) did his prescription screening. On one occasion, he saw a very scibble handwritting from a prescription. This prescription was prescribed to the Rheumatoid Artritis patient. In that prescription, no matter how we look at this prescription ,the writting wrote as methotrexate 2.5mg o.m. Pharmacist in charge who knew a mistake, showed it to the dispensers to see. He then asked how are they going to dispense it?Dispensers answered one tablet every morning.
Later, pharmacist asked the doctor on call, the doctor was intended to be 2.5 mg once weekly, but doctor is abbreviated as he refers to his o.w. is once weekly. So,doctors sometimes also can make mistakes. Because the abbreviations in medicine, got no such o.w. but only o.m.(every morning) .That doctor scribble, o.w. also wrote like o.m.
Fortunately, pharmacist noticed it earlier,if not , patient that supposed to take the medication once a week will become once daily , the side effects will be very serious, because Methotrexate is not an ordinary drug.
I didn’t mean to dig the weakness at doctors, but just want to emphasis that pharmacists can play their important role in separation of prescribing & dispensing in healthcare system. i.e. TO SOLVE DRUG RELATED PROBLEM.
I am a nearly registered pharmacist studied and working in Australia now. I am working as a clinical pharmacist, specialising in oncology pharmacy. As a pharmacist, we not only dispense medications, but we serve other important roles as well. Roles that might not be obvious to the laymans but hopefully getting more acceptance in the health professions. Here in Australia, a pharmacy can only be owned by pharmacist and to be opened, there must be a pharmacist on duty. We provide simple primary care to the public, advise them about over the counter medications for general illness eg fever, acne, diarrhoea and if there is a need, we will refer them to the doctor. We check for drug interactions, the dosage, adverse drug reactions and we provide patient counselling whenever they are started on new medications.
I might not have save lives as directly as a doctor, but I have certainly prevented a couple of deaths by correctly poorly written prescriptions. Poor drugs choice, fatal adverse effects, wrong route etc..they are just bound to happen especially in a busy hospital with newly registered drs.
We just have a new law change which will allow the pharmacists here to provide medical certs. The roles are evolving really quickly, we provide free advice to the public.
I have worked in a Malaysia hospital before and I have seen how messy the system is…drugs that are not longer used in developed countries but still persist due to lower cost. Drugs which have caused death..and cases closed with diagnosis written as unknown, shocking but true.
Will I ever come back to work in M’sia? Compulsory 3 years government service, low pay and low respect..may b no. I don’t study 4 hard years in uni just to be a store keeper.
To all the doctors still want to hold on to their gold pots, wake up and ask yourselves….is it worth it? Patient safety should be your main priority…
Have fun debating guys..hopefully in the end, patients will still be the main winner!
You guys please spare a thought for old limkamput who is still struggling with the side effects of psychotropic drugs known as ‘happy’ drugs!
Neither doctor nor pharmacists have stopped him from getting his hands on such dangerous anti-depressants.
thephunkypharmacy,
i dont know about there but here, this is the situation…
1) foods are given by nutritionists directly to each patient, they check on the folder whats going on with that patient and decide on what type of food they get. not only patients who were given foods directly but also those who are fasting for preop and postop. they go to each patient and counsel them on foods. not nurses
2) radiographers who take radiographs not staffnurses
3) physiotherapist who do physiotherapy not nurses
4) docs who take history, physical examinations, diagnoses and treatment plan not nurses
everybody plays their part except for pharmacists of course
its nurses dispense drugs for them
see the picture?
undergrad2 Says:
Today at 19: 46.22 (4 hours ago)
You guys please spare a thought for old limkamput who is still struggling with the side effects of psychotropic drugs known as ‘happy’ drugs!
Neither doctor nor pharmacists have stopped him from getting his hands on such dangerous anti-depressants
Whoever corrects a mocker invites insult;
whoever rebukes a wicked man incurs abuse;
Do not rebuke a mocker or he will hate you;
Rebuke a wise man and he will love you;
Instruct a wise man man and he will be wise still;
Teach a righteous man and he will add to his learning
Every prudent man acts out of knowledge, but a fool exposes his folly Cheers”
Still on that Prozac!
Yes, Godfather!
Should we haul the guy with the cheap lap top now typing his comments frantically under the influence of psychotropic drugs, putting down his anguished thoughts to paper that nobody cares to read?
Nothing pleases me more than to see the narcissistic MP from Kg. Attap being hauled back screaming and kicking to be detained in one of the many drug rehabilitation centers reserved for him!
I’ve never come across a more narcissistic personality than this limkamput! It gotta be the Prozac or the Zoloft!
i m a pharmacy student in U.K. n i cannot but notice how illformed people back in malaysia are.
This posting speaks for itself –
limkamput Says:
“I think my postings here are more sought after than Sdr Lim’s. Let’s face it; I am just too smart …”
This is also what this prick says about the DAP –
limkamput Says:
December 10th, 2007 at 12: 44.12
To DAP, what can I say other than making sure your agenda is not subtly captured by Chinese chauvinists. And one more thing, please don’t shout too much in Parliament. You people should talk and not shout.
Prolonged use of Prozac results in short term memory loss ?
Don’t forget paranoid schizophrenia! That’s more than memory loss!
Here’s a clue to his identity and ethnicity!
limkamput Says:
May 3rd, 2008
“Just one question: if a Nincompoop (hence limkamput) or Ah Beng without fame and money got into trouble..”
He uses the handle ‘limkamput’ because it rhymes with ‘nimcompoop’ – he says. A narcissistic personality no doubt! He thinks we’re all dumb and cannot see through.
He has some really serious issues with himself.
We should call him by his preferred name!
limkamput Says:
May 3rd, 2008
Not at all, it is supposed to be nimcompoop, but i used the chinese version.
This discussion is going from semi-broad-based perspective to childish retaliation. Alright undergrad2 you win. Let the federal and PR do the cost-benefit analysis now alright. =)
Attention Deficit Disease (or ADD) manifests itself this way – memory retention is so bad that the patient does not remember in the afternoon what he said in the morning, much less what he said days ago !
syncbasher83, a Malaysian doctor who says Inggerik (I think this is how he pronounces English) is not important, and yet as far as I remember their lecturers in medical faculty taught in English from the 1st year. How did he manage to graduate? And now when he is practising, again he says Inggerik is not important. And now I wonder how does he get himself up-to-date with the fast-paced medical advancement? Just imagine when the newest British Medical Journal is published, does he wait for the translated version after 3 years (I doubt if there is anybody who cares to translate) or he gets somebody else to read for him or he doesn’t even care to update himself? Even if he understands the medical terms described inside, can he get the messages correctly?
syncbasher83, So you said you are proud to be an orang kampong, there is nothing wrong about it. But you seemed to be proud for being a ‘jaguh kampong’, because you don’t know the world outside, because either you don’t care or you don’t understand what is happening outside, for one reason, poor command of english. Truly the best portrayal of our MALAYSIA BOLEH spirit: within Malaysia boleh, outside of Malaysia semua tak boleh.
I told u, syncbasher83, I WAS MADE A STOREKEEPER by my DOCTOR bosses, not that I chose to. We pharmacists are not given the chance to do things which we are supposed to do, and it is u, doctors who oppose to whatever suggestion that will grant us more authotity. When I worked for doctors last time, I couldn’t even muster my courage to tell my boss that Ponstan 1g tds is not a common dosage. That is what will happen when a pharmacist work for a doctor. Honestly, a general practitioner is not a pharmacologist, so who is he to decide if 1g of Ponstan could be better or this dosage would not harm the patient? I guess a doctor as arrogant as you could be the one who always THINK and come out with funny regimens, without referring to proper guidelines, just because YOU ‘THINK’ IT IS RIGHT, don’t you?
You can say whatever you wish, even critise pharmacists in every way u wish, it is up to you. If you think u are contributing to our society by doing so then go ahead. And I wana tell u one thing, since you work in a hospital, u should know that in government hospitals, only pharmacies are dispensing and not u doctor. Now I challenge you to go against the system. Why not doctors keep medicine in their outpatient clinics as well? One stop service, so to say. Then you can go further to suggest that pharmacy department should be abolished, and fire all the pharmacists because those assholes are not doing their jobs. Then you can become a hero of the medical profession, a legend, perhaps inducted in the Malaysian Book of Records as the first doctor who truly contribute for our society. MALAYSIA BOLEH!!!
I’m not a doctor nor a pharmacist. But I do not have to be one or the other to understand that it is important that the two be separated – not unlike barristers and solicitors in the U.K.
Allowing a doctor to dispense medications to patients is an unhealthy practice. Why unhealthy though not wrong?? Because the doctors’ judgment could be influenced by what drugs he carries. Like I said earlier, if a certain nimcompoop aka limkamput comes knocking on your doctor and you as a doctor diagnoses that he suffers from paranoid schizophrenia what are you going to do? If he suffers from a mild form of depression are you going to dispense the more powerful zoloft which is known to have caused suicide and murders? You don’t have paxil so do you dispense zoloft?
This situation will not arise if the doctor prescribes and the patient goes to see the pharmacist for the medication. The pharmacist will always carry stocks of anti-depressants.
The job of the pharmacist I believe is not just to dispense but make some of the medication. They have a healthy knowledge of the latest drugs in the market. They work not only with doctors but health insurance companies to determine what they should dispense. Health insurance companies may not want originals to be dispensed but instead the cheaper generics.
The patient may not be happy with his insurance companies about the pricing of some of the more expensive drugs. He may go back to his doctor and get his opinon on the other drugs that he could use.
Doctors, pharmacists and health insurance companies work together to provide the best health care for the patient.
“This situation will not arise if the doctor prescribes and the patient goes to see the pharmacist for the medication. ”
What if the patient ignores both the doctor and the pharmacist and goes on a self-medication spree instead ?
hahaha papaya,
serves u right, ur store keeping attitude showed it all. luckily ur bosses had realized it earlier that u worth nothing but store keeping
store keeping lah for the rest of ur life…
how did i manage to graduate? by going to the wards lah…
how did u manage to graduate? by store keeping maybe…haha
of course im contributing to my people…
unless some other, keep the pace at store keeping man…
u knoe store keeping which im sure an attendant can do it better than a graduated pharmacist…like u!
and of course these health attendants are seen more frequently in the wards than the store keeping pharmacist…at least they do their job as defined…
hey not ashamed huh store keeping coward, being paid unnecessarily only for store keeping? what a waste of rakyat’s money…u cheater…
pharmacist is defined as drug dispenser, if these pharmacists are doing their job as defined, ive no problem but
likewise some of them who refused to dispense drugs and always bugging the staff nurses to the job for them…of course its correctly that their bosses throw them into store keeping…haha serves u right!
Graduated by going to the ward? Something must be wrong with our education system here. Failed theory but still given chance to go clinical? Try studying in other country and see whether u can graduate or not. Our true ‘jaguh kampung’. Dah kantoi banyak kali tapi masih lagi gred ya, boleh tahan. u knoe i knoe la. bahasa mat salleh nie tak penting sebenarnye. Yay Malaysia Boleh!!!!
For your information I no longer work for doctors. I am not ashame though for my past working experience at least that is legal money. If my ex-bosses asked me to clean the ditches and sweep the floor, I don’t mind as long as I am paid.
On the other hand, I wonder why government employ lousy doctors like you to work for the people. That is truly a waste of money. In the labour room the midwives are all more experienced than u are. In the outpatient clinic u just copy everything prescribed by previous doctors from patient’s medical records. Are u sure u are copying the right thing? So u graduated with lousy pharmacology, but u managed to learn it bit by bit while working as a doctor, and after countless times of mistakes only to get the dosage correct. How many times have u been scolded by ur superior for stupid answers during ward rounds? And yet, you still have the guts to talk cocky like you are way superior than people from other professions, in broken english la of course. Malaysia Boleh la of course!
Our world is getting complex. The nature of modern medicine is very complex. To put the entire burden on doctor is too much, that is why even in medicine we have cardiologist to handle cases pertaining to heart, even that we have sub-specialization like cardiothoraxic surgeon… etc.
I would not want a cardiologist to perform maxillo-facial surgery on me and neither would I want a dentist to perform open-heart surgery even though both carry a medical or similar degree.
In the same vein, a pharmacist are specialist in pharmacology and its pharmaceutical practice, and it is only proper that a specialist handle its own department. I would not want it any other way.
EP
hahaha papaya,
clean the ditches and sweep the floor
serves u right!
and of course u dont mind
coz ur level is just store keeping lah…
“What if the patient ignores both the doctor and the pharmacist and goes on a self-medication spree instead ?” GODFATHER
Then you”ll have an old paranoid schizophrenic with a narcissistic personality prowling the streets of Kg. Attap for young girls! You’ll have an MP from Kg. Attap who waits at the door of Parliament every day including days when Parliament is not in session, representing a non-existing constituency, who sometimes would refuse to leave Parliament demanding that as Agong he doesn’t have to.
In case you budding pharmacists and doctors don’t already know, the narcissistic personality we’re talking about is none other than this Malay Pak Lebai from Kg. Attap somewhere in Hokkien speaking area who now prowls the threads of this blog. He is delusional even when it comes to his race!
He is a nimcompoop who uses the handle ‘limkamput’ and this is by his own admission.
While on the subject of pharmacists and physicians (as they should be called to avoid confusion – you don’t want limkamput with a fictitious Ph.D. from Kazakhstan in palm reading to set up a medical clinic in your neigborhood, believe me!), why should we be concerned with how physicians called GP in Malaysia, called primary care physician where I am now, make their living? Our first priority should be to the patient.
Malaysia’s belief in the laissez-faire economy suggests that the number of doctors like lawyers and the other professions is best left to the free market forces. There is a need for more pharmacists in Malaysia. So you budding physicians may want to reconsider. If you intend to migrate to the U.S. the chances of you finding a job as a pharmacist are better. They don’t have enough pharmacists here.
The is a standing instruction out there
make jobs for our graduates…..and who is more interested and duty bound to exercise this line…
But we all know it is a sad story , because it is too dangerous for the general public and there no point is taking sides who does the job better, I find we are being dragged into a problem which does not exist at all.
If it ain;t spoilt don’t repair it, it has worked for 50 years in the private sector, what more do we need to know
Many of the local grad are mistakenly extruded out and are just not there, they are not enough suckers around except ……to take them and we know there is only one big sucker and he want to pass it to …..
Regarding this issue, I’d like to correct the public’s misconception about pharmacists in general. Elsewhere in the developed countries, pharmacists are duty-bound to enquire much into the patients’ medical history and information before diagnosing general diseases and dispensing drugs.
Additionally, if Madam Ong were to approach a pharmacist in Australia, for example, the proper procedure was that the pharmacist would contact the physician who was treating Madam Ong to get more information before dispensing any drugs to her. Thus, avoiding any unnecessary problems.
The problem with the pharmacists in Malaysia today is that some do not follow the necessary procedures before dispensing drugs. Only a few days ago when I was trying to purchase a controlled drug, the pharmacist did not even ask what I intend to use the drug for! However, in my opinion, all this is caused by the complacency that have set in for more than 50 years of being relegated to a 2nd-class medical provider in Malaysia since the Poisons Act of 1952 was implemented in Malaysia. It is also because of this that we have not enough pharmacies in Malaysia (supply-demand) or “Since all clinics are able to dispense medicine, why should I open a pharmacy?”.
So please do not put all the blame on pharmacists. If you want someone to blame, blame it on the government for implementing the Poisons Act 56 years ago.
But I digress. Since it’s virtually impossible to set up so many pharmacies in so many places in such a short time IF our Health Minister implements this change, let me recommend something else. What we can do, for now, is the TRANSPARENCY in the doctors’ bills. If you know how much the doctor is charging you for what type of drugs, then it’s a first step in taking control of your medications. Please check out my blog for more points in my argument (http://sonjainc.blogspot.com/2008/04/lot-on-my-head-recently.html).