25 Jun, 2014
MALAYSIA has one of the best primary healthcare services in Asia. Anyone feeling unwell can walk into any government clinic and be seen by a medical personnel including a qualified doctor though the wait may be long.
Similarly patients can see a private practitioner at any time of the day as long as it is the working hour of the clinic and treatment is affordable. The government had allowed private primary care doctors to charge a maximum of RM135 but it is rarely followed.
We have enjoyed a good healthcare system since independence despite complaints from some quarters of shortcomings but generally the healthcare is of quality and affordable.
The issue of separating dispensing from the general practitioner to exclusively to the pharmacist has caused a lot of worry to the medical provider and patients. The drawback is patients would have to visit two venues to be treated: a clinic and then the pharmacy.
Patients worry if the exact medication will be available in pharmacies as prescribed or the pharmacist may dispense alternatives with a similar active component or something close to the active substance.
It is essential that the doctor have the feeling of satisfaction that the patient has taken the right prescribed medication and not something different.
The issues that need to be thought about in detail:
» Are pharmacists available throughout the opening times of the pharmacy and will there be 24-hour retail pharmacies? The question of economic viability for a pharmacist and their assistants to keep a 24-hour service going and the restriction of such service in shopping malls and the security in shop lots is much to be desired.
» The cost of medication and consultation will be separated. It is obvious that the cost cannot be clumped as one thus the total increase of treatment cost will be unavoidable.
» The convenience of having the doctor to monitor the patient’s progress based on the exact medication prescribed will no longer be the same and the time spent by the patient in having to visit two places for one complaint: the doctor and the pharmacist is not economical for the patient. The whole idea of integration of healthcare with the spirit of one stop will be defeated.
In the early days: pharmacists were involved in the compounding of medication that would mean preparing medication based on active ingredients but most medications today are prepared in doses and packaged by pharmaceutical companies under strict protocols.
Pharmacists particularly community pharmacists now advise patients in terms of selection, dosages, interactions, and side effects of medications, and act as a learned intermediary between a prescriber and a patient but in Malaysia and some Asian countries this role is done well by the doctors as medical studies have a compulsory pharmacology subject.
The role of pharmacists is probably more important in hospitals where the prescription is done by various specialties and the need of details are more necessary than primary care.
It is hoped that doctors in primary care play a greater role in dispensing as they are qualified to do so thus the need to separate this service is avoided to steer clear of unnecessary difficulties to both medical providers and patients.
Datuk Dr Kuljit Singh