HARESH SAYS: Claims of monopoly as doctor-pharmacist squabble — but what about the patients?

As published in Malay Mail today.

Haresh Deol

ACHOO! The sound of Mr Trainee sneezing echoes throughout the hypermarket. 

While manning the cashier, he rubs his nose with his bare hand, mucous and all spread across his palm and he dries it off by rubbing his hand on his pants.

“RM49.70” he says as he hands out his bacteria-laden hand, flashing a smile without realising some of his nose residue is sticking on his upper lip.

And there is no need to wonder why nine out of 10 people lining up at the checkout lanes were either coughing or sneezing.

It is in the air, so they say. Some claim it tends to get hot and dry during the Chinese New Year, so they blame it on Mother Nature. 

And the first place they go to is their neighbourhood general practitioner (GP). Oh yes, the flu and cough doctors who some, without even taking your temperature or listening to your heartbeat, will quickly prescribe two strips of paracetamol or a bottle of cough syrup that would knock you off instantly. Some are staunch believers of strong antibiotics, strong enough to cure your ills and aches within 72 hours.

So yes, in the GP you trust. Within hardly 10 minutes, you obtain your medicine from the ‘pharmacist’ — who graduated with SRP and has been a home maker for 30-odd years before realising she needs a job to make ends meet. Pay RM50 and you go home, with a medical chit if you’re ‘lucky’.

But doctors say a different tune will be sung come April. Goods and Services Tax (GST) aside, they insist the Health Ministry would introduce dispensing separation. They claim the introduction of such mechanism was the first step towards the 1Care for 1Malaysia health system which mirrors the National Health System in United Kingdom.

In October 2011, I wrote that a single body will manage the 1Care system. Then deputy health minister Datuk Rosnah Abdul Rashid Shirlin said the funds of the system would be managed by a “single not-for-profit government autonomous agency that would be supervised by the ministry”.
She also acknowledged the scheme had already started, despite criticism by certain parties. She added: “We would have done a lot by 2015 but the actual deadline is 2020”.

Some three months later, I received an email that was circulated to GPs nationwide. They were against the idea of the 1Care system and even set up a Facebook page ‘Tak Nak 1Care’ to voice their grouses.  

Earlier this month, I was approached by more doctors. They insisted a hybrid system would kick in by April where patients would have the choice to purchase medicine from clinics or buy from pharmacies. This will last until April next year before the system is fully introduced. Meetings were held, as reported by Malay Mail ‘Anxiety attack for doctors’ on Feb 6. Their grouses are aplenty. 

But they have been assured by Health Minister Datuk Seri Dr S. Subramaniam yesterday that nothing has been finalised at this point.

Those in the industry also whisper about “monopoly” by certain quarters, claiming tycoons had been lobbying the system for years as they hoped to reap massive profits once implemented. Is it sheer coincidence that a direct-selling company is now in the business of opening up more pharmacies? 

But pharmacists claim otherwise. They say doctors were whining as they would not be able to make money from selling drugs. Some argue doctors would lose out on kickbacks as often promised by drug companies. 

They insist pharmacies will open 24 hours if the demand is there. A senior officer from the National Pharmaceutical Control Bureau explained if one was required to see a doctor in the wee hours of the morning, the doctor could give the patient a jab for short relief before the patient obtain medicine from the pharmacy the following day.

“Doctors too tend to complain but none came forward when the ministry conducted a public engagement survey over the introduction of the system and the pharmacy bill. Also, the (health) ministry has not told us when to start (the scheme),” the officer said.

Those who work in government hospitals say there had been instances where doctors wrongly prescribed dosages or the type of medicine and this was rectified by the pharmacists — something not seen in private clinics as most do not have a qualified personnel manning the dispensary.

And once the Pharmacy Act is introduced, pharmacies will be regulated, just like how doctors are scrutinised by the Malaysian Medical Council. 

Medical Defence Malaysia Bhd, had on its website, pointed out the proposal to transfer the dispensing function to pharmacists “would have the incidental effect of reducing to some extent the exposure of doctors to medico-legal problems”. 

“With a greater role for pharmacists would come a greater ethical and legal burden for them. For example, in a well-known case, a doctor’s poorly-written prescription of Amoxil 250mg led a pharmacist to dispense, without checking with the doctor, Daonil 5mg to a patient who was not a diabetic, thereby causing the patient to suffer severe hypoglycaemic shock and brain damage. 

“In court, the doctor was found 25 per cent liable and the pharmacist 75 per cent liable for the damages,” its website read.

Everything seems hunky dory on paper but many remain afraid of what can and will happen in reality. Section 12(1) of the Poisons Act 1952 states only a qualified person can dispense medicine, yet many who give out medicine at clinics can’t even pronounce the name of drugs, let alone explain what it is for. No one has been hauled up. 

Some stores sell prescribed drugs over the counter while anabolic steroids are easily available online without the need of prescription. The law is clear but the enforcement is severely lacking.

Patients also question why a certain pharmacy sells a certain type of drug three times lesser than the other, fearing the authenticity of the drug.

Thoughts of “monopoly” will arise. Haven’t we heard of a somebody linked to a someone securing sweet deals in the name of ‘progress’ and ‘development’?

Doctors too admit they ought to be blamed. They are brave to diagnose and dissect a human being but live in fear when it comes to voicing their opinions. Despite being highly educated, they can’t seem to comprehend the meaning of unity — thus explaining the various factions and associations within the industry.

As such, the average Joe and Jane on the street are left clueless. One thing for sure, the next time they sneeze or cough, they will only think of the possible price hike when visiting the doctor. 

Some form of transparency will help ease the anxiety. Patients, including you and me, are not bothered about squabbles between doctors and pharmacists. Perhaps our curious minds may wonder who will be making money from the implementation of a new system.

We just want to know how the current or proposed new healthcare system will benefit us. The patients are the biggest stakeholders, but sadly, we know nothing.

P/S: As my Hokkien in-laws would say, Keong Hee Huat Chye to all of you.

HARESH  is executive editor of Malay Mail. He can be reached at haresh@mmail.com.my or on Twitter @HareshDeol


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