Malaysian GPs are lamenting over the fact that many pharmacies are now “assuming the jobs of doctors” by diagnosing patients – recommending alternatives to prescription medicines and even dispensing prescription-needed medicines without a doctor’s approval.

This has caused “lacklustre business” and cause losses, as thousands are spent every month stocking up on medicines while having fewer patients.

“Nowadays, there are so many pharmacies, some of them do blood sugar or cholesterol tests, and even recommend medicines based on symptoms which their customers say they have,” highlights Dr Khatijah, a GP who owns a clinic.

“Pharmacists cannot diagnose patients, that’s what doctors are for,” expresses another doctor, Dr John (pseudonym), who attributes the cause to the 30% decrease in his business over the past year.

The Pharmacy Bill: Will it ever be written into law?

For many years, the Pharmacy Bill – which restricts doctors to only diagnosing and prescribing medicine, while pharmacies dispense them – has been proposed and debated, however it has yet to be passed.

Many GPs argue that Malaysia does not have the infrastructure to support such a bill, especially in rural areas. Pharmacists have also objected to five provisions in the draft bill, citing insufficient protection of consumer rights and patients.

However, GPs such as Dr Khatijah, welcome such a move as it would cut down on operating expenses.

“Right now, I spend no less than RM7,000 a month on medicines. Life would be much easier for me, because I would only have to stock up on medication administered through injections and life-threatening medicines which pharmacies cannot dispense,” she explains.

If the bill were passed, it is likely that GPs would increase consultation charges in line with MMA guidelines, as consultations would be their only source of income.

According to the 13th Schedule of the Private Healthcare Facilities and Services Act 1998, private GPs can charge between RM30 and RM125 for consultation.

A 50% surcharge can be imposed if consultation occurs outside of a clinic’s operating hours and a 100% surcharge can be imposed for house calls.

The turf war between pharmacists and GPs

The MMA has also received complaints on pharmacists who are not abiding by the rules. MMA president Dr Ravindran R Naidu says that the MMA has urged the Ministry of Health (MOH), particularly the Pharmaceutical Department Services’ enforcement unit to take action against such pharmacists.

Dr Ravindran opines that it’s far more dangerous when pharmacists dispense controlled drugs without a prescription.
Dr Ravindran opines that it’s far more dangerous when pharmacists dispense controlled drugs without a prescription.

“Pharmacists are supposed to dispense drugs like antibiotics or drugs for treating diabetes, hypertension and cholesterol only with a doctor’s prescription,” he says.

However, the MOH’s pharmacy enforcement unit (PEU) have taken action against doctors who dispense simple over-the-counter (OTC) medication in their clinics.

“If sundry shops, traditional Chinese medicine shops and convenience stores can sell OTC medication like paracetamol, why can’t clinics?” asks Dr Ravindran.

“It’s far more dangerous when pharmacists dispense controlled drugs without a prescription,” he added.

According to Dr Ravindran, the MMA supports the current Pharmacy Bill where doctors have dispensing rights, especially for the treatment of non-communicable diseases (NCDs) – as it also involves the regular monitoring of the outcome, which would prevent complications. MIMS

Editor's note: A follow-up response to this article has been published on 29 September 2017. 

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