‘In 15 Years As GP, Patients Hardly Ask For Prescriptions’

By CodeBlue | 19 August 2019

MPCAM says GP clinics are run by senior doctors who rarely make errors in prescribing medicine.

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KUALA LUMPUR, August 19 — Doctors’ groups have dismissed pharmacists’ demand for mandatory prescriptions, saying that general practitioners (GP) are capable of dispensing the medicines that they prescribe.

Medical Practitioners Coalition Association of Malaysia (MPCAM) president Dr Raj Kumar Maharajah said GP clinics already use electronic prescriptions and maintain prescription books to record all drugs dispensed.

He said it did not make sense to give paper prescriptions to patients unless patients wanted to get medications outside the clinic.

“It makes no sense because the doctor in the GP clinic is the head of the pharmaceutical services in the clinic as well, as mentioned in the PHFSA (Private Healthcare Facilities and Services Act 1998),” Dr Raj Kumar told CodeBlue.

“The pharmacy in the clinic is just in the next room. Do you need to print a prescription for the patient, for him to come to the next room and give it back to you?

“However, if the patient requests to buy the medicines elsewhere, then it makes sense to do this. In my 15 years as a GP, I have had hardly any patient asking me for a prescription.”

In a recent town hall with Health Minister Dzulkefly Ahmad, pharmacists called for mandatory prescriptions to compel doctors to provide patients prescriptions, regardless of whether patients requested for it. The current policy is mandatory prescriptions only upon patients’ request.

Malaysian Pharmaceutical Society president Amrahi Buang had cited 2018 statistics by the Medication Error Reporting System (MERS) under the Health Ministry that found about 72 per cent of medication errors occurred during the prescribing process, of which about 93 per cent was reported by pharmacists.

In response to figures raised by Amrahi, Dr Raj Kumar said prescriptions in public hospitals were written by trainee doctors, while those in government health clinics were penned by junior doctors and medical assistants.

“Prescription errors [have] many aspects; incomplete name/ IC number written is a prescription error, ineligible writing is an error, no signature / chop is an error,” he said.

“GP clinics are run by senior doctors who have completed five years’ minimum training in a public hospital,” Dr Raj Kumar added. “GPs see primary care cases repetitively. When you do things repetitively, the chance for error is almost zero.”

Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) president Dr Steven Chow said the statistics cited by Amrahi Buang were from government facilities, as he expressed concern about pharmacists’ demand for mandatory prescriptions.

“Asking a mother or family to go searching for a pharmacy at 2am on a rainy morning with a febrile wailing child is ridiculous, bordering on irresponsibility, when their doctor just sitting in front of him can explain and commence the medications and the reasons why, and the effects and side effects,” Dr Chow told CodeBlue.

“The pharmacist may have the theoretical knowledge of the side effects of any particular medicine; so do the doctors. But which medication is important for a particular patient, suitable for his present state of health and illness, only his caring doctor knows, unless the government is of the view that all patients are the same and all illnesses are the same and one size fits all.”

Dr Chow claimed that the real issue was not medicine price controls or mandatory prescriptions, but “the hidden drive for a single-payer national health insurance and national health financing.”

“Having just a one-tier system, single-payer (like NHS-UK) would be a step backwards, as the public has less choice, pay more taxes and when that one system fails (as evidenced in the UK now), many have gone on to buy their own private insurance anyway. It ends up with a two-tier system eventually.”

Malaysian Medical Association (MMA) president Dr N. Ganabaskaran said following a stakeholders’ engagement in Port Dickson in December 2015 about the Pharmacy Bill that discussed mandatory prescriptions, the government decided in 2016 that separating the prescribing and dispensing of medicine was only feasible under a national health financing system.

“Let’s focus on a national health financing system and policy than on micro issues which is more important and urgent for the nation,” he told CodeBlue.

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